sibling visitation policies?

[spacey]

Hi..........

We have recently had many parents requesting that the siblings of our babies be allowed to visit. In the past we allowed children to visit their baby brother or sister but that policy was changed due to growing concerns about infection risks. In our area, community acquired MRSA is becoming much more common and we also worry about RSV season during the winter months.

I have been working on a compromise of sorts.......that would allow the siblings to visit if the visit is pre-scheduled and supervised. Their entire visit would be managed by an RN and would include some education at their level about "their" baby, a bit of teaching about infections and the usual hand washing procedures all visitors follow. In addition, I would plan to have the children gown, glove and mask before entering the unit and touching the baby. It would be a special day and pictures would be taken, etc. This visit would then not be repeated until the baby's status changed....and then only at the parents request.

Do any of you have sibling visitation? Do you have policies in place that you could share with me? It would surely help if I could take the experience of other units to share when I present this plan to the decision makers!

Thanks so much,

LGreenRN

(spacey)

[Stefan Johansson]

Great question!

During the non-RSV-season (spring-summer-autumn) we generally allow relatives and siblings to visit IF they are well and without any signs of common colds etc.

During the RSV-season (i.e. according to the virology lab, when they see RSV+ cultures from the emergency rooms around Stockholm) we have quite strict guidelines and do not allow any visitors besides the parents.

Fortunately, we do not have so much of MRSA in Sweden (yet...) so we do not worry much about that.

Generally I think visiting policies are difficult to set, there are not much of "evidence" out there, so common sense is what's left for guidance. And common sense is not also a general thing, I mean that we have quite different opinions about what's reasonable.

[ian woodroffe]

Hi Spacey

I was in the middle of a lengthy reply to you and lost it so I am unsure whether you had any of the message.

In Cambridge we accept well siblings after lots of hand washing- on entry into the Unit and again on entry into the 6 bedded room where the baby may be.

I think your idea of guided visits is fantastic -we hope to aim for the same but we would have to involve volunteers as we do not have the staff recourses to manage.

i am thoughtful about gowning. We do not ask others to so the same and would the sibling be left feeling that they are a special carrier of something aweful? If the baby died we would need to remember that children can engage in magical thinking and often feel responsible for the death- would you be feeding into that by gowning and masking on visits?

Is there any evidence that MRSA or RSV frequency is increased after sibling visits? I think it would be an area of concern but without some evidence that siblings do make things worse the sibling could be the focus of unreasonable fear.

I think there is much to be done on supporting sibling visits and we are looking at the possibility of sibling learning sessions before vistis.

Just some early morning thoughts on your enquiry-I would love toknow how it develops for you.

With every best wish

Ian Woodroffe

[Guest bittybabygrower]

We allow siblings older than 3 to visit for 30 minutes once a day. The parents are required to set it up before they come in so that we can make sure nothing is going on in the pod at that time. They have to scrub in just like the parents and use hand sanitizer if they are to touch the baby. We screen them at the desk for any illness and if they have had the nasal flu vaccination they aren't allowed to visit for one month (live virus). If the kids are older, over 10, and well behaved and quiet then we let them stay the whole time the parents are there. The littler ones don't even last the 30 minutes and we will ask the parents to take them out if they aren't cooperating with them. We do encourage the siblings to make signs and color pictures for the baby and we hang them by the beds.

For MRSA kids, only the parents may visit them and they have to gown with their visit.

We are looking into limiting visitation for RSV season, but we have been very lucky in the past as to have not had any cases.

We have child life specialists that also will come and be with the siblings and play with them and talk with them about their preemie brother or sister.

[Guest Gail B]

We allow siblings into our unit with Parents. They must be well, wash their hands and put on a gown. They are not allowed to touch baby or anything else but just look.

[Guest lorimac]

We allow siblings to visit with parents as long as health screening is clear and they must wash just as parents do. We do not have limitations to the visit as long as the children are "well behaved" and not causing a distraction in the unit they may stay

as long as the parent wants. Of course during RSV there are restrictions to no visitors under the age of 13.

[NICU RN 7]

We allow siblings over the age of 16 to visit unrestricted, and siblings under that age to visit once (or twice for an extended stay patient) with a Child Life Specialist who can guide them in appropriate hygiene and contextualize the experience.

[drakjaleel]

We allow siblings over the age of 16 to visit unrestricted, and siblings under that age to visit once (or twice for an extended stay patient) with a Child Life Specialist who can guide them in appropriate hygiene and contextualize the experience.

Is there any recommended or evidence based sibling/any other attender visiting policies available for NICU

[Bernhard Bungert]

Long time gone since last post. We start to develop a visiting policy. But - the deeper the insight - the greater the Problem. Peluso AM J Perinatol 2015 Aug; 35 (8) 627-30 described  increased rate of RSV-Infections during RSV - Season in the "visiting Group": worth reading. We thing about medical checks of the young visitors, complette vaccination, single room visits only, Age-restriction (only > 6 years), written parents consent, Time Limitation for those under 12 years. Sounds a Little bit  too elleboratated but in time of high hygienic susceptibility and bad expierences of German NICUS with "outbreakes" of MRGNs we have to be carefull.

We have no place for careing for siblings at the time parents visit the preemies (an aditional Problem).

there are People anywhere with written policies and/or expierence?

[gayle omansky]

During "non flu season" we have 24hr open family visiting. We have parents fill out a "sibling visiting" form attesting that the siblings have been fever, cough, congestion & rash free for the past 48hrs. The parents fill out the form once & we expect that they will not bring in children if the situation changes. No other children under 18 yrs allowed. 

We do have issues around the children not being monitored or contained by parents. We also have a nearby visiting room with a few toys that parents can trade off visiting the baby & containing the siblings. 

"Flu season" as announced by the state department of public health - likely 11/1-5/1 closes visiting to siblings.

we have had a few (over many years), contained (2 babies at a time) RSV outbreaks. We have recently had to move babies into our isolation room for viral respiratory symptoms & put on droplet/ contact precautions. These babies all had ill family members.

rigorous hand washing policy & constant hand gelling as modeled by staff helps, but it is a difficult balance between being family friendly & protecting our babies. We encourage FaceTime & have 2 iPads on the unit for this purpose as a visiting substitute.

Best, Gayle