Seeing Is Believing - and Understanding - for Children With Siblings in ICU

The intensive care unit looms as a mysterious, frightening place to children whose siblings are critically ill. But, a program at Texas Children's Hospital helps kids understand the "why" and "how" of the tubes and wires, then takes them into the unit for one-on-one visits.

Although the ICU is usually off-limits to children under 14, siblings are allowed to enter the area with child life specialists. Teresa Edmunds, a child life specialist at Texas Children's, said visits help siblings cope with the hospitalization.

"Often, feelings like jealousy and guilt build up if a child doesn't get to see a brother or sister in ICU," she says. "Also, children might hear things they don't understand and develop irrational fears but not ask questions. If they can see their sibling, it helps them feel much better."

Before they enter the unit, Edmunds meets with the visiting child, bringing along her teaching kit, which includes photographs of ventilators, monitors and medicine machines, as well as actual blood pressure cuffs and other props. In age-appropriate language, she explains what the child will see.

"I let them feel the blood pressure cuff and heart monitor wires and play with them if they want," she says. "When I'm telling them about the equipment, I try to use words they understand. For older children I can say `oxygen,' younger children might understand `air' better."

Edmunds often makes dolls to help younger children understand their sibling's medical treatment.

When the child is ready, Edmunds takes him or her into the ICU. At least one parent usually accompanies them.

"I take cues from the children's facial expressions," she says. "Usually, younger kids just want to see their brother or sister and don't care about the machines. School-age kids often want to touch the equipment, and older kids ask more questions."

If the patient is alert, a visiting sibling doesn't need to be prompted about what to say, Edmunds said. But, if a child has been sedated, the sibling sometimes needs encouragement to talk.

"I tell them to relax, sit beside the bed and tell their brother or sister they love and miss them," she says. "Then I give them their own time in the room."

Edmunds then steps outside and watches the visit through a window. When the visiting child leaves the unit, Edmunds is available to answer questions

"Siblings are curious about why mom and dad spend so much time at the hospital," she says. "It's good for them to see the equipment and their brother and sister. Also, it really does seem to make the patient feel better."

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©2006 Texas Medical Center

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