An infant's NICU stay is a high-stress time for both parents and siblings—and now there's a book that shows professionals how to make the entire family's NICU experience easier by addressing the needs of big brothers and sisters of all ages. The first and only guide to supporting siblings of infants in the NICU, this landmark resource helps clinicians, child life specialists, social workers, and other professionals guide parents as they
A must-have for all practitioners who work with families, this easy-to-read book is also a lifeline for parents of at-risk newborns, who will use the real-world advice and strategies to address the needs and concerns of their older children.
Enhanced with photos and true stories from the author's experience as a neonatal child life specialist, this invaluable book will ensure better support for new siblings and help make a stressful, emotional time much easier for everyone involved.
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Linda Rector, M.S., CCLS is an Independent Consultant in Houston, Texas. Ms. Rector is a Reach Out and Read Volunteer at the Good Neighbor Clinic in Houston, Texas. She served as a neonatal child life specialist for a number of years as well as a child life manager and child life specialist on a variety of units at Texas Children's Hospital in Houston, Texas. Ms. Rector also worked as a child life specialist at Driscoll Children's Hospital in Corpus Christi, Texas; a child life fellow at Children's Medical Center in Dallas, Texas; and a sixth-grade teacher at Calallen Independent School District in Corpus Christi, Texas. Ms. Rector graduated from The Ohio State University with a master of science degree in child development and from Texas Christian University with a bachelor of science degree in elementary education. She is a certified child life specialist and is certified in Texas as an elementary teacher with a kindergarten endorsement. In November 2001, Ms. Rector received the first annual Reba Michels Hill Award from Baylor College of Medicine, Department of Pediatrics, Section of Neonatology. In 1993, she was a member of the psychosocial team from Baylor College of Medicine, Houston VA Hospital, and Texas Children's Hospital requested to work with children released from Ranch Apocalypse (the Branch Davidians' compound) in Waco, Texas. She has given a number of presentations and interviews on topics such as the education, training, and role of neonatal child life specialists, infant brain development, pain management for infants, and debriefing protocols for traumatized children.
Excerpted from Chapter 6 of Supporting Siblings and Their Families During Intensive Baby Care by Linda Rector, M.S., CCLS
Copyright © 2007 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Many siblings are interested in visiting the baby in the NICU, and, if they are unable to do so, they can feel excluded from this important family event. Visiting, talking to, and touching the baby allows siblings to begin the bonding process or to continue the process begun during the motherâ€™s pregnancy. Visitations also help siblings begin to integrate the baby into their family, as well as recognize the baby as a separate and unique individual with his or her own set of needs, likes, and dislikes.
The American Academy of Pediatrics (1985) reported that sibling visitation is an important aspect of family-centered care. As policies and procedures are developed, it is important to include siblings in the unitâ€™s and hospitalâ€™s definition of family-centered care. Staff can have a variety of issues or concerns about siblings visiting in the NICU. Meyer, Kennally, Zika-Beres, Cashore, and Oh (1996) reported that NICU staffâ€™s concerns decreased and sibling visitation was viewed more positively after a sibling visitation program had been put in place. Staff can also help make sibling visitation programs successful. Montgomery, Kleiber, Nicholson, and Craft-Rosenberg (1997) described a sibling visitation approach in the NICU that had been adapted by nursing staff to make the process less time consuming and easier to follow. They described how materials were arranged and were made easily accessible to staff when they were needed.
BENEFITS OF SIBLING VISITS
Sibling visitations can provide valuable information to the babyâ€™s bedside caregivers. Occasionally during sibling visits, the health care team can become aware of safety concerns, siblingsâ€™ developmental delays, or health issues that need to be addressed before the baby goes home. It is much easier to address these issues early in the babyâ€™s hospitalization rather than later in the discharge process or after the baby is home.
Some babies may be hospitalized for extended periods, which can make it more difficult for siblings and other family members to bond and interact with them. The relationship between siblings is important, and providing opportunities to get it off to a positive start while the baby is in the hospital is beneficial. Ways in which siblings respond to visiting the baby in the NICU often depend on their developmental level, although siblings at the same developmental level may respond differently on the basis of their temperaments, past experiences, support systems, and coping abilities.
