Healing with Harmony: Music Therapy in the NICU – PediaCast 590

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Show Notes

Description

Kalin Moran, Lelia Emery, and Chloe Heintz visit the studio as we explore the role of music therapy in the Neonatal Intensive Care Unit. Discover how music is making a big difference for little patients. We hope you can join us!

Topic

Music Therapy in the Neonatal Intensive Care Unit

Guests

Kalin Moran
Music Therapist
Nationwide Children’s Hospital

Lelia Emery
Music Therapist
Nationwide Children’s Hospital

Chloe Heintz
Music Therapist
Nationwide Children’s Hospital

Links

Music Therapy at Nationwide Children’s Hospital
Giggle ’n Groove Upcoming Events
NICU Music Therapy Institute
Music Therapy Helps Kids Heal and Learn
Virtual Music Therapy with Lelia (YouTube)
Music for Kiddos (YouTube Channel)
Certification Board for Music Therapists

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by the Music Therapy Program at Nationwide Children's Hospital. 

[Music]

[Dr Mike Patrick]
Hello everyone. And welcome once again to PediaCast.

We are a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.

It's episode 590. We're calling this one Healing with Harmony: Music Therapy in the NICU. I want to welcome all of you to the program.

So, music is powerful. It can calm, soothe, and even heal. And for premature and other newborns in the neonatal intensive care unit, music therapy is making a difference in surprising and meaningful ways.

Today, we're going to explore how board-certified music therapists support babies and families in the NICU from easing pain during procedures to strengthening bonds through live music recordings and developmental programs. We'll also share how families can use music at home to comfort and support their children and also to support their own lives and their own mental health. So, we're going to talk about all of these things from the NICU to the home and beyond.

Of course, in our usual PediaCast fashion, we have a terrific panel of guests joining us in the studio to discuss the topic. Kalin Moran, Lelia Emery, and Chloe Heintz are all music therapists at Nationwide Children's Hospital. They'll join us soon.

So, stick around as we uncover the healing role of music therapy in the neonatal intensive care unit. Before we dive in, I do want to remind you the information presented in every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.

If you're concerned about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org. So, let's take a quick break.

We'll get our experts settled into the studio, and then we will be back to talk about music therapy in the neonatal intensive care unit. It's coming up right after this. 

[Music]

[Dr Mike Patrick]
Kalin Moran, Lelia Emery, and Chloe Heintz are all board certified and licensed professional music therapists at Nationwide Children's Hospital.

They have a passion for supporting premature babies and other infants along with their families in the neonatal intensive care unit at Nationwide Children's. So, what exactly is music therapy and how does it support infants and families? And is music therapy something parents can do at home?

We'll have answer to all of these questions and more but first let's pause and offer a warm PediaCast welcome to our guests. Kalin Moran, Lelia Emery, and Chloe Heintz. Thank you all for stopping by the studio today.

[Kalin Moran]
Thank you so much for having us. 

[Lelia Emery]
Yeah, we're happy to be here. 

[Chloe Heintz]
Excited to be on.

[Dr Mike Patrick]
Yeah, I'm really excited to talk about music therapy as well. Kalin, let's start with you. What exactly is music therapy and how is it different than simply listening to music?

[Kalin Moran]
It's a great question. So, there's a formal definition by the American Music Therapy Association that states music therapy is the clinical and evidence-based use of music intervention to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program. I know that's very wordy.

So, a shortened version is music therapy is the use of music to accomplish non-musical goals.

[Dr Mike Patrick]
Yeah. And then how, how did this get started? How did we discover that that music can be therapeutic and that there are best practices for, for using it?

[Kalin Moran]
The concept of music being used therapeutically dates back all the way to like the writings of Aristotle and Plato. But music therapy as a profession really began in the 20th century after World War I and World War II. There were community musicians who would go in and play at veterans' hospitals and there were notable physical and emotional responses, which then led nurses and doctors to request hiring musicians by the hospitals.

And then the demand grew for a college curriculum and just became evident further that training was needed prior to these musicians entering the facility.

