Support for Siblings During a NICU Stay
Having a baby in the NICU is difficult for the whole family. While attention naturally centers on the newborn, it's important to recognize how siblings are affected. Older children can feel confused, anxious, or left out. This post provides practical advice and tips for including siblings in the NICU experience so they feel informed, supported, and loved during this challenging time.
Understanding sibling reactions
Children may respond in different ways, including:
Confusion: Young children may not understand why the baby isn’t home.
Anxiety: They may worry about the baby’s health and safety.
Jealousy: They can feel replaced or believe they’re getting less attention.
Regression: Younger children might revert to earlier behaviors, such as bedwetting or thumb-sucking.
Behavioral changes: Older children may show shifts in mood, appetite, or sleep.
Noticing these responses makes it possible to respond with empathy and support.
Age-appropriate explanations
Tailor your words to your child’s age and development. Use your child’s developmental level—not just their age—to decide how much detail to share. Suggestions:
Toddlers (2–3 years): Keep it very simple. Say something like, “The baby needs extra help to get stronger. The doctors and nurses are helping the baby.” Use pictures or dolls to show what you mean.
Preschoolers (4–5 years): Explain that the baby needs special care in the hospital. If the baby was born early, explain that in simple terms. Reassure them that it’s not their fault and that everyone loves the baby.
School-aged children (6–12 years): Offer more detail. Describe some of the equipment and why it’s used, but avoid too much technical information that could overwhelm them.
Teenagers (13+ years): Be honest and open. Teens may have more complex questions and emotions; invite them to ask questions and share how they feel.
Ways to Involve Siblings
If sibling visits are allowed, ask the NICU team how to prepare your child beforehand and whether there are age, illness-screening, or infection-control requirements.
Make something for the baby: This could be a drawing, a handmade card, or another item approved by the NICU team.
Choose a special blanket, drawing, photo or stuffed animal for the baby. Ask the NICU team what items are permitted at the bedside and where they can safely be placed.
Read stories to the baby (in person or via video): If your child can't visit, consider recording them reading a story or sharing a message that you can play for the baby, if permitted by your NICU.
Personalize your baby's space (if allowed): Drawings, photos, or artwork can help siblings feel included. Ask your NICU team what can safely be displayed and where.
Help with baby-related tasks at home: Folding baby clothes, preparing a room for the baby, or choosing a special outfit for when the baby comes home.
Addressing Sibling Feelings and Concerns
Validate their feelings: Let them know that it's okay to feel sad, angry, or confused.
Spend quality time with them: Make sure to schedule dedicated one-on-one time with each child, away from the hospital.
Reassure them of your love and attention: Remind them that the baby's NICU stay doesn't change your love for them.
Answer their questions honestly: Don't avoid difficult questions. Provide age-appropriate answers to their concerns.
If changes in mood, behavior, sleep, school functioning, or anxiety are persistent or concerning, consider talking with your child's pediatrician or another qualified mental-health professional.
Maintaining Familiar Routines
While it's important to acknowledge the NICU experience, it's equally important to maintain a sense of normalcy for siblings.
Stick to routines as much as possible: Maintain regular mealtimes, bedtimes, and school schedules.
Encourage participation in extracurricular activities: Continue with sports, clubs, or hobbies.
Plan fun family activities: Set aside time for outings, games, or other activities that everyone enjoys.
By providing a stable and supportive environment, you can help siblings navigate the challenges of a NICU stay with greater resilience.
Key Takeaways
Supporting siblings during a NICU stay requires patience, understanding, and a willingness to address their emotional needs. By providing age-appropriate explanations, involving them in the baby's care, validating their feelings, and maintaining a sense of normalcy, you can help them cope with the situation and feel loved and valued during this challenging time. Remember that every child is different, and what works for one sibling may not work for another. Be flexible, adaptable, and most importantly, present for your children.
Sources & Clinical References
Levick J, Quinn M, Holder A, Nyberg A, Beaumont ED, Munch S. Support for Siblings of NICU Patients: An Interdisciplinary Approach. Social Work in Health Care. 2010;49(10):919–933. doi:10.1080/00981389.2010.511054.
Committee on Hospital Care and Institute for Patient- and Family-Centered Care. Patient- and Family-Centered Care and the Pediatrician’s Role. Pediatrics. 2012;129(2):394–404. doi:10.1542/peds.2011-3084. This AAP policy statement was reaffirmed in December 2025, so it's still a useful authoritative source.
Schwartz KE, Nye RT, Colt S, Hill DL, Feudtner C. Association of Very Low Birth Weight Infants With Parental and Sibling Mental Health Care Usage. Pediatrics. 2024;153(5):e2023064143. doi:10.1542/peds.2023-064143.
Hand to Hold. Supporting Siblings During a NICU Stay. 2025. This is a parent-facing resource rather than a peer-reviewed clinical reference, but it's directly relevant to your practical recommendations about routines, recorded messages, books, NICU-approved toys, and sibling involvement.
Helping NICU Siblings Feel Included 💛
When a baby is in the NICU, siblings often have big feelings too—confusion, worry, sadness, or simply missing their new baby brother or sister. Finding gentle ways to help them feel included can make a meaningful difference. From what I’ve seen in the NICU, siblings often sense more than we realize, even when they don’t fully understand what’s happening.
It can be a challenging balance to support your baby in the NICU while also caring for your family at home.
That’s why I created the Bright Sprout NICU Sibling Coloring Book—a printed coloring book designed to help siblings better understand the NICU experience in a child-friendly, comforting way. With gentle illustrations and familiar NICU themes, it gives children a way to ask questions, express feelings, and stay connected.
Whether you’re looking for a thoughtful gift for a NICU sibling or another way to support brothers and sisters of NICU babies, this book was created with your family in mind.
As an NNP with over 26 years of NICU experience, supporting the entire family—including siblings—has always mattered deeply to me.
A note about this resource: Bright Sprout provides educational and supportive information for NICU families. This content is not intended to replace medical advice, diagnosis, or treatment from your baby’s healthcare team. Every baby and NICU journey is different. If you have questions or concerns about your baby’s health or care, please talk with your NICU team.