Sibling visits can benefit the baby as well. They give the baby an opportunity to not only interact with his or her siblings, but also to begin the bonding process with his or her family as a unit. In addition, sibling visitations and interactions with family members can offer the baby a sense of familiarity that can help the baby adapt to the home environment.
Providing opportunities for toddler siblings to visit the baby gives them a chance to begin to learn ways to interact safely and appropriately with the new baby and also gives the family time to bond and interact. Toddlers can have difficulty comprehending exactly what has happened. They may be aware that the baby is no longer in Mommyâ€™s tummy, but without support and developmentally appropriate explanations, they may be unsure of where the baby is now. It can also be difficult for them to understand that the baby is in the hospital if they are unable to actually see the baby there.
Their visits with the baby can help reassure them where the baby is and can provide a reference for future conversations about the baby. For example, parents can say, â€œRemember, the baby is in the hospital. We went to see him there. You gave him the balloon, and he gave you the big sister T-shirt. Here is the picture that the nurse took of us while we were there.â€ Also, because toddlers tend to have short attention spans and are easily distracted, their visits should be kept brief.
Visiting the baby in the NICU can provide the visual reference that many preschoolers may need to help clarify and reduce possible misconceptions and misunderstandings. Their perception of the hospital and the NICU may be some faraway place the baby has been sent for some unknown reason. Meeting various members of the health care team can help reassure them that someone is taking good care of the baby when they or their parents are not around. During their visits, preschool siblings can also learn how to interact safely with the baby and how to assist with the babyâ€™s care.
During visits to the baby in the hospital, school-age siblings can learn how to interact safely and help provide care without overstimulating the baby. Andrade (1998) stated that sibling visitation provides opportunities for bedside caregivers to share information with siblings about the baby. These members of the health care team may be able to help clarify some of the misconceptions and misunderstandings siblings may have about the babyâ€™s issues. Visiting the NICU also gives siblings a chance to meet and begin to develop a relationship with consistent members of the babyâ€™s health care team.
Visiting the baby in the NICU can help preteen siblings learn more about the babyâ€™s hospital experience and medical condition. Preteen siblings can also learn ways to interact with the baby and participate in the babyâ€™s care from consistent members of the babyâ€™s health care team. As they become more familiar with these caregivers, they may feel more comfortable about asking them for information.
Adolescent siblings may be interested in learning aspects of the babyâ€™s care during their visits, but may have little experience with infants and can be apprehensive. Some adolescents may hesitate to share all their questions and concerns with family members for a variety of reasons, so developing a relationship with members of the babyâ€™s health care team can be beneficial for them.
SCHEDULING SIBLING VISITS
The timing of sibling visits should be a family decision and can be based on issues such siblingsâ€™ interest level, parentsâ€™ preference, the familyâ€™s cultural beliefs, siblingsâ€™ developmental level, distance between the hospital and home, and the familyâ€™s available transportation. In some NICUs, sibling visitation guidelines and policies can also affect the timing of sibling visits. Other matters to consider when planning for sibling visits are the health of the baby, the mother, and the siblings. If the mother has health problems following delivery, families may have difficulty providing transportation and support for siblings. Also, visits will need to be postponed or rescheduled if siblings are sick or have been exposed to an illness.
Frequency and Length of Visits
The frequency and length of sibling visits can vary from sibling to sibling. Some siblings may want to visit often, some not at all, and others may be somewhere in between. Also, some siblings may want to have long visits in order to interact with and help care for the baby, whereas others may just want to check in and see how the baby is doing. The frequency and length of visits can be affected by siblingsâ€™ developmental level, temperament, interest, and attention span, as well as the babyâ€™s health and any procedures that may be occurring at the babyâ€™s bedside. The length of visits can also vary as siblingsâ€™ interest levels change throughout the babyâ€™s hospitalization. Allowing siblings to have choices about the frequency and length of their visits gives them some control over how their relationship with the baby develops, which can help them cope with this experience.
