Dr. Jayne Standley explains how, why, and when to use music therapy in the neonatal intensive care unit (NICU) in her book Music Therapy with Premature Infants: Research and Developmental Interventions. But, my blog’s title question comes up often, and understandably so! Especially when the medical goal is to promote baby from the “survival/pacification phase” to the “HOME with family phase” as gently and smoothly as possible. So, the question stands: Does music in the NICU overstimulate infants? When music is used improperly, then the answer is a resounding yes. When a radio program or CD plays continuously for hours at a time over a loud speaker, or when musicians play in a NICU with neither NICU music therapy training, nor knowledge of sound level recommendations, then yes, music can be detrimental to the infants’ neurological development. Also, when an infant is in the survival phase, then he/she is not ready for a developmental treatment such as music therapy.

However, music therapy can be beneficial to an infant who is medically stable, during and beyond the cautious stimulation phase. When the medical team decides that baby is ready for developmental stimulation, the occupational therapists and music therapists cautiously provide sensory stimulation, and document observations of infant behaviors. If baby exhibits any signs of overstimulation, then treatment is paused or terminated, according to the research-based protocol. But when baby is tolerating stimuli, then music therapy is a great way for baby to gain practice self-regulating during multi-modal stimulation (MMS), a common NICU music therapy intervention. Deanna Hanson-Abromeit has shown how music therapy interventions produce similar results to NIDCAP (Newborn Individualized Developmental Care and Assessment Program), a widely used and accepted, research-based program for NICU environment and care delivery. Music therapists work together with the medical staff as part of the team. Check out the list of 35 hospitals that already use music therapy in the NICU. Here are some criteria we use when treating infants in a NICU with music therapy:

1. Minimum weight of approximately 3 lbs.
2. Clinical stability
3. Readiness for developmental stimulation

Additionally, referrals can be based upon any of the following infant needs:

1. Irritability, agitation, behavioral distress
2. Sedation, sleep, pain
3. Self regulation
4. Respiratory difficulties
5. Feeding, sucking, weight gain
6. Parent/family bonding
7. Lengthy hospitalization

A couple of weeks ago, I wrote an easy-to-read list of NICU music therapy research-based effects. Keep in mind that music is acoustically different than noise. Accumulation of sounds in the NICU consists of machine-generated and human-generated noise. Noise in the NICU is unpredictable, disorganized, unfamiliar, with an extremely wide range of frequencies. Music in the NICU provided by a music therapist who has specialized NICU MT training is predictable, familiar, organized, with form and a very narrow range of frequencies. This quality of sound elicits calm behaviors. NICU music therapists first assess the patient, devise a treatment plan, implement the treatment plan in conjunction with other therapies (e.g. physical, occupational, speech), document patient progress, evaluate, and modify the treatment plan to stay on target with patient goals. Also important to take note is that NICU music therapists use culturally-specific, familiar, live music for baby. (For example, if the baby comes from a Spanish-speaking family, the NICU music therapist will probably include Spanish lullabies in the treatment.) Research shows that infants respond preferentially to their native language.

More on the Academy of Pediatrics sound level recommendations, NICU sound level reporting, and modern NICU design is coming up in a blog post soon. Until then, whether you are a NICU music therapist, healthcare professional, or family member, please leave comments if you have any questions or feedback. I’d love to hear your thoughts!