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Thursday, March 31, 2011

Preparing children for the arrival of a new sibling

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By Dr. B. J. C. Perera MBBS(Ceylon), DCH(Ceylon), DCH(England), MD(Paediatrics), FRCP(Edinburgh), FRCP(London), FRCPCH(United Kingdom), FSLCPaed, FCCP, FCGP(Sri Lanka) Consultant Paediatrician

The arrival of a new baby can bring many changes to a family. Parents spend a lot of energy on preparations and getting things sorted out prior to the arrival of the new baby. After the baby arrives, much of the family’s attention involves meeting the newborn’s basic needs. When there are older children, one must remember the impact of the phenomenon on them. All this change can be hard for older siblings to handle. It is quite common for them to feel jealous toward the newborn and to react to the upheaval by acting out. However, parents can prepare their children for an addition to the family. Discussing the pregnancy in terms that make sense to children, making some arrangements and including the child or children in the care of the newborn can make things easier for everyone.

Sibling rivalry usually starts right after or even before the arrival of the second child or subsequent children. The older child often becomes aggressive, "acts out" or even regresses. This regression means acting more like a little baby. Examples are the child wanting a bottle or passing urine in his or her pants and clothes.   It is quite important to prepare an older child when the parents know that the mother is pregnant. Older siblings need to know what to expect and they need time to adjust. Even after the baby arrives, there are many things that one could do to make the adjustment easier. It must be remembered that having a new baby in the family may be one of the tougher things that an older child has to deal with.  However, it may eventually be one of the greatest gifts that the parents can give them.

There is no right time or perfect way to tell a child about an impending sibling arrival. When discussing the pregnancy, it is necessary to consider the parents own comfort level and the child’s maturity level. Preschoolers, for example, may not grasp concepts of time, so it might not mean much if one says that the baby will arrive in a few months. It may be more useful to explain that the baby will arrive in a particular season, referring to perhaps festive days such as the New Year or Christmas or Deepavali. The little ones will then understand the timing.
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Parents often wonder as to how much of details of the new arrival they should provide for the other siblings. It is best to be guided by the questions that the child asks. A four year old may ask "Where do babies come from?" Despite how it sounds, the child is not really asking the parents to explain the details of the act of procreation but probably wants to know where, literally, they come from. It may be enough to explain "The baby comes from the uterus, which is inside the mother’s belly." A child who wants to know more will then ask for further details.

After the news is broken, the parents should talk to the older children often enough so that they can share new thoughts and concerns as they arise. However, they should not talk about the new baby every day unless the child or children bring up the subject. They need to know that the new baby is not the only important thing in their life. One needs to talk about the reasons for wanting another child, about what babies are like and about how they grow inside a mother’s belly. If the sex of the new baby is not known, they need to talk about that too. But one must not try to build up expectations for one gender over the other. It is a nice thing to ask the older siblings about possible names that the parents are considering.

If the older children want to know why the parents want another baby, it is wise to tell them as honestly possible the reasons. However, one should not claim that they are doing it for the older children’s sake. In talking about the coming baby, one should try to give the older siblings a sense of ownership. It is very wise to, from the very beginning of the discussions, refer to the new baby as "your brother" or "your sister" or "your brother or sister".

If a child shows more interest in the impending arrival of the baby, several activities can encourage that. It is good to go through the present children’s baby pictures, provide them books about childbirth and babies, provided it is developmentally appropriate for the children, visiting friends who have infants, packing a bag for the hospital, get the children to think of potential baby names and taking them to the doctor when the mother goes for her pregnancy follow up visits. Several developed countries have sibling birth classes, which many hospitals offer to provide orientation for soon-to-be brothers and sisters. These classes can include lessons on how to hold a baby, explanations of how a baby is born and opportunities for children to discuss their feelings about having a new brother or sister.

Parents should tell the child about the pregnancy somewhat early. The child needs to hear about it from the parents rather than from anyone else. If the child needs to be moved to another room it should be done well before the new baby arrives. This is also applicable to any other major changes such as weaning, toilet training and starting preschool or child care. The siblings should be given a realistic idea of what to expect when the baby first arrives. It is particularly important for them to know that the new baby is likely to take up a lot of time of the mother and the baby will not be a playmate as yet. One should read books about pregnancy, birth, newborns and baby siblings with the other siblings and them a chance to ask questions, voice concerns and vent feelings inspired by the books.

Parents should show pictures and videos of the older child when he or she was a baby to the same child and tell the child about what he or she was like a baby. The child needs to know how excited the parents were when he or she was in the womb, about the birth and subsequent progress as a baby. The child could be instructed to hold a doll very gently and teach the child how to touch and hold a baby very gently. One could let them participate in preparations in any way possible.  Give them choices, such as choosing the baby’s coming home outfit from two acceptable options. There is of course the question of allowing the older children to be around the hospital when the mother actually gives birth. If the child or children are to be around, one needs to make sure that there is an adult around whose only job is to be there for the children. When the baby actually arrives, they will be some of the first few of the family members to get to know and even hold the new arrival.