[Dr Mike Patrick]
Yeah, really interesting. And it sure makes sense. Lelia, how does one then become a music therapist?

And I'll ask you personally, like how did you get interested in this field? And then what does someone have to do if they are also interested in pursuing this?

[Lelia Emery]
Sure. I'll start with the how did I get interested in music therapy part. I actually had cancer as a child.

And so, I grew up with a lot of friends also going through cancer treatment and really learned about music therapy through them and how it supported them in the hospital or through grief counseling after the fact. And I'd always loved music. And that's kind of where I was able to align my two passions.

So that was really awesome. As far as training to become a music therapist. So, like Kaylin mentioned, there is a college curriculum.

We have a bachelor's degree in music therapy at the minimum. And what that entails is four, four and a half years of undergraduate study, taking classes from everything from psychology to music specific courses. So, music theory, we have like a primary instrument that we study, but also music therapy specific courses on different ways to use music therapeutically with different types of people in different areas.

It also involves hands-on practicum placements. So actually, doing music therapy under direct supervision. The last step of training is a six-month full-time internship.

We are actually an internship site here at Children's and we have two interns who just started at the beginning of September, which is pretty exciting. And then after you complete all your training, you have to sit for a board exam. So, students who are interested in pursuing that should really just Google music therapy programs.

Our music therapy association, AMTA at musictherapy.org has a list of all the approved training sites in the country.

[Dr Mike Patrick]
Yeah, that is, that is really, really fascinating. The NICU in particular is certainly a specialized environment. Is there a particular training that you need to work in the NICU or is it just sort of on-the-job training?

How did you get placed there?

[Lelia Emery]
Yeah, so there is definitely additional training to work in a NICU. I was lucky enough that I got to receive this training as part of my undergraduate curriculum. My, one of my professors was a fellow in the Institute.

So, she trained people. I'm actually now a fellow in the Institute as well. So, I get to provide hands-on training, but to get your NICU specific training, it involves lecture, reading, hands-on training with a fellow, and then an additional exam after that to make sure that you are competent and being able to support this very fragile population.

[Dr Mike Patrick]
Yeah. Yeah. Chloe, you know, premature babies undergo a lot of stressful procedures and someone who has not spent much time in a NICU may not be aware of that, but there are a lot of stressful things going on.

It tends to be, even though we try to keep it quiet, it still tends to be sort of a stimulating, noisy environment because there's so many other babies in close proximity. There's always something going on. And sometimes that does involve painful procedures as well, like putting in IVs and doing a spinal tap or what we call lumbar puncture, you know, they may need to be on a ventilator, just lots of stuff going on.

Is music therapy something that you use to reduce that kind of stress or is it more for the parents there in the room?

[Chloe Heintz]
Yeah, music therapy can definitely be used to support infant stress as well as support parents that are in the room. So, like you said, our babies in the NICU, they undergo many stressful procedures, whether it is like IV placements, lab draws, or even just changing their diaper can be really stressful for some of our babies. So, we use music to help meet babies where they are, typically using singing.

Sometimes if they're older, we might throw in an instrument. If families are there, we encourage them to sing to their baby as well. And we change the music based on infant response to kind of support them going from maybe an overstimulated, agitated state to a calm state.

So yeah, we support many procedures and help reduce infant stress that way. And also not only for the infants and parents, but our medical team has also reported that they find music therapy in the room to be helpful for them when typically if they have to do this procedure and the baby's crying, like they just have to do their job, but having that added support can be helpful to them as well.

[Dr Mike Patrick]
Yeah, so really everybody benefits, right? And I'm sure you benefit as well because it's something that you're passionate about and that you love doing. And I'm sure when you get that response, especially from the baby, you know, when they start to calm down and you can tell that they're listening, that must be really, really rewarding work.

[Chloe Heintz]
Oh yeah, it definitely is. When you see that immediate response, it's pretty cool.

