Kelsey Allen

IR1 pd. 3 English 10 GT

February 28, 2020

The power of music intervention for preterm infants

A parent’s hope for their child is that they live a healthy and fulfilling life, though some

infants are born premature. According to the Center for Disease and Control Prevention, one in

every ten infants are born before 37 weeks of pregnancy, also known as premature. The effects

of premature birth are detrimental to the health and wellbeing of a child, causing stress to a

parent as well (Ghetti 2), Though, an infant’s time in the womb introduces them to sounds that

can be replicated in order to prepare a comfortable environment after birth. ​Alongside

traditional treatment, music intervention for premature infants improves the stability of

their heart rate, respiratory rate, and caloric intake to improve their quality of life as a

newborn.

When an infant is in the womb, it hears its mother’s heartbeat frequently and consistently

throughout the entirety of the pregnancy. The placenta, a nutrient filled liquid in the mother’s

womb, also creates a sound that an infant can recognize that can provide comfort and relaxation

after birth. (Loewy 24). Familiarity regarding sound is an influential aspect to an infant’s early

life, as they can recognize the beat and sound created by the heartbeat and placenta, defined by

music in nature. Music in nature is the concept that naturally occurring sounds in nature create

music and the brain can recognize this. A simpler example would be singing birds, that would be

a sound classified as music and not just noise. This applies to the sounds made in the mother’s
womb as well (Uzunoglu 3). According to a study of infant brain activity conducted by Michael

Balter, there was “a peak that arose about 750 milliseconds after the stimulus decreased in

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intensity if the baby was repeatedly exposed, or habituated, to the same number...But if the last

in the series of numbers was changed...the peak shot back up to its prehabituation level”. The

heartbeat has a consistent beat that only tends to fluctuate during differing amounts of activity.

An infant can follow the beat and sense the changes when there are different tempos and paces.

In a study by Stanislas Dehaene, he found that there was a “jump” in the infant’s brain whenever

the number of beats changed in a provided audio. Consistency is the key to making this type of

beat familiar to a child after birth. At a conference, Dehaene and others interpret[ed] [the] results

as further support for the idea that humans possess an intrinsic number sense long before they

can speak or perform calculations” (Balter 11). Evidence also shows that because music has a

consistent beat, for example, four beats versus three beats, an infant can sense the changes from

four to three, that they were able to recognize the pattern in the first place. This ultimately

provides insight into how infants perceive music so that music intervention can be implemented

into treatment knowing that they do recognize what music is. Otherwise, there would be no point

to having a child listen to music when they can’t differentiate noise to music, though it is proven

that the human brain can, in fact, do that.

Infants are familiar with many sounds once they are born, and to compensate for the lack

of these sounds outside of the womb, music therapists have created ways to recreate them. One

of the ways to recreate this is through = ​“the Remo ocean disc, [which] is a musical instrument

that is round and is filled with tiny metal balls. When the disc is rotated, the metal balls move
slowly to create a sound effect that is contained and quiet and meant to simulate the fluid sounds

of the womb” (Loewy 21). ​This instrument is designed to simulate the fluid sounds of placenta in

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the womb, something that an infant is most familiar with. The familiarity aspect allows the child

to make connections to what is comforting to them, as birth is considered a trauma and can make

an infant uneasy. Outside of the womb, an infant is exposed to a hospital environment that is full

of people, from the nurses and doctors to other infants and visitors. Making a child more

comfortable in this environment will allow for easier treatment and recovery time so that the

child doesn’t have to depend on ventilators and tubes to stay alive.

Another instrument used to comfort a premature infant is ​“The gato box,...a small

rectangular tuned musical instrument that is used to provide an entrained rhythm in soft timbre

meant to simulate a heartbeat sound that the neonate would hear in the womb” (Loewy 22). ​The

heartbeat is consistent and makes a natural beat that is easily replicated outside of the womb

using the gato box. This instrument is just another way to connect familiarity to the infant. As

discussed earlier, the heartbeat is a consistent sound heard in the womb of a mother; infants

spend nine months listening to this heartbeat every day. The familiarity aspect of a child’s brain

is important to adapting to an unknown environment, therefore making the replication of the

heartbeat crucial.

Any living person cannot live without a steady heart rate. ​An inconsistent heart rate

will cause immense stress on the premature infant’s body, causing them to physically

overwork themselves just to survive. Use of music intervention to calm an infant has

proven effects of slowing and keeping a consistent heart rate.

 One of the biggest problems found in premature infants is the inconsistency of their heart

rate; the heart is a vital organ in any person’s body and the extra stress alongside all other

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problems only adds to their debilitating condition (Edgren 9). The gato box is an instrument that

simulates the sound of the heartbeat, as heard in the mother’s womb during pregnancy. This

instrument can allow for a comfortable and nurturing sound to improve the consistency.

The familiarity aspect of hearing the heartbeat in the womb and hearing it again after

birth allows for a comfortable environment for the child to get used to in such an uncomfortable,

loud space as the NICU, according to Charlie Storck, a NICU nurse at Holy Cross Hospital.

