(Version 2.0  05/02/02 - 10/02/02)

The visitation policy for children in the NICU has recently been revised.  No children < 5 years of age are permitted in the NICU.  Children ages 5 - 12 years old who are siblings of an infant in the NICU have limited visitation.  Teenagers > 12 years old are allowed to visit as adults.

            The new restricted visitation policy for siblings in the NICU is an attempt to balance the psychosocial and emotional needs of the sibling with the need for infection control for the infant patient.  The literature suggests that sibling visitation enhances bonding and improves siblings understanding of and attachment to their new family member.  However, unsupervised and unlimited visitation by young children increases the risk of community viral exposure and does not necessarily benefit the sibling if time in the unit exceeds the child's patience and attention span.

Therefore, siblings ages 5 -12 are invited to visit their new brothers and sisters in the NICU on weekends only*.  These visits should be limited in time to 15 - 30 minutes in accord with the child's age and attention span.  These visits should be sibling oriented with time taken to explain to the sibling what their brother or sister will look like (pictures of equipment are available to assist in preparing the sibling) and time taken to answer the child's questions.  Sibling visitation brochures are available for parents prior to the first visit.  Volunteer and Child Life services are being recruited to have juice and cookies available for several hours on Saturday to increase the positive impact of the visit on the sibling.  The sibling should also be provided with a certificate, a picture of the baby, and other memorabilia (booklets, coloring book, etc.) from the visit.

Although the emphasis is on quality time rather than quantity time for siblings, the primary focus of NICU care remains on the critically ill infant.  To protect the patient from infection, all siblings must undergo a health screening before entering the NICU.  The parents must complete a questionnaire attesting to the sibling's health, immunizations, and exposure status.  An MD, often the pediatric housestaff, should perform a screening physical exam; and the sibling MUST be shown how to properly wash his/her hands.  A handwashing video targeted at the pediatric age group may soon be available.  Once approved, the sibling is given an apple sticker that allows admittance for 24 hours and is signed in by the parent in the log book.

This new sibling visitation policy is in effect on a trial basis only.  Feedback collected over the next several months from NICU staff and parents alike will assist with the future development of a neonate and family-centered visitation protocol.

*Under special circumstances (for example: bereavement, pre-operative cardiac surgery) siblings may be permitted to visit at other times during the week at the bedside nurse's discretion.  The bedside nurse granting special permission should discuss this decision with the charge nurse and/or his/her co-workers so families can be made to understand any exceptions to the rule.

Effective 5/1/02.  Discussed at Clinical Division meeting 4/15/02 and Unit Board meeting 4/23/02. Reviewed in Collaborative Pathways meeting 5/22/02.

References:

 Montgomery LA, et al. A research-based sibling visitation program for the neonatal ICU. Critical Care Nurse 1997; 17: 38-40.

 Meyer EC, et al. Attitudes about sibling visitation in the neonatal intensive care unit. Archives of Pediatrics & Adolescent Medicine 1996; 150: 1021-6.

Oehler JM and Vileisis RA. Effect of early sibling visitation in an intensive care nursery. Journal of Developmental & Behavioral Pediatrics 1990; 11: 7-12.