Table 1.

A parent's guide to helping children visit in the PICU

Age	How child sees world	Things to consider
Infant Up to 18 months	Afraid of separation from caregivers	Will not remember places or what happens but sense how those around them feel and will react in like manner
	May be afraid of strangers	Try to keep to child's usual schedule
	Upset by changes in sleeping or eating times	Visit when child not tired or hungry
	Watch parents and others around them to see how to react to new situations
Toddler 1.5 to 3 years	See themselves as center of their world	Keep explanations simple like “your brother has a sick tummy” or “your sister has a hurt head”
	May have magical thinking about why things happen	Tell them nothing they did or thought about caused illness
	Don't understand much about being sick or hurt	Keep favorite toys or blankets close by to help them feel safe
	Watch parents or others around them to see how to react to new situations	Help them use words to tell about how they feel or ask questions. Give them lots of time to find words.
	Needs usual routines (nap time, snack time) to feel in control	Get them to draw a picture or tell a story about how they feel or what they see
	May have tantrums, more crying and clinging when stressed	Keep time at hospital short
	Needs space to run and play away from hospital
Preschool 3 to 5 years old	May ask many “why?” questions	Keep explanations simple
	Take words to mean what they know from everyday life. For example, may think a “broken leg” is broken right off as with a broken doll	Try not to use scary words like “cut”
	May think that their thoughts or actions caused things to happen (eg, brother is sick because thought they didn't like him or sister is hurt because they bumped them with toy)	Ask them about what they are feeling and give them lots of time to get their feelings and thoughts out
	May have trouble sleeping, eat less, or be active after visiting	Drawing pictures or telling stories with dolls or puppets may help
	Only understand a bit of the situation	Tell the child it is not their fault their brother or sister is sick even if it does not seem possible that they might think that
		May choose not to visit and use other ways to keep in touch (eg, pictures or videos)
		Child may respond in matter-of-fact way and want to leave soon
		Point out familiar things like toys, blanket, book
School age 6 to 12 years	Listens well and beginning to understand more complexity	Ask what they know about the situation
	May say they understand to look more grown up	Provide more information even if don't ask
	May not want to ask questions because they are embarrassed	Illustrations may help them to understand
	Like to feel in control of situation	May feel guilty about brother or sister being sick or injured because can't help them
	May be embarrassed if express emotion such as crying	May want 1 or 2 days to think about visiting and prepare themselves
	Beginning to understand body injury and may have questions about death	Keep visits short (5 to 10 minutes) in case embarrassed by emotions that are not controlled
	May remember details but in an exaggerated form	May benefit from concrete task (hold hand, put on lotion, read story)
	May be afraid they will get sick as well	Point out familiar things like pictures, toys, blanket
		Let them know it is okay to cry and okay not to visit
		Let them know that the chance of them getting sick as well is small
		Keep answers honest. Tell them what you know and don't know.
Adolescent 12 to 17 years	Like to be in control	Give them time to prepare for visiting
	Like to be with friends (peer group)	Try to help them keep in touch with their friends if possible
	Understand situation as whole and what it means in longer term	Carefully explore what they know and don't know, because they may worry about what others think and don't want to be embarrassed
	May look physically grown-up but still need lots of support and understanding	Reactions may be out of proportion with event–may be upset or crying, or not talk at all
	May have many questions, some with no easy answer	Encourage them to talk about feelings instead of acting out feelings
	Have clear understanding of body injury and may have questions about death	Try not to give them too many adult responsibilities during this time. They may not want to help with family decisions. Ask them about this.
		Keep answers honest. Tell them what you know and don't know.
		Have support persons (social worker, teacher, spiritual leaders) speak with them if appropriate