[Dr Mike Patrick]
Yeah. Is there ongoing research in this field? You know, we're always trying to find the best way to do things, and you know, is there a better way, something more efficient?

Is there research happening in music therapy and particularly in healthcare settings and in NICUs?

[Chloe Heintz]
Yeah, there is just a wide array of research in pediatrics and healthcare and music therapy, also in the adult world. That could be a whole other podcast. And then in the NICU in particular, there is lots of research going on as well.

We've actually done quite a few studies here and we just did over the past year or two, I don't know, we did a study looking at music therapy during a painful procedure. So, during circumcision actually in particular, and there's always more research that needs to be done. There's actually not a whole lot of research in procedural support in the NICU specifically, but that is starting to change.

And so, yeah, we're always trying to find what's the right type of music therapy, dosage, timing and stuff so that we're doing best practice in the NICU.

[Dr Mike Patrick]
Yeah, yeah. Because just like anything, and I love that you said dosage and timing. Because, you know, everything that we do, every intervention has, you know, benefits, but then may also have things that aren't so great.

And I can imagine that if you have a baby who's already overstimulated, like you might find that right music and maybe they just want quiet. And so, you just have to sort of judge, you know, what is working in the moment. And that's going to be a lot different from one baby to another.

There's no one size fits all, I would imagine.

[Chloe Heintz]
Yeah, you got that exactly right. So, yeah.

[Dr Mike Patrick]
And then how do you involve families in all of this? I imagine that it's not something that a lot of people have been exposed to and certainly you don't see it, you know, when you see medical shows on TV, for example, you know, the things that the public typically has experience in, in terms of healthcare settings. So, I imagine there's a lot of interest and folks, you know, would want to get involved as best they can and maybe even understand how they can do the same sort of thing home to continue that once they're discharged.

So how do you get families involved?

[Kalin Moran]
Incorporating the family into our care is really an important aspect of our work. So, we acknowledge that for families being in the NICU is a really stressful time. And we know that babies respond really well to caregiver voices.

That's what's familiar to them. And so, we do encourage and educate parents on the proper uses. Music, encourage them to, to sing or if they're not comfortable singing, like talk to their baby, it really is so helpful for not only comfort, but language development.

And so, we provide that education and support and encourage them that, you know, to them, they sound like Beyonce to their baby, and they don't have to be a professional singer to, to use their voice and to, to sing to them and comfort them. And so, we also provide family support and opportunities for family bonding by playing songs that are important to the family. So, using that preferred music genre of the family, and we can also do songwriting as well.

So, helping families to create a lullaby for their baby, that's unique and special to them. It's a really special opportunity that we can take part in with our families on the NICU.

[Dr Mike Patrick]
Yeah, yeah, absolutely. Chloe. So, this is of course, live music that we're talking about with recorded music.

Is that something that can be as beneficial? You know, there may be facilities that don't have access to music therapists. Is that something that folks could just listen to music or is the live aspect of it really important?

[Chloe Heintz]
Yeah, that's a great question. And that's something that a lot of healthcare professionals are really interested in is how can we be using recorded music in a helpful way in the NICU. We as music therapists obviously love our live music.

We think that's really important, especially in the NICU setting where our infants are fragile and we really have to be reading into their cues, and we can change what we're doing live in the moment. Whereas when you play a recording, you hit play and then that's that. You can't, all you can do is stop it if an infant has maybe an adverse reaction to that.

But that being said, we do encourage parent recordings through our program here. We have a program called Sounds of Love, which maybe I'm getting ahead of myself, but parent voice at the bedside is super important. Like Kaylin was saying, we really want our families to stay connected with their infant, even when they can't be at the bedside 24-7.

And that parent voice is so important for our babies to hear that we coach parents through how they can be using their voice through a recording. We also have instructions for bedside nurses and anyone who might be playing these recordings for when to play them, when maybe it's not a great time to play them and allowing for breaks in between.

