Music Therapy in the NICU: Treating Our Littlest Patients

Music therapy can treat a large population of patients and that includes people who are a few weeks old to people who are over 100! To learn more about music therapy for infants, I interviewed Holly, one of our own music therapists at C.S. Mott Children’s Hospital.

Holly graduated from Eastern Michigan University in 2016 with a bachelors in music therapy. She completed her internship, became board certified, and worked in a community hospital for about 5 ½ years. Holly has a masters degree in child and adolescent developmental psychology and is certified in NICU music therapy through Florida State University. Recently she took a position at C.S. Mott Children’s Hospital and became the only music therapist in Michigan solely working in the Neonatal Intensive Care Unit, or NICU!

To work in a NICU as a music therapist most hospitals don’t require extra certifications, but it certainly helps to have them and has become the standard of practice in the field of music therapy. There are two certifications a music therapist can receive to become better equipped to work in the NICU and they are called “Rhythm, Breath, Lullaby” and “NICU MT” and Holly has the latter. Becoming certified in NICU MT involves a 3-part program that includes an 8 hour lecture, a 2-day on-site training process in which you work hands-on with patients, and then a take-home exam.

(Note: Some of these images do not take place in the NICU but are of infant patients.)

Holly has always been interested in medical music therapy and, unfortunately, her undergrad didn’t focus much at all on music therapy for neonates. Working in the NICU involves working with a very vulnerable population and it is important to know how to utilize music to help them heal in a safe way. Holly was able to work with neonates in her internship however and told me how she “fell in love” with that population. “It’s a dream to be only in the NICU now because there are not a lot of opportunities currently to just be a NICU music therapist.” She goes on the say, “I am fascinated by what music can do with these premature infants. They are brought into this world at such a vulnerable state and they do need to be part of the world before they are really ready and music is a good tool to gently bring in stimulation that we can control and we can watch in real time as they process it. If it’s too much we can pull back. If they can handle more, we can present more. It is controlled stimuli that can help them process the uncontrollable stimuli in their environment.” She continued to talk about how things like diaper changes, doors opening, sinks being turned on and off, and so on aren’t predictable or controlled but often happen in the NICU. These sources of stimuli may be hard for the baby to process but music can be purposely predictable and adjusted to help ease infants into processing what is around them.

What does music therapy in the NICU look like?

The music used in the NICU is simple. Singing on “ooh’s” or humming, simple lullabies and finger picking patterns. “We’re constantly looking for signs of positive stimulation or overstimulation”, Holly told me. “We also do something called Multi-modal Neurological Enhancement (MNE). You hold the baby and rock and introduce a little bit of stimuli at a time. First you’ll hum then sing on “ooh’s” then add words, all while you go through a 22-step touch progression. If it is too much for the baby you’ll go a few steps back and wait for the baby to regulate. Research has shown that this will help a baby learn to process their environment because of the controlled stimuli that is being introduced. Research has shown that babies are able to go home sooner if you introduce MNE to them.”

Many of the infants Holly treats are in the NICU because they were born prematurely. Holly always asks how old the baby is and that gives her an indication of how much stimuli to initially introduce. She also commonly sees infants who have Fetal Alcohol Syndrome or Neonatal Abstinence Syndrome, which means the babies mothers consumed alcohol or drugs during pregnancy and the babies are experiencing withdrawal symptoms. She also works with babies with genetic malformations. In addition to providing positive stimulation, some other music therapy goals in the NICU include improved breathing, improved feeding, weight gain, and decreased stress.

Neonatal music therapy isn’t just for the infants, however. “It’s important to have music therapy in the NICU not only for the patients but also for the families. Sometimes they can’t hold their baby because they aren’t old enough or stable enough to be held and a lot of families have told me that they feel that their child isn’t theirs but belongs to the hospital, which is an upsetting feeling.” However, music therapy can make space for these families to be able to connect with their baby. Holly has used interventions like lullaby-writing with families, writing affirmations, listening to them, and showing them a healthy way to be able to interact with their child. She can even teach families how to use MNE on their baby and be able to participate in their healing process.

Speaking on her favorite memories as a neonatal music therapist, Holly told me about how, as a student, the first music therapy session she participated in was in the NICU she now works at at C.S. Mott. She expressed how meaningful it is to her to have seen everything come full-circle. One of her favorite parts of working in the NICU is offering heartbeat recordings. Often, especially if the mother is also admitted into the hospital, the mother and baby cannot be together. However, through a heartbeat recording, the baby can hear their mother’s heartbeat and vice versa. Heartbeat recordings are recorded and Holly can play any song the patient prefers, using the heartbeat as the beat of the song. It becomes a special song that the family can keep for the rest of their lives. They can also record the mother’s voice and use it similarly. Sadly, sometimes the infants pass away during their NICU stay and these heartbeat recordings become a part of the patient that the families can always have. Finally, Holly told me that she enters people’s lives at their most vulnerable and is so grateful when they open their hearts to her and allow her to help them connect with their baby in their most difficult moments.