A study led by UT Southwestern found that parents whose child was admitted to the Neonatal Intensive Care Unit continued to see their child as medically fragile after the child’s recovery. Researchers created a therapy program to help them respond to the stresses of parenting and avoid being overprotective. (Photo credit: Getty Images)
DALLAS – Sept. 23, 2025 – A cognitive behavioral therapy (CBT) program developed for parents whose child was born prematurely reduced harmful perceptions that their child remained medically fragile, according to a new study led by UT Southwestern Medical Center. Published in Pediatric Research, the study is the first to show that an intervention could lower parental perceptions of child vulnerability (PPCV), a critical factor in a child’s development.
Vulnerable Child Syndrome (VCS) can occur when parents continue to see their child as medically fragile, even after a full recovery from serious illness or premature birth. This can lead to overprotective parenting, which has been linked to developmental and behavioral challenges later in childhood. Researchers created a therapy that gives parents tools to examine and shift how they respond to stress once their child has been released from the Neonatal Intensive Care Unit (NICU).
Margaret Hoge, M.D., is Assistant Professor of Pediatrics in the Division of Neonatal-Perinatal Medicine at UT Southwestern and Medical Director of the Thrive NICU Follow-Up Clinic at Children’s Health.
“Our therapy content focuses on teaching parents recognition of how stress and traumatic stress affect parents’ perceptions of their child’s vulnerability, their emotional responses to those perceptions, and the parenting reactions. It gives them the confidence to choose the most realistic and helpful thought, feeling, and reaction to anything that worries them about their child,” said lead author Margaret Hoge, M.D., Assistant Professor of Pediatrics in the Division of Neonatal-Perinatal Medicine at UT Southwestern and Medical Director of the Thrive NICU Follow-Up Clinic at Children’s Health. “Parents have told us of the many times they use the skills learned in our therapy to help them once they are at home and away from the supports of the NICU. They become flexible and appropriate in their thoughts, feelings, and reactions to stressful situations.”
The study adapted the structure of a previously tested therapy model but reworked the content to address PPCV and VCS more directly. Unlike earlier programs, which often focused on parent anxiety or depression early in a child’s NICU stay, this intervention targeted parenting perceptions after a child is discharged, when stress often resurfaces.
Researchers enrolled parents of infants born before 31 weeks of gestation at Parkland Health and randomly assigned families to receive either standard care or the CBT intervention. Most participants were insured through Medicaid, reflecting a patient population that often faces structural barriers to post-discharge mental health care.
The five-session therapy began at 33 weeks postmenstrual age, which combines the baby’s time in the womb with the time since birth, and continued until the child turned 6 months old. Post-NICU care was coordinated through the Thrive Program at Children’s Health. Delivered in English or Spanish, the sessions followed a structured, trauma-informed CBT design to address the broad impact of trauma on individuals, including exercises to help parents prepare for and appropriately navigate the emotional challenges of returning home with their infant.
Among the 20 families that completed the study, those who received the therapy reported notably lower perceptions of their child’s medical vulnerability. Those who received standard care reported no change. A follow-up statistical analysis found a 95% probability that the therapy was more effective than standard care. Parents also noted lowered mental health symptoms after completing the therapy. Parents rated the program highly, with satisfaction scores near the top of the scale. They said they thought other NICU parents should also receive this therapy, as it helped them tremendously.
The findings address a persistent need in NICU follow-up care: the lack of structured mental health support for parents affecting interactions with their child after their child is discharged from the NICU. By demonstrating feasibility in a Medicaid-insured population, the study points to a scalable, equity-focused strategy for improving outcomes in families of medically vulnerable infants.
“This provides a new treatment modality for NICU parents that addresses a critical gap in current care standards,” said Dr. Hoge, a Dedman Family Scholar in Clinical Care at UT Southwestern. “We hope that this will become a standard part of care for NICU patients and could also be expanded to other pediatric populations.”
Other researchers who contributed to the study are Lina Chalak, M.D., M.S.C.S., Chief of the Division of Neonatal-Perinatal Medicine and Professor of Pediatrics and Psychiatry at UTSW; Elizabeth Heyne, PA-C at UTSW and Children’s Health; and Roy Heyne, M.D., Adjunct Professor of Pediatrics at UTSW.
This study was funded by a grant from the Jerry M. Lewis, M.D. Mental Health Research Foundation.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 24 members of the National Academy of Sciences, 23 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 140,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5.1 million outpatient visits a year.
About Parkland Health
Parkland Health is one of the largest public hospital systems in the country. Premier services at the state-of-the-art Parkland Memorial Hospital include the Level I Rees-Jones Trauma Center, the only burn center in North Texas verified by the American Burn Association for adult and pediatric patients, and a Level III Neonatal Intensive Care Unit. The system also includes two on-campus outpatient clinics – the Ron J. Anderson, MD Clinic and the Moody Outpatient Center, as well as more than 30 community-based clinics and numerous outreach and education programs. By cultivating its diversity, inclusion, and health equity efforts, Parkland enriches the health and wellness of the communities it serves. For more information, visit parklandhealth.org.