[Dr Mike Patrick]
Yeah. And I would imagine as a music therapist in the healthcare setting; you're really just focused on the music and its impact on the child and the family. Whereas if you put a recording on as a nurse and you've got, you know, three patients all together and you're running from one place to another and alarms are going off and people are asking you questions, if the music is irritating to the baby, you may not notice that right away.

And so at least with the live person doing the music right there, you know, you're really focused in on the patient and the family and seeing that reaction and making instantaneous changes, you know, when something's not working, you know, in order to maybe try something out that's different and you can do that on the fly. So that's really a cool service. Tell me a little bit more about the Sounds of Love again.

[Chloe Heintz]
Yeah. So, it's our parent recording program. So, like Kalin said, we try to get our families as involved as possible in multiple ways.

But as music therapists, we want to encourage their use of their voice at the bedside, whether that is singing, which of course we love, or if it's just talking to their baby or reading stories, poems, some parents like to read prayers and we can work with them to record their voice and then put it on a speaker so that babies can hear them maybe overnight when they're awake and parents aren't there. Or if parents go back to work, there are numerous reasons why parents might not be at the bedside.

And something else that we can do is encourage sibling or extended family involvement too. So, lots of grandparents likes to get down on this. We get lots of fun sibling recordings that we edit and make sure they're quiet enough for these teeny babies to hear.

We've also gotten like aunts, uncles, and cousins and stuff too. So, it's a great way for family to feel connected and supportive of this baby that's in the NICU for any length of time.

[Dr Mike Patrick]
Yeah. Yeah. Kalin, what are heartbeat recordings and how do you guys use those?

[Kalin Moran]
Heartbeat recordings are a really cool intervention we offer often for legacy making for patients nearing end of life and also for patients celebrating milestones, maybe a six-month, one year, their due date, milestones such as those. And the way it works is we have a stethoscope with a microphone on it. So, we record the infant's heartbeats.

We come back and edit it on our software to take out any background noise, and then we can offer to family to pair a song with the heartbeat. And so, then the heartbeat kind of becomes like the drumbeat, the backbeat of the song, and it can be a really special memory item to have, and families can keep that and continue to listen back to their baby's heartbeat recording for the rest of their lives.

[Dr Mike Patrick]
Yeah. Yeah. That is, that is a really cool.

Now, Lila, you know, some babies in the NICU are just there for a few days and then others are there for a really long time, especially those very premature babies who have a lot of feeding and growing to do. Does music therapy change depending on the sort of stay that a patient has and in particular, the length of time that they're there?

[Lelia Emery]
Yes, absolutely. So, like Chloe mentioned earlier, live singing is very slow, steady, quiet for our preterm infants. As they do get older, we're able to incorporate different types of music, different instruments to really support their overall development.

In our NICU especially, our entire therapy team takes a very proactive approach to supporting these babies and we try to make things as typical as possible for our families. So, if you think about like a baby who gets to go home right after they're born, they're often held and sung to and talked to like constantly, even sometimes subconsciously, like parents don't even realize it. There's like the joke about the mom, like how to spot a mom in the wild and she's just kind of swaying in line at the grocery store, not actually holding a baby.

So obviously when they're in the NICU, this very abnormal clinical environment, they don't get those natural opportunities. So, we have to create them. So, getting them out of bed to hold them whenever they are medically ready for that sort of stimulation.

As they do get older and start to have better brain development, we can like increase the different types of like speeds and tempos of music we do, can bring in more parent-preferred music. We have lots of small baby-sized instruments to incorporate different sounds. Like if you think about a baby who's at home, they might hear the dog next door barking or, you know, the laundry, like all these things that we don't necessarily think about being different and special, we can kind of bring into the NICU in different ways.

And like Kaylin mentioned, milestones are really important. So, we document those milestones too, whether it's with the heartbeat reporting or just taking pictures of the baby for their parents the first time they hold a shaker. All of these can be really important to supporting the overall family.

When their baby is in the NICU for six, 12, 15 months.

[Dr Mike Patrick]
Yeah. And then how can parents continue this at home? I'm sure that there's a lot of folks who, once they're exposed to it and they see the benefits, think, well, I don't want to give this up when I have to leave the hospital.

