My NICU training experience

There is an abundance of published research about the field of neonatal intensive care (NICU) music therapy. Multiple articles have been reviewed right here, on the COMT blog. In May, I attended the clinical fieldwork portion of the National Institute for Infant & Child Medical Music Therapy at Norton Women’s and Children’s Hospital in Louisville, Kentucky. Over the course of two days, I got hands-on experience implementing music therapy interventions on the most fragile humans, premature infants or infants born with Neonatal Abstinence Syndrome (when a baby is withdrawing from drug exposure in the womb). Months before these clinical hours in the hospital, I attended the lecture portion of the Institute, in Dallas, Texas, hearing from clinicians who have been working in this population for decades, including Jayne Standley, distinguished researcher and creator of the PAL (Pacifier Activated Lullaby) system, Darcy Walworth, author and creator of the Bright Start Music program and Michael Detmer, NICU researcher and adjunct faculty professor at the University of Louisville. 

Over the course of the two day institute, I participated in multiple music therapy sessions focused around two music interventions: 1.) utilizing the Pacifier Activated Lullaby machine to stimulation proper breath/suck/swallow rhythm for feeding, and 2.) Multimodal Neurological Enhancement, using touch, sound and vestibular stimulation for neurological development. 

In our first visit of the day, as one of my colleagues played the guitar at a low volume and slow tempo, I first hummed, then sang a familiar children’s lullaby (Mary Had a Little Lamb) while holding a small, beautiful pre-term infant girl. As the infant displayed signs of positive stimulation (cooing, eye contact and nuzzling), I applied gentle pressure in a choreographed order from her head and around her body to increase tactile stimulation. If at any point, baby girl showed signs of overstimulation (crying out, grimacing, displaying a ‘halt-hand’ finger splay) the stimulation was stopped until baby calmed. This intervention is implemented to increase stimulation and neurological development with the end goal of infant being discharged from the NICU sooner. This application of gentle touch, rocking and singing is taught to parents/guardians and encouraged as bonding time as well as a neurological process for baby. 

The second intervention implementation I participated in utilized the Pacifier Activated Lullaby device to increase feeding success for infant suckling. More information on the PAL device can be found here.  The device plays music when a baby sucks correctly on the attached pacifier, using the brain’s reward system to encourage and reinforce non-nutritive sucking which not only soothes an infant (like any pacifier does) but aides the infant in feeding by mouth, another goal a baby must achieve before NICU discharge. 

I was able to observe and participate in multiple sessions throughout my time at the institute, while also learning of other ways music therapists are used in the NICU setting, including using music to calm babies with Neonatal Abstinence Syndrome, recording mother’s voice in lullabies to play at bedside when parents can’t be in the hospital 24/7, lullaby songwriting, and bereavement and grief work when an infant passes. 

To earn the NICU-MT designation, and have your name on the registry, a music therapist must attend this institute (a lecture and clinical portion), complete outside reading and pass an exam. The field of music therapy in children’s hospitals is growing with over 50% of hospitals having MT-BC’s on staff. With an emphasis on current research and evidence-based practice, I have no doubt that music therapists will be vital parts of the interdisciplinary team in all NICU settings in years to come. 

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Kristen Lynn Pugh, MT-BC

Central Ohio Music Therapy, LLC