Music Therapy in the NICU

 One of the many fields in which music therapy serves is within the Neonatal Intensive Care Unit. This population is comprised of infants that were born prematurely, with injury, illness, or complications resulting in developmental delays. As you can imagine, the individuals being cared for in the NICU are vulnerable and treatment is incredibly delicate. In addition to the children being cared for, music therapists also dedicate attention to the emotional well-being of the parents and families. Music therapists work to improve the sensory and physiological development of the patients, as well as strengthening the bond between the parent and child for the duration of treatment. Research for NICU music therapy supports that music therapy is effective in promoting the development of NICU infants and decreasing length of stay in the hospitals.

Sensory Development

Sensory development is one of the many goal areas that music therapists can target. When an infant is born prematurely, most of the senses are not yet equipped to take in the world around us in a comfortable way. The music is often used to either stimulate or pacify. Music to stimulate promotes developmental skills such as awareness and auditory/visual tracking.  Pairing music with other forms of sensory input such as tactile stimulation (i.e. stroking and light massage) can decrease the total number of hospital days and increase the weight gain for infants receiving treatment.

In order to provide levels of music that are appropriate for sensitive infant ears, music therapists will only pick guitars in the key of A at 55 decibels or the key of C at 65 decibels. Other forms of presenting the music stimuli include recorded music, special headphones, and tools like the PAL (pacifier activated lullaby). These tools are also appropriate because of the volume control abilities. 

Physiological Development 

One of the most critical health issues to address in premature infants are respiratory and oxygen saturation levels, which are directly impacted by behavior and amount of pain. The regular rhythm of prolonged music stimuli help to pacify or calm the infant and regulate the respiration. This leads to improved oxygen saturation levels as well. The music in this instance also helps reduce the disturbance of other abrupt or loud noises that might arise in a hospital setting and startle the infant, leading to disturbance in respiratory rates. 

Another developmental benefit that music therapy can provide in the NICU is non-nutritive sucking or NNS. This behavior involves the suck-swallow-breathe response that is necessary for nursing. While most infants in the NICU are fed intravenously, it is important that this behavior is reinforced. Music therapists developed the Pacifier-Activated-Lullaby that reinforces the proper NNS behavior with soothing music. This tool is now widely used and is supported by research to be incredibly effective. 

Parents Are Patients Too

While devoting services to infants in the NICU, music therapists never dismiss the emotional well-being of the parents. Having a child in the NICU can be an overwhelming and emotional experience, with the early days of the parent-child relationship being spent in an intensive care unit of a hospital. Music therapy offers interventions that promote the bond between the parents and child to enhance the connection through difficult circumstances. Research has shown that parents that are taught how to use the music and multimodal procedure increased their visitation time in the NICU and felt empowered to enhance their child’s development. There were also fewer infant stress behaviors and significantly more appropriate parent interactions. 

Another way to enhance the connection between child and parent is a recording of a lullaby. The music therapist would facilitate the parent in singing and recording a lullaby that is played for the infant when the parents are not around. This allows the parents to have time to take care of their own needs but not lose an opportunity to connect with their new little one. 

Another way that music therapy can address the emotional well-being of the parent would be providing musical interventions with the parent that target their own goal areas. This might include lyric analysis to process emotions, songwriting activities, or other opportunities to record. This time though, the recording is of the infant for the parent to listen to. The music therapist can record the infant’s heartbeat and provide a musical accompaniment on an instrument or with lyrics written by the parent. These recordings are given to the parent to have a tangible connection when they are away from the child. 

Final Notes and Credits

Large amounts of music therapy research have been conducted over the past 30 years, and music therapists are required to have a specialized NICU certification to work with this population. Many professional music therapists dedicate their careers to NICU research, treatment, and early childhood development. This article contains information from the text Music Therapy with Premature Infants: Research and Developmental Interventions, written by music therapists Dr. Jayne M Standley and Dr. Darcy Walworth. Dr. Standley served as the Director of the National Institute for Infant and Child Medical Music Therapy and was involved in the development of the PAL. Both Dr. Standley and Dr Walworth taught as professors at Florida State University in the music therapy program. Kathryn Wright, MT-BC obtained the NICU certification, and both she and I have a soft spot in our hearts for NICU music therapy and the overwhelming impact it has on the infants and families. 

-Rylee Carfer and Kathryn Wright