What can parents do at home to keep the music therapy going?

[Lelia Emery]
Yeah, absolutely. So, we like to give parents some discharge info on different ways to use music because there's so many opportunities to engage with their little one in a like non-threatening, fun way. So, using music to support speech goals, whether that is through incorporating a lot of like vowel songs.

Like if all the rain drops, the chorus is just ah, ah, ah, ah, and that's really encouraging for babies to kind of repeat that back. Using movement songs to encourage babies to clap their hands or even just swaying to the beat. All of these things can help support overall development.

Even using rhythmic support when reading can lead to better reading outcomes later in life. And then we're actually really lucky that we get to offer outpatient groups for our families in the Columbus area. For those who are farther away, and we try to provide them with resources, we have a little like recorded music, like Beyond Miss Rachel that we give to families too, just so they know like all the different opportunities there are for them to follow along with someone who has made early childhood music like their passion and their goal.

That way they don't have to reinvent the wheel because it can be really overwhelming to discharge from the hospital.

[Dr Mike Patrick]
Yeah, yeah, absolutely. Chloe, tell us a little bit more about the outpatient programs that you guys do and one in particular called Giggle and Groove, which I love that name by the way. What exactly is Giggle and Groove and how does that support these youngsters who have graduated from the NICU?

[Chloe Heintz]
Yeah, so Giggle and Groove are our music therapy class for caregivers and infants, toddlers to just support developmental milestones after they leave the NICU or even just support our community members at large. So, one of the ways that we do support our NICU graduates through this program is that the class is free to all our NICU and cardiac graduates from nationwide. And then community members can join for only five dollars, which is a steal these days.

And we just work on different things like following directions, bonding, listening, different movement activities, grasping, reaching, you name it, we do it in that class. And we actually have expanded to two locations at this point. We have a group at the Westerville Close to Home and the East Columbus Close to Home and we support infants six months corrected to two years.

So, it's been a lot of fun.

[Dr Mike Patrick]
And it's really great, I'm sure, from your point of view, too, that you can actually follow some of these kids after they go home, because especially the ones that have been in the NICU for a long period of time, there are attachments that are made between the clinicians and the baby and with the family. And you really all start to feel like a family and then all of a sudden, they're gone. And so, this does provide some continuity for you guys.

And I'm sure that's also helpful for the family, too, especially since you're providing a service that that really is comfort oriented. I'm sure it's great from their point of view to see you guys again, too, after they go home. Do you find those relationships continue in that way after folks leave the NICU?

[Chloe Heintz]
Oh, yeah, for sure. It's really fun to see the babies we've worked with out in the wild, so to speak, whether that's in a giggle and groove class or even just when they come back for follow-up appointments and you see them in the hallway and you get to chat about how much they've grown and now they're singing these songs that you did with them in the NICU. So that's been really special for sure.

[Dr Mike Patrick]
Yeah. Yeah. And then what about parents and families just in terms of music as something that we can also use, especially during stressful periods?

How can we use music therapy in our own lives? And Kaylin, how do you use it in your life?

[Kalin Moran]
Music can be incredibly therapeutic, so families can definitely use concepts and ideas from music therapy. Of course, music therapy involves the trained professional, but there are our principles such as the ISO principle, which is all about meeting someone where they're at musically. So, if you're in a really anxious state, you might want to find a song that kind of matches that that feeling and can help to regulate your own emotions.

So, choosing a song with a quicker tempo or if you find yourself feeling kind of down or grieving, finding a song that matches that mood, maybe it's in more of a minor key and then slowly changing the music over time to bring you to that desired state. If you find yourself feeling in that sad, grieving state and you want to feel more hopeful, you can even kind of put together a playlist of like, OK, here's my super sad, dark song. Here's my slightly less of a little quicker tempo.

OK, we've changed to a major key. And then by the end of that playlist, we're bopping around to a really upbeat, fun pop song. So, I find music to be incredibly supportive not only of my emotions but also helping with motivation.