Storck explains that the NICU can get “hectic” and “out of control” at times if there is an

emergency. The NICU is a bay where all infants preside in a hospital, though there are very few

private rooms if a parent would wish to utilize that option, if available. Typically, an infant will

be kept in a bay where the sounds of crying children, nurses, and over stimulus can continue to

stress an infant after birth. Being able to listen to comforting sounds in a stressful environment

with the gato box with allow for a nurturing and familiar setting in the NICU.

The gato box is an instrument used to replicate the sound of the heartbeat. Evidence of

this instrument improving an infant’s heart rate is clear in Joanne Loewy’s study where she

states, ​“Lower HRs were recorded ​during​ the intervention only for lullaby and gato box,” “HR”

representing heart rate. ​There is data showing that the use of the gato box has a significant effect

on an improved infant heart rate during active use of the instrument. The use of this instrument

can provide optimal benefits for a premature infant’s heart rate. If the infant can maintain a
steady heart rate, their body won’t have to work as hard to keep everything functioning which

will overall improve the health of the child at their hospital stay.

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The heart rate of a premature infant is typically unstable, for their bodies were not

prepared for a sudden birth. The stress on the body impacts the heart and makes it work harder in

order to keep functioning. As a vital organ, it is crucial that the heart rate stays consistent. With

the gato box, this type of music intervention can improve the consistency so the child can have

an overall stronger foundation for other bodily functions.

Due to the severity of a premature infant’s condition, a child’s ability to breathe on their

own is hindered greatly. Respiratory distress syndrome is the most common problem that occurs

among premature infants.​ ​This problem makes it necessary for children to be kept in an incubator

with consistent oxygen flowing in a jet ventilator, according to Charlie Storck. ​The use of music

intervention to calm a child can improve the consistency of their respiratory rate and

independence from the NICU support systems.

The ocean disc is an instrument tested by Joanne Loewy and “​There appeared to be a

trend for RR for the ocean disc with higher RRs ​during​ intervention and ​after​ intervention”

(Loewy 36), “RR” referring to respiratory rate. ​The ocean disc was found to improve the

respiratory rates of the infants after the use of the instrument more than any other instrument or

music type. While the gato box improved the respiratory rate as well, the ocean disc had a more

significant impact. This could imply that the use of both instruments at the same would provide
optimal benefits. To replicate the sounds of the placenta is to access a familiar sound for an

infant to listen to, making the ocean disc an effective method of intervention.

When infants are born premature, their conditions, such as respiratory distress syndrome,

can cause long term effects that give them disabilities, which inhibit their ability to develop

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neurologically (Edgren 5). This can cause an infant to struggle in their early life, as they will be

behind all other infants and cannot learn as quickly and efficiently as others. The early stages of

life are crucial to learning; foundational skills are developed and will mark a starting point for

growth in a child’s brain and cognitive skills.

Along with learning disabilities, the stress of dealing with their health at such a young

age can cause even more stress on the body itself as they deal with it for, potentially, the rest of

their life (Shoemark 2). It is in the best interest of the patient to try and prevent such stressors on

the body. Both the infant and its parents benefit from a healthy life that was improved early on

with music intervention, stress and anxiety are alleviated from that aspect of their life for the

further years to come.

The stress on a premature infant’s body is immense, and the ability to breathe

independently is crucial to healthy bodily functions. Improving the quality of life for a child

early on is key to building the foundational skills that follow them for the rest of their life.

Premature infants are stuck to ventilators in the NICU environment and are forced to be

dependent. The faster they can get off of the ventilator, the better their outcome for independence

will be.
 Nutrition is essential to providing energy to any person. According to Charlie Storck,

infants struggle with many basic activities, one of the most important being feeding.​ ​The oral

feeding rates of premature infants are, on average, extremely low and they must be force fed to

make sure they are getting the necessary amount of nutrients to remain in a healthy condition.

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The use of music intervention to train an infant to respond to positive stimulus can benefit

their healthy eating habits.

A common image when thinking about infants is using a pacifier to comfort them. The

Pacifier Activated Lullaby (PAL) is a device used in the NICU to teach infants how to use a

pacifier, which ultimately gets them used to the feeling of feeding from their mother. This device

works by playing a lullaby or recorded audio of the child’s parent/guardian singing a lullaby to

reward the infant whenever they use the pacifier correctly (UCLA Health). The sound of the

parent’s voice is preferred when using this device because the child gets to learn the sound of

their parent while constantly being surrounded by other professionals and infants in the NICU

(UCLA Health). This device has been tested several times and is actively being implemented

into the NICU environment due to its popularity and quality (​Bieleninik 16).

The concept of familiarity comes into play here because the infant must become familiar

with the parent voice in order to become more comfortable and ultimately less stressed

(Uzunoglu 7). By learning to respond to their parent’s voice, an infant can learn to recognize and

be comforted by their parent even if they are not always around. The span of time spent in the

NICU is long and stressful for an infant. While every parent would want to be with their child
every step of the way, this is not always possible due to the busy lives and schedules of the adult.

