STANFORD, Calif. - Cocooned in tubes and wires, too fragile to be held, small, sick newborns fight for life in neonatal intensive care units. Though many go home healthy, the babies' harrowing starts leave indelible marks on their parents. To learn exactly how parents are affected, Richard Shaw, MD, a child psychiatrist at Lucile Packard Children's Hospital and an associate professor at the Stanford University School of Medicine, is studying post-traumatic stress disorder among moms and dads whose infants stayed in a NICU. (His latest paper on the subject was published in the March-April issue of the journal Psychosomatics.) He recently sat down for a Q&A session on the topic.

Question: How could PTSD interfere with a parent's ability to be a good caregiver?

Shaw: Parents with PTSD tend to be highly anxious and prone to overinterpret mild distress in their children as indicating possible serious illness. They may constantly expect their child to become ill, recreating the feelings of anxiety and distress they experienced at the time of their child's birth. They may repeatedly bring their children to the doctor - often unnecessarily - and, in so doing, foster a pattern in which their child manifests physical symptoms as a way to express emotion.

Parents may also develop symptoms of what has been termed the 'vulnerable child syndrome.' In this syndrome, parents with a history of having a medically fragile infant become overprotective, limiting their child's independence, because they want to make up for their child's trauma. This may result in children becoming oppositional and defiant as they get older.

Q: What were the most important aspects of your recent findings?

Shaw: We found very high rates of symptoms of traumatic stress in parents of NICU infants in the first few weeks after birth. The parents' symptoms may include nightmares about their child's birth and hospital stay, intrusive memories, a tendency to be jumpy or on edge, sleep difficulties and attempts to avoid reminders of the trauma. In our sample of parents, mothers tended to be more symptomatic, possibly because they are more likely to be at the bedside, and are therefore more likely to experience the traumatic aspects of their child's medical problems.

Q: Did any of your findings surprise you?

Shaw: We were surprised to find that fathers had a delayed reaction in terms of their trauma response. By four months, maternal trauma symptoms had diminished, but fathers' symptoms had increased, and in fact exceeded those of the mothers. It appeared that fathers tend to keep their emotional reactions in check for the first few months, perhaps to allow full support to be given to the mothers. However, by four months, when the mothers are recovering, the fathers go through a very difficult period. Awareness of this phenomenon is essential to ensure that the fathers' needs are not overlooked or neglected.

Q: In your research, the severity of the infants' illness did not correlate to parents' stress levels. Why not?

Shaw: In trauma research in general, the severity of the response tends to depend more on the characteristics of the victim, and less on the circumstances of the trauma. Some individuals seem to be quite resilient and less likely to develop symptoms of PTSD. Others, especially those with prior history of trauma exposure, or those with poor coping abilities, are more vulnerable. These factors appear to be more important than the severity of the child's illness.

Q: What follow-up care should we provide for parents after an infant's NICU stay ends?

Shaw: Parents should be carefully evaluated and offered appropriate psychological support. They should be educated about warning signs in themselves - insomnia, nightmares, irritability, etc. - and involved in hospital-based parent support groups. They also benefit greatly from advice from other parents who have gone through similar NICU experiences. Packard Children's, for example, has a Parent Mentor Program to provide support of this nature. In addition, to advance research in this area, we have recently submitted a grant to study the usefulness of brief, supportive psychotherapy for NICU parents.