So, completing tasks like I'll put it on when I'm trying to clean at home, it makes it a little bit more enjoyable and kind of finding playlists or designing playlists to help kind of bring me to a more desirable state. So, there's a lot of wonderful ways that music can really help decrease cortisol, decrease the stress levels that you're experiencing to help you find joy and relaxation.

[Dr Mike Patrick]
Yeah. And I that makes so much sense. And I'm sure that there's folks who I'm hoping that there's a lot in the audience who have are having an aha moment right now that that, you know, I can see where that would work.

And when you are maybe in a sad mood and then resting in that sadness and listening to sort of melancholy music but then have that playlist gradually take you to a higher level and to, you know, a more energetic, upbeat soundtrack that then can also go along with your with your mood. I love that. And I think I need to try that myself.

[Kalin Moran]
Yeah. Music can be incredibly validating. It helps us to feel supported, like we're not alone in that feeling.

[Dr Mike Patrick]
Yeah. Yeah, absolutely. Lila, I'm sure music therapy extends outside of the NICU at our hospital.

What are some other places where music therapy happens? And just tell us more about the program in general at Nationwide Children's Hospital.

[Lelia Emery]
Yes, it absolutely expands past the NICU. We actually have the largest pediatric team in the entire country with 15 music therapists. Those music therapists are in all inpatient areas of the hospital.

So, every floor of our main tower building, including hematology, oncology, the pulmonary unit, et cetera, you name it. We also have music therapy in our in-home hospice and palliative care teams. We have three wonderful therapists out there and we have one music therapist in our behavioral health pavilion.

We do offer a couple outpatient experiences, too, with our outpatient pain program, our giggle and groove groups, which we mentioned, dialysis, the infusion clinic, you name it. And we're really trying to expand even more just to provide as many people as possible with the really beneficial music therapy experience. It's pretty awesome.

I've been here for 12 years now in October, and the way music therapy has grown at this hospital is really incredible. I can't wait to see what we do next because the team's really awesome.

[Dr Mike Patrick]
Yeah, and we'll put a link in the show notes over at pdacast.org. It's episode 590, and we'll put a link to the music therapy program at Nationwide Children's Hospital. We'll also have a lot of other links for you, so be sure to check those out, including upcoming events for giggle and groove.

So as was mentioned, for $5, you can join in on the fun, especially if you have a little one at home that would benefit from giggling and grooving. And I think we all could benefit from that. So, we'll have that a link to the upcoming events on the website.

Also, an interesting program at Florida State is a NICU Music Therapy Institute. And so, if you are interested in learning more, we have folks, of course, in the audience from all over the country, not just here in central Ohio. And so, we do try to spotlight other services and places where you can learn more.

And the NICU Music Therapy Institute is a good one again in Florida State. We also have a music therapy helping kids heal and learn. It's a 700 children's blog post that Lelia did.

And Lelia, you're the content creator of the group, I think, because there's also a virtual music therapy with Lelia on YouTube. And so, we'll put a link to that. Music for Kiddos is a great YouTube channel.

And then we do have some more information if you're interested in becoming a music therapist. The certification board for that profession has lots more information, and we'll put a link to that in the show notes as well. So again, check those out over at pediacast.org for episode 590. So once again, Kalin Moran, Lelia Emery and Chloe Heintz, thank you all so much for stopping by and chatting with us today.

[Kalin Moran]
Of course. It was an honor to be with you. 

[Lelia Emery]
Yeah. Thanks for having us. 

[Chloe Heintz]
Thanks, Dr. Mike.

[Music]

[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that. Also, thanks again to our guests this week.

Kalin Moran, Lelia Emery and Chloe Heintz, all music therapists at Nationwide Children's Hospital. Don't forget, you can find our podcast wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube and most other podcast apps for iOS and Android.

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And until next time, this is Dr. Mike saying, stay safe, stay healthy and stay involved with your kids. So long, everybody.

[Music]