The recording of the parent voice with the PAL is an efficient way to keep the parent involved in

the healing and maturing process of the child without needing their constant presence.

Being rewarded by the sound of their parent’s voice teaches the infant about how to

respond regarding a certain situation and can learn what it means to do something right versus

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wrong. Emotion regulation is​ “interactive, goal-dependent explicit, and implicit processes that

are intended to help an individual manage and shift an emotional experience”​ (O’Kelly 1). The

reward system of the PAL stimulates emotion regulation, for it teaches the infant how to eat

based on a positive and comforting response from the music. This skill is key to every single

person’s social life and relationships and it follows them throughout a lifetime.

Many infants struggle to learn how to eat when they are first born, though this becomes

an even bigger problem for premature infants. Their bodies are so frail and delicate that nutrition

and getting energy is key to their growth and weight gain over time. The PAL is an excellent tool

for infants as they get to learn how to eat with a reward system. As well as learning to eat, infants

also get to learn how to respond to their parent’s voices and positive stimulus overall to develop

their emotion regulation. Both of these skills are crucial to physical and neurological

development that will improve the child’s lifestyle for many years to come.

Premature infants are born before the necessary time it takes for an infant to fully

develop. Many will struggle in sustaining and regulating their own body and health at such an

early stage of life. Though, the medical community has been exploring the depths of music
intervention and therapy to improve stress in patients. For infants, music is an excellent way to

destress an infant because of music in nature.

The sounds of the mother’s womb is considered music and recognizable in the brain of an

infant. Replicating these sounds has been proven to provide beneficial effects to premature

infants due to the familiar sounds acting as a comfort tool amongst louder sounds and other

voices in a hospital environment. Even at such a young age, infants can sense the changes in

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beats and numbers in order to focus on how a song changes and produces patterns out of those

changes (Cirelli 1). Being able to recognize patterns lets the infant become familiar with the

music which also adds a sense of comfort to a continuously stressful environment. Parents of

premature infants should know that there is an option for them to benefit the quality of life for

their child; they don’t have to be as anxious for their child or feel like a failure (Priesnitz 13).

Music intervention has proven benefits of an infant’s heart rate, respiratory rate, and caloric

intake which can ultimately improve the health of a child struggling to live solely on a ventilator

in a hospital.
 Works Cited
Balter, Michael. “What Makes the Mind Dance and Count.” ​Gale in Context​, 1 June 2001,
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Bieleninik, Łucja, et al. “Music Therapy for Preterm Infants and Their Parents: A
Meta-Analysis.” ​Pediatrics​, vol. 138, no. 3, Sept. 2016, doi:​10.1542/peds.2016-0971​.

Cirelli, Laura K., et al. “Measuring Neural Entrainment to Beat and Meter inInfants:
Effects ofMusic Background.” ​Frontiers in Neuroscience,​ vol. 10,2016,
doi:​10.3389/fnins.2016.00229​.

Edgren, Altha Roberts, and Rebecca J. Frey. "Prematurity." ​The Gale Encyclopedia of
Medicine​, edited by Jacqueline L. Longe, 5th ed., Gale, 2015. ​Gale In Context:
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​ ongitudinal Study of music Therapy’s

Ghetti C, Bieleninik Ł, Hysing M​, et alL
Effectiveness for Premature infants and their caregivers (LongSTEP): protocol for an
international randomised trial​BMJ Open ​2019;​9:​e025062. doi:
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Loewy, Joanne, et al. “The Effects of Music Therapy on Vital Signs, Feeding, and Sleep
in Premature Infants.” ​Pediatrics,​ vol. 131, no. 5, May 2013, pp. 902–18,
doi:​10.1542/peds.2012-1367​.

Music Therapy Study on the NICU | UCLA Mattel Children’s Hospital - YouTube.​
https://www.youtube.com/watch?v=9N5vz5Fx6bA​. Accessed 20 Oct. 2019.

O’Kelly, Julian. “Frontiers | Theory-Guided Therapeutic Function of Music to Facilitate

Emotion Regulation Development in Preschool-Aged Children | Human
Neuroscience.” ​Frontiers in Human Neuroscience,​ 14 Oct. 2015,
https://www.frontiersin.org/articles/10.3389/fnhum.2015.00572/full​.

Priesnitz, Wendy. "Music is Medicine for Body and Soul."​ Natural Life Magazine,​ May
2006​. sirsissuesresearcher,​
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Shoemark, Helen, et al. “Constructing Optimal Experience for the Hospitalized Newborn
through Neuro-Based Music Therapy.” ​Frontiers in Human Neuroscience,​ vol. 9,
2015,doi:​10.3389/fnhum.2015.00487​.

Storck, Charlie. ​Personal Interview.​ 17 Dec. 2019.

Uzunoglu, Selim. "Music for Healing and Brain Development." Fountain, July,
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