Having a baby in the neonatal intensive care unit is a difficult time in any parent’s life. Trying to balance your need to be with your baby in the NICU with responsibilities at home and work is challenging under the best circumstances. But when you have other young children at home, those challenges are multiplied. They need your time and attention, too.
One of the most valuable things we can offer our children in times of crisis is clear, consistent information. Children need their questions answered in a way that is both reassuring and age-appropriate. Understanding where your child is developmentally will help you understand their concerns and respond in ways that meet their unique needs. The following are some of the most common questions siblings may have and some suggestions on how to answer.
Why was my brother or sister born early? Did I cause this?
It is very common for siblings to worry that they caused their brother or sister to be born early. They might think that something they said or did made this happen. Maybe they resented having to share their mommy and daddy with anybody else. Perhaps they even wished the baby wasn’t going to be born at all. These are typical, age-appropriate responses to a new sibling, but now that the baby is in the NICU, they will need reassurance that they did not cause this. Knowing it is not their fault is often more important than knowing the medical reasons behind their sibling’s early birth.
What to say: “This is not your fault or anybody else’s fault. Sometimes babies come early and sometimes babies get sick. Your parents and the doctors will do everything we can to help your sibling grow into a healthy baby.”
Are you mad at me? Did I make you sad?
Young children have a hard time understanding that they are not the source of what the adults are feeling. Unless they are told otherwise, they will assume that they have done or said something to make their parents or caregivers unhappy. Children need to know that nothing they did or said is causing you to feel this way. Explain that it is the situation – seeing the new baby so tiny and sick and not being able to bring the new baby home – and not them that makes you sad and upset. They also need to know that these feelings are temporary.
What to say: “We are not upset or angry at you. It makes me sad that the baby needs to be at the hospital instead of at home. It will get better, but it will take a little while. Sometimes we will feel happy. Sometimes we will feel sad. We will always love you and the baby.”
Will I “catch” what my baby brother or sister has?
Children are used to hearing adults talk about catching other people’s illnesses, such as colds, and assume that they can catch any illness another child has. You will want to reassure children that while some things like viruses and germs can be passed from one person to the next, the baby’s illness was not passed on from anyone and can’t be passed on to anyone else.
What to say: “The baby is in the hospital because that is the best place for him/her to grow and get healthy right now. The baby’s body is still growing. That is different from being sick from catching a cold or germs. We wash our hands and cover our sneezes to protect each other, but you never have to worry that you will be sick like the baby is sick.”
Is the baby hurting or in any pain?
Seeing a baby surrounded by machines, wires and cords can be a scary experience for a child who has an image in their mind of how newborn babies look. For children, trips to the doctor are for when they are sick or need immunizations. The constant presence of medical staff in the NICU can bring back memories of these experiences and make children believe that their sibling is either sick or in pain.
Parents and caregivers should acknowledge and validate siblings’ fears but should reassure them that the baby’s health care team is working hard to make sure the baby is not hurting. Providing age-appropriate definitions for the medical equipment being used will also help a sibling understand why certain items are used in the care of the baby.
What to say: “The things the doctors and nurses are doing make the baby feel much better, not worse. The tubes help give the baby food, air, and medicine that will help them grow and become stronger. If they need to do something that might hurt a little – like getting a shot or taking a little blood – they are very gentle and careful like when the doctors and nurses helped you.”
What do all of the sounds the machines make mean?
For siblings, a hospital NICU may be their first real hospital experience. Children associate what they see on television with real life. On television shows, the sounds and alarms usually mean something bad is happening. So a lot of children believe that when hospital machines make noise that someone is in trouble or may die. Reassure siblings that the medical staff is doing everything they can to make sure the baby is safe and that the machines help make sure this is happening. It is also a good idea to provide siblings with age-appropriate explanations of the equipment being used. Often the nurses can assist with this, so feel free to ask them.
What to say: “Although the hospital machines can be noisy, they are used to help keep the baby comfortable and safe. Sometimes they just make noise to let the medical team know if the baby needs something. Other times the noises mean that everything is going well. If there is a problem, we will tell you, not the machines.”
Will the baby ever come home from the hospital?
When babies are in the hospital for extended periods of time, siblings may believe that they will stay there forever. Explain that the doctors and nurses are doing everything they can to get the baby ready to come home. It helps to explain that when babies are in their mommy’s tummy, they are protected and get everything they need to grow. Then tell them that babies who are born early need to learn lots of things that they would have learned in their mommy’s tummy if they would have stayed in longer. Parents or caregivers can give examples, such as keeping their bodies warm or learning how to suck on a bottle to eat. The most important thing to stress is that the hospital and all of the equipment are protecting the baby just like the mommy’s tummy would be doing.
What to say: “When a baby is growing inside of the mom, her body gives it all the food, oxygen and protection it needs. When they’re born, all babies need to learn how to do this on their own. When a baby is born early, it takes it a little longer to learn how to breathe and eat. The doctors and nurses are helping to teach the baby, and we’ll help too when the baby is ready to come home.”
Who will take care of me once the baby comes home from the hospital?
Siblings often feel that they are not as important as the new baby because the new baby has needed so much care. They assume that when the baby comes home, they will always need the same amount of time and care. Reassure siblings that you will always make sure they are taken care of and encourage them to be proud of the things siblings can do independently. Explain that the baby can’t do any of these things on their own so may need more help at times, but that doesn’t mean they are loved more than you love your big kid.
What to say: “All new babies need someone to take care of them. You did. And Mommy and Daddy did too. But they won’t need this much time forever. Having a baby is going to add to the love we have for each other. When we all take care of each other, the love gets bigger, not smaller. We will always have enough love for everyone in our family.”
- Siblings need to be told – and shown – how important they are.
- Carve special time out of the day to spend with siblings alone, such as during the baby’s nap time.
- Celebrate your older children and their unique qualities.
- Incorporate them into the family’s daily routines.
- Help them find a role that fits their talents.
- Give them responsibilities that make them feel competent and proud.
- Be sure to stress the things that he or she can do that their baby brother or sister can’t.
Most importantly, tell your children to communicate their feelings with you. We all need to learn how to ask for help when we need it. Encourage them to tell you if they are feeling sad or like they need some special time alone with you, to tell you. Show them that they can depend on you and the other adults who love them. Whenever they need a little extra time, love and attention, show them that you will be there for them and that you will do your best to meet their unique needs.
Rector, Linda (2007). Supporting Siblings & Their Families During Intensive Baby Care. Baltimore, MD: Brookes Publishing.
Anne Claire Hickman, CCLS, CIMI, Child Life Specialist at Dell Children’s Medical Center of Central Texas (Personal Communication, June 9, 2012).