Having a baby in a neonatal intensive care unit (NICU) is stressful for the entire family, including big brothers and sisters. How children respond to having a sibling in a NICU depends partly on their ages. A toddler may be most upset at being separated from you. Older children may be worried about the baby. You can make the experience a little easier on your other children by spending some special time with them and explaining what's happening with their baby brother or sister. When your children are relaxed and coping well, you may be able to cope better, too.

You may wonder how you're going to help your children cope when you're having trouble coping yourself. And you may wonder where you're going to find the time when your baby needs you, too. But even a little bit of your time can make a big difference. And remember — you can handle this experience and you can help your other children handle it, too. Here are some things to think about.

What Your Children May Feel
Your children may experience many different feelings during your baby's NICU stay. If your children are old enough, encourage them to talk about their worries and to ask questions. This will help you understand what they are feeling. Reassure them that their feelings are normal, and that you share some of them. While each child is unique, many experience some of these feelings:

• Confusion over why the baby must stay in the hospital, or why Mom and Dad are so upset
• Anger over changes in daily routines and separation from you
• Jealousy toward the new baby, who is taking so much of your time
• Guilt over any negative or angry feelings toward the baby, and fear that these feelings caused the baby's condition
• Abandonment because you are spending more time with the baby than with him
• Fear that the baby is suffering or will die

How Your Older Children May Behave
Your older children may not always be on their best behavior during the baby's NICU stay. Some may regress, adopting behaviors that are more common in younger children. Others may act out, or even appear to reject you. But be patient!  With these behaviors, your children are telling you that they need you more than ever.

Don't be surprised if your children show some of these behaviors:

• Excessive clinginess
• Disobedience
• Increased irritability
• Toilet-training setbacks or bedwetting
• Return to drinking from a bottle
• Thumb sucking
• Eating or sleeping problems
• Difficulties at school
• Difficulties in social situations or with peers

What You Can Do to Help Your Other Children
Try to set aside some special time each day with each of your older children. Small, but meaningful, moments like snuggling together while reading a bedtime story, preparing breakfast together or singing songs while riding in the car can help reassure your children that you love them.

Be honest with your children. They may have many questions, but they may not know how to ask.

Explain to your children what's going on with their baby brother or sister in words they can understand. For example, you could tell them that the baby is too small or too sick to come home and must stay in the hospital until he is bigger and stronger. Also explain that you will need to be away from home more than usual to be with the baby in the NICU.

Let your children know that you may sometimes be upset or even cry because you are worried about the baby, but you are not upset over anything they did.

Try to maintain your children's daily routines as much as possible. This can help make the situation less stressful for your children. When you can't be there, ask a favorite relative or other caregiver to keep up visits to the playground or other activities your children enjoy.

Calm your children's worries. Some children may fear that you will love them less now that the new baby is here. Reassure them that this is not the case, and describe the qualities in each child that make her special and unique. Make sure your children understand that nothing they did or felt contributed to the baby's illness. Some children also fear that they may need to be treated in the NICU if they become ill. Reassure them that only sick babies need special care in the NICU, not big, strong children like them.

What Big Brothers and Sisters Can Do
It's important for your children to become involved with their baby brother or sister right from the start. The birth of a baby is a major event for the entire family, and your older children should not be left out. If possible, you should bring your older children to the NICU to meet and spend time with the new baby. (See below for a discussion of how to prepare your children for visiting the NICU.)

There are also activities your children can do at home to help care for the baby. While your baby is in the NICU, you may want to ask your older children to:

• Color pictures to put up near the baby's bed
• Select a favorite photo of themselves or the entire family for the bedside
• Choose a stuffed animal or other soft toy to put in the baby's bed (may not be allowed in incubator)
• Put together a photo album of pictures of the baby
• Create their own storybook about the birth of their baby brother or sister
• Help prepare the baby's nursery for homecoming

Preparing Your Children for the NICU
Many children are eager to meet their new brother or sister. You should encourage them to come to the NICU, if possible. Each NICU has its own guidelines about siblings. Some NICUs permit only siblings who are at least 2 or 3 years old. Find out what the rules are in your NICU, then prepare your older children in advance for what they will see and hear.

• Tell your children what their baby brother or sister looks like, including the baby's size.
• Describe the incubator and the equipment that is helping the baby. Let them know that any tubes and wires attached to the baby don't hurt him.
• Show your children pictures or videos of the baby before they come to the NICU.
• Your children may find the machines in the NICU less scary if you explain what some of them do. For example, the incubator helps keep the baby warm and protects her from germs. The ventilator helps the baby breathe until her lungs get strong enough for her to breathe on her own. The intravenous line gives the baby food to help her grow because she is too small or too sick to eat. Also explain that some of the eqiupment is noisy and alarms may go off. The alarms tell the doctors and nurses that a baby may need care.
• Explain the procedures for a NICU visit. For example, your children will need to wash their hands before they touch the baby (if they are allowed to touch the baby). Tell them whether they will be able to hold the baby, or whether they will have to wait until the baby is stronger. Let them know if they must stay quietly by the baby's incubator, or whether the NICU has a playroom nearby for siblings.
• Explain who will take them home after seeing the baby and what they will do.
• After spending time with the baby, see if your children have any questions about the baby or the equipment, and answer them simply but honestly. Some NICUs have a staff member who can help you identify books and other resources that can help you explain what goes on in the NICU to your older children.

When their baby brother or sister is in the NICU, your older children may be upset or worried. No matter how old they are, your children need your support during this difficult time. Even though your time is limited, there are many simple things you can do to help your children cope. 

Resources
Evan Early, by Rebecca Hogue Wojahn (Woodbine House, 2006).

Waiting for Baby Joe, by Pat Lowery Collins (Albert Whitman Publishers, 1990).

Watching Bradley Grow: A Story About Premature Birth, by Elizabeth Murphy-Melas (Longstreet Press, 1996).

August 2009