We do agree with what the authors mean that parental presence and visitation are distinctly different. Parental presence is critical for the medical and psychological well-being of pediatric and neonatal patients. In rereading our article, we do recognize that we used the term "visitor" more than we intended and can understand why that was concerning to readers. Because of the unique distinction between visitors and parents, when the de-escalation algorithm was expanded to other units in the hospital, there was a distinctive algorithm made for visitors that validates our belief in the difference and importance of parental presence. We do, however, feel like a de-escalation strategy for parents remains a priority in units such as ours to ensure the safety of our staff. While parents are critical to the care of infants, it is not acceptable for anyone to verbally abuse, berate, or threaten staff. It is key for nursing leaders to support a therapeutic environment for patients, parents, and staff.

-Ann Schwoebel, MSN, RNC-NIC

Clinical Nurse Education Specialist

Intensive Care Nursery

-Elizabeth Quigley, MSN, RNC-OB

Nurse Manager

Intensive Care Nursery

Pennsylvania Hospital

Philadelphia, Pennsylvania