A parent holding their baby in the NICU, surrounded by a collaborative medical team.

Navigating NICU & PICU Long Stays: How to Ensure Coherent Care Decisions for Your Child

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Discover strategies for families to advocate for consistent and well-informed medical decisions in neonatal and pediatric intensive care units where physician rotations are frequent."

For families with infants in the neonatal ICU (NICU) or pediatric ICU (PICU), the journey is often marked by complexity and uncertainty. One significant challenge is maintaining coherent decision-making when care is overseen by a rotating team of physicians. This constant shift raises critical questions: Is there genuine consensus among the various clinicians involved in your child's care? Is achieving this consensus even practical, and is it truly in your child's best interest?

A recent study in Pediatric Critical Care Medicine sheds light on these concerns, examining the attitudes of neonatologists and pediatric intensivists regarding decision-making for children with chronic critical illnesses. The study emphasizes whether medical professionals feel obligated to seek consensus and disclose conflicts within the care team. Understanding the dynamics at play can empower you to advocate more effectively for your child's needs.

This article will break down the key findings of this research, explore the challenges of decision-making in the NICU and PICU, and provide actionable strategies for parents to ensure their child receives consistent, well-informed care during long-term hospital stays. We aim to equip you with the knowledge and tools necessary to navigate this challenging landscape with confidence.

The Challenge of Physician Rotation: Why Consistent Care Matters

A parent holding their baby in the NICU, surrounded by a collaborative medical team.

In many NICUs and PICUs, attending physicians rotate on a weekly or bi-weekly basis. While this system ensures that doctors are fresh and able to provide focused care, it can also lead to fragmented decision-making. Each physician may have slightly different approaches, potentially causing confusion and inconsistencies in treatment plans. For parents, this can feel like navigating a maze, unsure of who to trust or which direction to follow.

The study highlighted a significant disparity: less than half of physicians (around 40%) felt a professional responsibility to seek a consensus decision for procedures like tracheostomies in chronically ill infants. Yet, a majority reported making consensus-based recommendations in practice, while about 15% deferred entirely to the family without offering a preferred treatment. This inconsistency underscores the need for parents to be proactive in seeking clarity and ensuring a unified approach.

Here are key considerations about physician's responsibility:

Seeking Consensus: The study revealed that only a minority of physicians felt professionally bound to seek consensus.
Actual Practice: Despite this, many physicians reported making consensus-based recommendations.
Family Deferral: A notable percentage completely deferred to the family, potentially leaving parents feeling unsupported.

Another striking finding was the difference in attitudes between neonatologists and intensivists. Neonatologists were more inclined (32%) to agree that the decision should rest solely with the family, while intensivists (20%) were more likely to seek team consensus. This divergence highlights the varying philosophies within the medical community and reinforces the importance of understanding your care team's approach.

Empowering Parents: Strategies for Ensuring Coherent Care

While the challenges of physician rotation and differing opinions can feel overwhelming, parents can take proactive steps to ensure their child receives the most consistent and well-informed care possible. By understanding the dynamics at play and advocating for clear communication and collaboration, you can help create a more unified and supportive care environment for your child and family.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1097/pcc.0000000000001260, Alternate LINK

Title: Caring For Long Length Of Stay Patients In The Neonatal Icu And Picu

Subject: Critical Care and Intensive Care Medicine

Journal: Pediatric Critical Care Medicine

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Kate Madden, Jeffrey P. Burns

Published: 2017-09-01

Everything You Need To Know

What exactly are the NICU and PICU, and why are they relevant?

The NICU, or Neonatal Intensive Care Unit, and the PICU, or Pediatric Intensive Care Unit, are specialized units in hospitals that provide intensive care for newborns and children, respectively. These units are equipped to handle complex medical conditions and often involve long-term stays. Physician rotations, where doctors change on a weekly or bi-weekly basis, are common in these settings. This can sometimes lead to fragmented decision-making and inconsistencies in treatment plans, as each physician may have slightly different approaches. Understanding how these units function and the potential challenges is crucial for parents navigating their child's care.

How does physician rotation affect the consistency of medical care in the NICU and PICU?

Physician rotation in the NICU and PICU can impact the consistency of care because each doctor may have different approaches and opinions, leading to variations in treatment plans. The study revealed that not all physicians feel obligated to seek consensus on treatment decisions, with neonatologists sometimes more inclined to defer to the family's decision compared to intensivists, who are more likely to seek team consensus. These inconsistencies underscore the importance of parents being proactive in understanding the dynamics and advocating for a unified approach to their child's care.

What does it mean for doctors to 'seek consensus' in the NICU or PICU, and why is that important?

Seeking consensus in the NICU and PICU refers to the process of medical professionals coming to a mutual agreement on the best course of treatment for a child. While the study indicated that less than half of physicians felt a professional responsibility to seek consensus, many reported making consensus-based recommendations in practice. However, a significant percentage deferred entirely to the family. Achieving consensus is important because it ensures that treatment decisions are well-informed and supported by a unified medical team, leading to more consistent and coherent care for the child.

What differences in attitudes exist between neonatologists and intensivists in these intensive care settings?

The study mentioned differences in attitudes between neonatologists and intensivists. Neonatologists were more inclined to agree that the decision should rest solely with the family, while intensivists were more likely to seek team consensus. This divergence highlights varying philosophies within the medical community and reinforces the importance of understanding your care team's approach. Recognizing these differences can empower parents to ask more informed questions and advocate effectively for their child's specific needs, ensuring that treatment aligns with the family's values and preferences while still benefiting from expert medical opinion.

As a parent, what can I do to help ensure my child receives coherent and consistent care during a long stay in the NICU or PICU?

Parents can ensure more consistent and well-informed care for their child by taking proactive steps. These include actively participating in care discussions, asking clarifying questions to understand the rationale behind treatment decisions, and fostering open communication between all members of the care team. By understanding the dynamics at play, such as physician rotation and differing opinions, parents can advocate for clear communication and collaboration. Additionally, it is helpful to understand the roles of different specialists, such as neonatologists and intensivists, and how their approaches may vary.