Introducing an Older Child to the NICU

Photo credit: Anne Claire Hickman

The NICU experience can be a bewildering and frightening experience for the parents of a premature or unwell baby, so imagine the idea of a NICU from a young child’s perspective.  One day mom is at home, caring for the child and the next morning mom is nowhere to be found after having to get up late in the night to go to the hospital. Mom didn’t come back, a new baby is born, but the older child can’t see the new baby yet and dad or grandma isn’t sure when mom will be home. This can be a lot of new information to be thrown at a child. When my twins were born we had a young son who was almost 2 years old. Since he was quite young, he did not understand the things going on were not the norm. Thankfully I was still able to see my son very regularly in the first few days, but we did speak to a Child Life Specialist to find out tactics to explain prematurity to a child as young as 2 years old.

In today’s post, I have teamed up with Certified Child Life Specialists, Riann Horan and Shaindy Alexander of Toronto, Ontario, who were glad to offer some suggestions on how you can help create a bond between your children that lasts a life time!

As the parent of a baby admitted to the NICU you may anticipate one of the most bittersweet experiences you will be when your other child or children get to meet your new baby. Although your experience may not have been the introduction you had imagined, taking the time to prepare your older child and make them an active participant in the baby’s life can help reduce the fears and concerns your older child may have.

Before the visit to the NICU:

• Explain in simple language the reason your new baby is at the hospital. Be honest.  For example:  “Baby was born a little early and needs to be at the hospital where the doctors and nurses can help baby grow bigger and stronger.”
• Some great ways to start the conversation about meeting your new baby include, “What do you know about the baby?” “What have you heard people talking about regarding the baby?” “Is there something you are wondering about the baby?”
• Describe the sensory experience your child will have when they enter the NICU. What they will see, smell, and hear and prepare them in advance if they can touch the baby or not.
• Take a picture of your baby and tell your child what job each of the tubes, wires and machines does, such as, “This tube helps your brother or sister to eat.”
• If your child asks a question, then they are ready for the answer. Choose familiar words when answering.  Your child may see your baby unclothed and in a diaper and wonder, “Is the baby cold?” You could answer, “These lights help keep her warm.”
• Let your child know that the baby is a different kind of sick than having a cold or the flu. This alleviates fears that they will need tubes/hospitalization etc. if they themselves get sick.
• Remind them that this is not their fault. There is nothing that they did to make their brother or sister be born early or the fact that they need medical help.  Wishing they could meet them “now” or wishing that mommy wasn’t pregnant anymore did not make this happen.
• Take breaks when talking about this topic if your child starts to play or gets fidgety. Some children cope better with small amounts of information at one time.
• Reading a book about baby in the NICU can help your child know that asking questions is okay and let them know that other kids have baby brothers or sisters in the hospital too.
• Have your child select a new item at a store to give the baby and give them a matching one, this can help to form attachment and allow them to feel connected to the baby when they can’t be together. A great example is stuffed animals. If your children at home miss the baby they can hug the stuffy or whisper messages to the stuffy for the baby.
• Kids like having “jobs”. Have your child select a job that you know they can succeed at such as drawing picture to put at the baby’s crib side. Doing their job makes them feel like they have purpose to their visit.
• Validate that all the feelings that your child might have are okay. It’s okay to be happy, sad or scared or unsure.

During the visit to the NICU

• Ensure the room is ready for the visit prior to your other children going into the room. The room should be calm and other babies in the room are stable or that the curtains are pulled (if possible).
• Take a picture of the baby, the bed space, the machines…right before the visit and show the sibling(s) to help prepare them. Leave time for questions and processing if they need it before entering the room.
• At any point during the visit if your child(ren) ask questions that you don’t know the answers to, ask a nurse or other healthcare provider to help explain.
• Keep visits short and provide opportunities for questions at the bedside.
• Take pictures of the visit if appropriate.
• Don’t assume/guess how your child is processing the visit. Ask them open ended questions. For example, if your child looks distressed, when asked how they are feeling, they might simply say they are hungry!

After the visit to the NICU

• Take time to debrief and ask if there are any new questions or feelings. Check in at different times of the day because some kids like to chat over dinner or at bedtime after they have time to think things through.
• Integrate the baby into your child’s life. Look at pictures, talk about the baby and tell them about progress the baby is making.
• Try to keep routine as much as is possible. If your child is staying with someone else, have them stay with one person if possible, or have someone stay in your home with them.
• Make visits with the baby a regular part of the routine. For example, set your child’s expectations that you will visit the baby on Tuesdays, Thursdays and Saturdays after lunch.
• Keep expectations of behavior the same. Eg. Kind words and manners are still expected while in the NICU.
• If your other children are having a difficult time coping, seek out resources in the community or at the hospital for extra support.