Helping Siblings Cope When a Baby Is in the NICU

Key takeaways

Use simple, honest words that fit your child’s age, and tell them clearly that the baby being sick is not their fault.
Confusion, jealousy, anger, guilt, loneliness, and worry are all normal. So is acting younger for a while.
Keep daily routines as normal as you can, and let teachers and caregivers know what’s going on.
Drawings, family photos, and a chosen soft toy can go to the baby’s bedside. Sibling visits depend on your unit’s rules, so ask your unit.
If stress seems ongoing or your child is having a hard time at home or school, talk with your child’s doctor, a therapist, or the NICU’s child life or social work team.

This page is general information, not medical advice. Every baby is different — talk with your baby’s NICU team or pediatrician about what is right for your family.

Explaining the NICU by age

Children of every age notice when something is wrong, even if they don’t ask. Northwestern Medicine’s child life team says it’s key to keep siblings involved, keep routines in place, and answer their questions honestly. One message matters at every age: this is not your fault.

Toddlers (about 1 to 3)

Toddlers can’t understand most medical information, but they pick up on your stress and often show feelings through behavior. Keep it very simple:

Try something like: “Our baby was born, but he is tiny and sick. The doctors need to take care of him in the hospital until he grows and gets better. Let’s look at his picture together.”
Help them name feelings: “Daddy feels a little sad because the baby is in the hospital. It’s OK to feel sad sometimes.”
Separations are hard at this age. Tell them when you’ll be back (“when it’s time for dinner”) instead of slipping out.
Hold off on big new steps like toilet training, a new bed, or weaning for now.

Preschool and school-age children (about 4 to 11)

Children this age may secretly believe something they did, thought, or wished made the baby sick. Some worry they could get sick and have to stay in the NICU too. Be honest, simple, and accurate:

“The baby needs the doctors and nurses to help her while she grows and gets stronger. Sometimes babies are just born early. It’s not anyone’s fault.”
Explain the equipment kindly. CHOC suggests describing an incubator as a special bed that keeps small babies safe, and March of Dimes suggests explaining that tubes and wires don’t hurt the baby.
Reassure them that only sick babies need the NICU, not big, strong kids like them.
Watch their pretend play. Kids often act out what’s on their minds, and it can show you their questions.

Teens (12 and older)

Teenagers may have strong feelings they don’t share, and they may be asked to take on a lot at home.

Talk regularly and honestly, and share how you’re feeling too. It makes it easier for them to open up.
If they’ll research on their own, point them to trusted sites. Northwestern suggests kidshealth.org, marchofdimes.org, and handtohold.org.
Encourage healthy outlets like journaling, art, exercise, or music.
Make sure there’s always a trusted adult they can talk to when you’re not home.
Be careful not to hand them so many chores that school and friends slip.

Common reactions

March of Dimes notes that older brothers and sisters of a NICU baby may feel:

Confused about why the baby has to stay or why you’re upset
Angry about changed routines and time away from you
Jealous of the baby who takes so much of your time
Guilty, and scared that their angry feelings caused the baby to be sick
Lonely, or worried that the baby is suffering or will die

Behavior often changes too: being clingy, not listening, crankiness, wetting accidents, wanting a bottle again, thumb-sucking, eating or sleeping problems, or trouble at school. As March of Dimes puts it, children who act this way are telling you they need you. Northwestern Medicine adds that regression is usually a temporary response to stress, so try to respond with patience and extra attention rather than punishment.

Keeping routines steady

Keep the day familiar. Meals, bedtime, and school help children feel safe. If family dinner now happens at the hospital, Hand to Hold suggests moving that time to breakfast or bedtime.
Use consistent caregivers. Give grandparents or sitters the details of your child’s routine and favorite things.
Tell teachers and caregivers. They can offer extra support and let you know about changes.
Stay in touch when you’re away. Call to read a bedtime story, leave love notes, or make a small photo book with pictures of the family and the new baby.
Protect a little one-on-one time. A bedtime story or a car-ride chat tells them they still matter.

Including big brothers and sisters

Siblings feel better when they have a role. March of Dimes and hospital child life teams suggest:

Coloring pictures or making a card to hang near the baby’s bed
Picking a favorite photo of themselves or the family for the bedside
Choosing a stuffed animal or soft toy to bring to the NICU (check your unit’s rules first)
Making a photo album of the baby, or a story book about the baby’s birth
Helping choose the baby’s clothes or get the nursery ready for homecoming
Making a list of things they can do that the baby can’t yet, and things they’ll teach the baby

Sibling visits: ask your unit

Each NICU sets its own sibling rules. Some allow siblings only above a certain age or during certain hours. Units often check that young visitors are healthy: children who visit must be well, should be up to date on their immunizations, and should stay home if they have symptoms like a cough, runny nose, or fever. Many units also tighten visitor rules, often including children, during cold and flu season, when RSV and other respiratory viruses spread. Before you plan a visit, ask your unit what its current policy is.

If a visit is allowed:

Show pictures or videos of the baby first and describe what they’ll see and hear, including alarms.
Keep it short. March of Dimes suggests less than 30 minutes.
Bring another adult who can take your child home so you can stay with the baby.
Afterward, ask what they noticed and answer questions simply and honestly.

Some hospitals have child life specialists who help prepare siblings, explain equipment in kid-friendly words, or offer a sibling playroom. Ask whether yours does. For a broader look at the unit, see what to expect in the NICU.

Books that can help

Northwestern Medicine’s NICU child life team lists these NICU-specific picture books and workbooks for siblings:

The Big Sibling Guide to the NICU: Adventures in Child Life by Diane Morales, a workbook for ages 3 to 12
Cradles of Courage: Adventures in the NICU by Brittany Thrift, written by a pediatric nurse, for ages 3 to 12
Waiting for Baby: A Sibling Visits the NICU by Jennifer Bracci, a picture book for ages 4 to 8

Read together and talk afterward, so you can clear up any mix-ups. Your NICU’s care team may have its own favorites.

When to get more help

Most children adjust with time, patience, and extra love. But Nemours KidsHealth notes that ongoing stress sometimes needs more support than a parent can give alone. Reach out to your child’s doctor or a therapist if:

Behavior changes keep going or get worse instead of easing
Your child is struggling at school, with friends, or with eating or sleeping
A teen seems withdrawn and isn’t talking to anyone

Ask your NICU whether it has a child life specialist or social worker who works with siblings. If anyone in your family, including a teen, is in crisis or talking about suicide, call or text 988, the 988 Suicide & Crisis Lifeline, available 24/7. In an emergency, call 911.

Friends and relatives can make a huge difference for big brothers and sisters, too. Share our guide on how to help a friend with a baby in the NICU. Offering to take a sibling to the park is one of the kindest gifts there is.

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