As the due date draws near, it is essential to make arrangements for older children to be taken care of and looked after while the mother is in hospital. One needs to remember that the father too will be quite involved in the process and is unlikely to have much time for the other children at home. Parents need to discuss these issues with the older children well before the time of admission to hospital. One should also consider allowing the older children to visit the mother and the new baby in hospital as soon as feasible. One needs to keep routines as regular as possible in the days and weeks around the baby’s arrival. If the parents are planning to make any room shifts to accommodate the baby, they have to do it a few weeks before the actual birth of the new baby. If the older ones are approaching a major milestone like potty training or moving from a crib to a bed, the parents need to make those changes well before the arrival of the new baby or postpone them until after the newborn baby has been home for a while.

Once the baby is home, the other children need to be helped to allow them to adjust to the changes. They should be included as much as possible in the daily activities involving the baby so that they do not feel left out. In most cases, the older children love to help and revel in being given little responsibilities and minor tasks to be performed for the little brother or sister. Many children want to help take care of a new baby. Though that "help" may mean that each task takes longer, it can give an older child a chance to interact with the baby in a positive way. Depending on their age, a big brother or sister may want to fold or fetch diapers, help push the carriage, talk to the baby or help dress, bathe or burp the baby. However, if an older child expresses no interest in the baby, one should not be alarmed. It can take time. Some occasions, like breastfeeding, should not exclude older children. The older ones need to know and appreciate that it is a perfectly normal phenomenon. The parents and others at home should try to take advantage of opportunities for one – to - one time with older children and perhaps spend time together while the baby is sleeping. It is amazing how much even just 10 minutes of uninterrupted one – on - one time can mean to a child and indeed even help their behaviour. One could let the child choose the activity and the parent should follow the lead. One needs to listen, really listen, to how the child feels about the baby and the changes in the family.  If they express negative feelings, one needs to acknowledge them and help the child to put their feelings into words. One should never deny or discount a child’s feelings. 

If at all possible, it is a good idea to set aside time each day for older children to get one parent’s undivided attention. Knowing that there is a special time exclusively for them may help reduce any resentment or anger about the new baby. One also needs to remind relatives and friends that the older children might want to talk about something other than the new baby.

With all of the changes that a new baby can bring, some older children might struggle as they try to adjust. Everybody around needs to encourage them to talk about their feelings about the new baby. If a child cannot articulate those feelings, they are not likely to come to terms with the pressures imposed by the new arrival. Of course if the older children play up or act up, one has to take things gently without bending the basic rules. It could be a sign that the child needs more one – on - one time with the parents but they need to make it clear that although his or her feelings are important, they have to be expressed in appropriate ways.

One might wonder as to why it is hard for older siblings to adjust to a new baby. There are many things that can contribute to a difficult adjustment. Research indicates that a child’s personality has the most effect on how they react to a new baby. Children with the closest relationships with their mothers have the greatest difficulties with adjusting to a new baby and children with a close relationship with their father seem to adjust better. The developmental stage of the older child or children may affect how well they can share the attention off the parents. Quite often, two-year-olds have considerable trouble getting used to a new baby, because their needs for time and closeness from their parents are still great. In addition, stress on the family can make it harder for an older child to adjust.

It is most important that everybody does everything possible before the baby is born to establish the routines that they need to adopt after the baby arrives. They should try and get the older siblings’ life going so smoothly that the arrival of the baby would not disrupt their routines. If the older siblings go to school or pre-school, they should continue without a break, even in the first few days after the arrival of the new baby. If there is a young child who still breastfeeds, one should wean that child off well in advance of the arrival of the new baby. Otherwise, the older child may still remember breastfeeding and whenever the mother feeds the new baby, the older sibling may feel, "Hey, that’s mine!" If the mother plans to take time off from work after the baby is born, she should stop working well before the baby arrives, unless she cannot possibly afford to do so. Otherwise your child will feel, perhaps quite rightly, that the mother is willing to stay home for the baby even though she never stayed home for him or her. Most children would love to have a little brother or a little sister and even in the rare cases where there are initial problems of jealousy, these can be sorted out with judicious actions.

KEY POINTS

= The arrival of a new baby is likely to lead to some changes in the life of most people.

= Older siblings need to be carefully prepared for the event.

= Discussions and dialogue with the older children is very important.

= The routines of the siblings should not be disrupted as far as possible.

= The siblings need to develop a sense of "ownership" of the new arrival.

= Care must be taken to get the older children involved in the entire process.
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