Pro Music Therapy

Premature Infants and Music Therapy: Soft and Slow Makes the Baby Grow

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The topic of music therapy with premature infants in social circles sometimes brings about the response, “Oh, how nice” as if it were a sweet entertainment idea. Among medical professionals, sometimes the response is “that’s completely inappropriate,” as if music therapists were unaware of the vulnerabilities of premature infants. That’s when I explain that NICU music therapy is an evidenced-based form of treatment specifically designed to improve the needs of premature infants.

Music therapy in the NICU uses evidenced-based interventions to meet the infant’s specific goals. Two such goal-oriented music therapy interventions used in the NICU include: Neurodevelopmental Stimulation and the Pacifier Activated Lullaby (PAL). Neurodevelopmental Stimulation (also known as multi-modal stimulation) is used to increase stimulation tolerance and to improve bonding between parent and infant. The Pacifier Activated Lullaby is used to improve feeding, improve the suck-swallow-breathe method, and increase oxygen saturation.

Neurodevelopmental stimulation involves an auditory stimulus (i.e., slow, soft, live singing) paired with a tactile massage progression, and, finally, vestibular stimulation (e.g., rocking). The music therapist teaches the parent how to perform the massage profession and to watch for any signs of overstimulation (e.g., grimace, red-face, stop-hand, finger splay, etc…). If any of these signs occur, the touch progression stops while the music continues. Once the infant achieves homeostasis, the touch progression resumes. Vestibular stimulation is added after the infant successfully completed the progression with the first two layers of stimulation.

The Pacifier Activated Lullaby is an FDA approved device which looks like a little plastic box placed in the crib above the infant’s head. Attached to the device is the infant’s personal cable, sensor, and pacifier. The threshold is set and the pacifier is placed in the infant’s mouth. The infant must suck at the set threshold level in order for soft, slow music to play from the device. The music plays for 10 seconds, and then stops. He or she quickly learns that in order for music to play, sucking must continue. The threshold is then set higher in order for the infant to suck at a stronger level and receive the contingent music reinforcement.

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While modifications can be made to meet the specific needs of each baby, the above paragraphs describe the general protocol. Research studies for the past 20 years have already been describing specific evidence for the use of neurodevelopmental stimulation and the PAL in NICU. Here is a list of research studies (nowhere near exhaustive) that explain in greater detail the significant results for these interventions in the NICU:

  • Standley, J. M., (2012). Music therapy research in the NICU: an updated meta-analysis. Neonatal Network, 31(5), 311-315.
  • Standley, J.M. (2011). NICU music therapy: Post hoc analysis of an early intervention clinical program. The Arts is Psychotherapy, 38, 36-40.
  • Standley, J. M., Cassidy, J., Grant, R., Cevasco, A., Szuch, C., Nguyen, J., et al., (2010). The effect of music reinforcement for non-nutritive sucking on nipple feeding of premature infants. Continuing Nursing Education, 36(3), 138-146.
  • Walworth, D., Standley, J. M., Robertson, A., Smith, A., Swedberg, O., Jarred Peyton, J. (2012). Effects of neurodevelopmental stimulation on premature infants in neonatal intensive care: Randomized controlled trial. Journal of Neonatal Nursing, 18, 210-216.

If you’re interested in a book, I recommend: Music Therapy with Premature Infants by Dr. Jayne M. Standley.