title: Candles in the snow: ritual and memory for siblings of infants who died in the intensive care nursery.
abstract: OBJECTIVE
  To assess the developmental impact of surviving a sibling who dies in the neonatal intensive care unit (NICU).
  
  
  METHODS
  Fourteen (13 adults, 1 adolescent) siblings of infants who died in Dartmouth-Hitchcock Medical Center's NICU between 1980 and 1990 were interviewed. The interviews were recorded and transcribed verbatim, and prominent themes were coded.
  
  
  RESULTS
  Six siblings rated family communication as veiled or a family secret; 7 reported unresolved parental mourning. Eleven siblings were rated high on anxiety themes, including concerns over future pregnancy or anxiety about their mother's health. Photos and family rituals were helpful to siblings in grieving and remembering the infant.
  
  
  CONCLUSIONS
  Although death in the NICU often has a brief course, consequences for survivor siblings can be life-long. Siblings born both before and after the death of an infant may be at risk and in need of psychological support. Family rituals and photos are important vehicles of communication, grieving, and memory for siblings and parents alike. Clinicians should allow siblings to be active participants in the infant's brief life and death.
authors.affiliation: Hood Center for Children and Families, Department of Pediatrics, Dartmouth Medical School, Hanover, NH, USA. Joanna.Fanos@Dartmouth.edu
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Fanos
authors.forename: George A
authors.initials: GA
authors.lastname: Little
authors.forename: William H
authors.initials: WH
authors.lastname: Edwards