Trauma from infant siblings’ death lasts for life, study finds

The memory of an infant sibling dying in a neonatal intensive care unit significantly affects older siblings for the rest of their lives, according to a recent study published in The Journal of Pediatrics by researchers at Dartmouth Medical School.

The study’s authors, DMS professors Joanna Fanos, George Little and William Edwards, drew their research from interviews with 13 adults and one adolescent whose siblings died in infancy at the Neonatal Intensive Care Unit at Dartmouth-Hitchcock Medical Center between 1980 and 1990.

According to the study, six participants reported “veiled” or secretive family communication, seven gave accounts of parents’ ongoing grief and 11 reported high degrees of anxiety, particularly concerning pregnancy and their mothers’ well being.

Siblings of deceased infants often experience depression, anger, guilt and helplessness, the study found. Families mourning the death of an infant are also at risk of familial abuse, the study found. Participants who lost siblings before the age of five described their mothers as relatively more defensive and domineering.

The study found, though, that some people appear to “weather the storm” after the death of an infant sibling, often trying to compensate by pursuing a career in medicine, Little said. Family photographs of the infants and traditions can also help allay a sibling’s grief, the study suggested.

The researchers decided to investigate the effects of sibling death because of their strong shared interest in family-centered care, Little, who established the NICU in 1972, said in an interview with The Dartmouth.

“We practice medicine,” Little said. “No matter how long we’ve been at it, we try to be better, and the appropriate way to be better is to gather evidence.”

He also noted that there is a limited amount of research on the issue.

“[Sibling death] hasn’t had a lot of attention in terms of studies,” Little said. “I think that’s why this study was accepted in a very well-regarded and peer-reviewed journal.”

Although the study sample was small and lacked demographic diversity, Little said he hopes to study other populations of different cultural, socioeconomic and religious backgrounds in the future. The researchers are also interested in expanding their scope to include grandparents who have lost grandchildren in neonatal intensive care.

Fanos, the study’s lead author, has previous experience as a psychological researcher and has investigated the impact of chronic disease on siblings, Little said.

“I see this study as a start,” Little said. “It did give us some evidence, but, like most research, it needs to be expanded.”

The sample size of the study was limited due to difficulty in finding participants, Little said. The team had to wait until participants were 18 years old or obtain approval from their parents. The researchers also tried to include other demographic groups, including residents of the Oakland, Calif., area, but received no responses from outside the DHMC NICU.

The study’s findings will help improve future care of families with infants in intensive care, Little said.

“We need to try to provide even better guidance to the families who are involved,” Little said. “That’s very hard because mom and dad are quite distraught, and the siblings often are not here.”

Fanos was unavailable for comment by press time. Edwards could not be reached by press time.

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