"I'm special, too": promoting sibling adjustment in the neonatal intensive care unit.

Zachary [born at 24 weeks gestation] was 13 inches long, and my parents often compared him to the size of my Barbie doll. He weighed one pound 12 ounces and was just skin, bones, and machine. Nicole, age 13, reflecting back on her experience as a six-year-old neonatal sibling (Parent-to-Parent Program, 1999) Sisters and brothers of newborns hospitalized in neonatal intensive care units (NICU) are faced with powerful and frightening images as they are unexpectedly hurled into this unfamiliar world. Siblings often experience strong emotions and reactions in response to this situational crisis, requiring support in the adjustment to the associated changes. The birth of a premature or critically ill newborn creates a crisis for the family (Bachman & Lind, 1997), as most of the family's energy is focused on the well-being of the infant. Similarly, the NICU staff engages in the minute-to-minute challenge of life-threatening events faced by the neonate. Thus, both parent and staff efforts are primarily aimed at the NICU baby who needs their attention and care. This is as it should be. There are, however, other members of the family--the siblings--who desperately need attention and care, but who may be overlooked--not intentionally, but because of the very nature of the crisis. In the midst of the chaos, commotion, and disorganization, there is often little time or energy for parents and caregivers to focus on what is happening in the daily lives of siblings. NICUs across the United States promote a family-centered care approach (Johnson, 1995) by offering programs and interventions designed to meet the unique needs faced by siblings. The literature describes the positive effects of sibling visitation programs in the neonatal ICUs on siblings (Oehler & Veleisis, 1990), their parents and family (Montgomery, Kleiber, Nicholson, & Craft-Rosenberg, 1997), and the bonding process with the hospitalized neonate (Burke, 1991). Psychoeducational interventions through hospital brochures and newsletters (Neo-Fight, Inc., 1994) and popular magazines (Jabs, 1992) inform parents about the unique needs of siblings, often offering a forum for parents (Pankow, 1997) and siblings (Monique, 1993) to share their stories. Books, written for children (Hawkins-Walsh, 1985), and coloring books (Gibson, 1997) explain the NICU environment and technology and help siblings identify and express their thoughts and feelings about the birth and hospitalization. There is no documentation to date regarding the use of parent or sibling groups as forums for specifically addressing the psychosocial needs of siblings. This article describes the "Sibling Night" program at DeVos Children's Hospital Neonatal Services at Spectrum Health that uses both parent and sibling groups to address the needs of siblings. In the context of sibling awareness of the "specialness" of the new baby because of the attention given to the neonate by hospital staff and parents, the sibling group is designed to help the siblings also feel special. It does so through parent education about the needs of siblings and by focusing on siblings in relationship to their world. Katie, age 6, echoes this need of siblings, "I liked Matthew's nurse! She asked me lots of questions about myself. She wanted to know all about me. I liked that!" (Peters, 2000). "SIBLING NIGHT" The NICU "Sibling Night" takes place every six to eight weeks and comprises a parent group and sibling group. Social workers serve as group facilitators and co-facilitate with nursing, social work interns, and trained parent volunteers. Parents, other adult caregivers and children (ages 3 to 16) are invited to attend. The meeting begins by inviting parents and their children to sit together in a circle on the floor. Sitting together in this manner creates a sense of informality and safety for the children. Because many of the children have never met the group facilitators, it is important that this introduction time be spent together. …