Some families may need assistance deciding when to schedule sibling visits. The babyâ€™s caregiving needs, such as their sleep and feeding schedule, as well as any scheduled procedures should be considered along with siblingsâ€™ daily routines. Younger siblings may have difficulty focusing on the baby when they are tired and hungry and can be easily overwhelmed and prone to temper tantrums. Therefore, planning visits around their naptimes and mealtimes may be beneficial. Older siblings are usually involved in school and extracurricular activities, as well as in activities with their friends. These activities should be kept as consistent and predictable as possible, with visits scheduled around them. If they have to miss school consistently to visit the baby, they can fall behind, and some schools may be reluctant to excuse siblings on a regular basis. Siblings may also become frustrated or resentful if they are consistently forced to choose between visiting the baby and participating in an activity they enjoy.
Parents who must travel a great distance to and from the hospital and are already under stress may have limited tolerance for exuberant siblings who accompany them. They can become upset with siblings who do not sit still and stay quiet on the way to the hospital, during the visit with the baby, and on the way home. Staying quiet and still for extended periods is often difficult for children, especially younger children who tend to have short attention spans, and this can influence how often parents are willing to take siblings with them to visit the baby.
Some hospitals have sibling activity rooms that can help families with this issue. Siblings are able to release some of their pent-up energy before they visit the baby in the NICU and again before the ride home. If this option is not available, families should be provided with information on inexpensive child-friendly activities, such as playgrounds or activity centers, located near the hospital.
Bedside caregivers may want to consider having special activities available in case siblings become restless and need a break while visiting at the babyâ€™s bedside. These activities may include coloring pictures or going with the bedside caregiver to gather clean linen or other supplies for the baby. Families may also need suggestions for travel activities. These activities should be safe and developmentally appropriate as well as inexpensive. In some hospitals, the volunteer services department may be able to help by providing families with toys that have been donated to the hospital. If parents remain reluctant to take siblings along to visit the baby, it might be suggested that they take videos and photographs of the baby to share with siblings at home.
STAFF AND FAMILY PREPARATION
Among the issues that should be considered before sibling visitations are the hospital sibling visitation policies and guidelines. These can vary from hospital to hospital, and families should be given a copy of this information. Some hospitals allow siblings to visit only on certain days or at certain times. Siblings can become upset if they are expecting to visit the baby on a specific day and then learn that they have to wait due to a hospital policy.
Families can also become frustrated if they perceive that some members of the babyâ€™s caregiving team are willing to bend the rules but others are not. Many families are better able to understand why and when rules can and cannot be bent when explanations are provided.
Young siblings can quickly become hungry, thirsty, or in need of a potty and may have difficulty waiting for an adult to find the cafeteria or a restroom. Knowing where various places are in the hospital can help facilitate sibling visits and reduce some of this waiting time. Examples of these areas might be
The path siblings should take through the NICU to get to the babyâ€™s bedside is also important. Families and the health care team need to be aware of what siblings might observe as they pass by other babiesâ€™ bedsides.
Distractions at the Babyâ€™s Bedside
Limiting the number of visitors and reducing distractions around the babyâ€™s bedside can help siblings better focus on the baby. Some distractions are removable whereas others are not, such as some of the medical equipment in or around the babyâ€™s bed. Siblings can be informed that they will see medical equipment, but it can be beneficial to remove or put away any unneeded equipment or supplies. Also, if the baby has a large number of toys around the bed, young siblings may want to play with them rather than interact with the baby. In this case, a few toys might be left out and the rest put out of sight during the visit. Many siblings will look for any special toys they have picked out for the baby, so these should be displayed at the bedside.
HELPFUL INFORMATION FOR THE HEALTH CARE TEAM
An awareness of certain issues before sibling visits can help the babyâ€™s health care team relate to and interact with siblings. Some of these issues are the number and ages of siblings in the family, as well as any diagnoses of development delays or learning differences. This knowledge provides caregivers with a better understanding of how siblings fit into their family unit, as well as how they cope and comprehend information.
Aspects of Siblingsâ€™ Medical History
Some siblings with health-related experiences may be anxious about visiting the baby in a health care setting and need frequent reassurance about the safety of the baby and themselves in this environment. Other siblings with some of these experiences, however, may feel comfortable in the health care environment and in seeking information from me...
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Book Description Brookes Publishing Company, 2007. Book Condition: Very Good. 1st Edition. Ships from the UK. Instructor's Edition. Former Library book. Great condition for a used book! Minimal wear. Bookseller Inventory # GRP96009728