Music Therapy in the NICU

The NICU is a scary place for parents. They watch their little ones sleep in little beds, swaddled with wires and cords, all hooked to machines that beep and blink. Then we (music therapists) come in to the, already terrifying, environment and suggest Neurodevelopmental Stimulation (previously known as multimodal stimulation).

You want to do what to my child?

Neurodevelopmental Stimulation is a technique used by NICU music therapists to help the infant tolerate and process different kinds of stimulation in their environment. This process helps the infant get ready to go home sooner by being able to remain calm in “over-stimulating” situations.

Neurodevelopmental Stimulation uses music in a slow, repetitive, lullaby format that doesn’t exceed a volume level of 60 decibels. The process begins with guitar followed by humming. Singing is then added, followed by massage. After the massage sequence is completed, rocking begins including the massage. Finally, the sequence is faded out once the 20 minutes is reached.

The massage progression follows the largest part of the body to the smallest part of the body and front to back (head, back, throat, arm, abdomen, leg, cheek, forehead, and nose to ear). The massage uses two to three fingers with a firm but gentle stroke. The infant needs to feel the massage but not enough to hurt or tickle them. As the massage begins, if signs of over-stimulation are observed, pause and give the infant time to calm and then restart.

Girls vs. Boys

A study found that males who received only singing and no guitar went home “15.7 days sooner than males who received guitar in addition to singing.” Furthermore, females in the experiment who received guitar in addition to singing went home “12 days sooner than females who were only sung to.” (Walworth, D., Standley, J., Robertson, A., Smith, A., Swedberg, O., & Peyton, J. (2012). Effects of neurodevelopmental stimulation on premature infants in neonatal intensive care: Randomized controlled trial. Journal of Neonatal Nursing, 18, 210-216.) From this study we learned that girls thrive with guitar while boys do not.

Here’s your sign

During this process observations are taken for over-stimulation and positive responses. Signs of over-stimulation are: halt hands, tongue protrusions, arched back, finger splays, red face, grimace, hiccups, and startle reflex. Positive responses are: smiling, head orientation, cooing, snuggling, and eye contact.

The entire process takes 20 minutes. Neurodevelopmental stimulation should only be implemented, at most, two times per day and never more than 20 minutes.

Personal Observations

I attended the NICU training institute at Tallahassee Memorial Hospital in Florida, in conjunction with Florida State University. Over the course of two days, I soaked up so much information plus received hands-on experience. Not only are the babies precious, but very intelligent. I was not expecting these little ones to be able to express “this is too much” or “oh, that’s nice, more!” through the use of their body language. It was exciting to use music therapy in a unique way to meet the needs of these NICU babies.