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NICU Music Therapy

Music Therapy NICU Referral

Image: Louis Armstrong

Documentation of Referrals
Intensive care units maintain procedures that include accountability and documentation of services. It is therefore useful to have a means of formality in the referral process. The following referral form accompanies the Criteria for Referral, and is especially useful at the beginning of music therapy program implementation. The form ensures that the infants will be seen, and presents the music therapist with a clear idea regarding the area of greatest need from a medical and social perspective.

As staff become familiar with the kinds of interventions the music therapy team will be making, the Criteria for Referral is filed and the form is used as the primary mechanism for on-going case treatment. It is recommended that the initial cases (at least three) of music therapy in the NICU be "piloted" and summarized through leadership meetings. The music therapist may report the efforts taken with the team and how the music therapy interventions were effective or ineffective and modified based on the team member's referral. As well, the techniques that were implemented can be illustrated (e.g., singing AHH and using the ocean drum to demonstrate an inter-uterine environment with supportively toned breath sounds in the case of the infant referred for respiratory distress). At this meeting, the referral form (filled-out) is duplicated for the staff, and the team efforts and contacts taken by the therapist are highlighted (e.g., therapist met with mom and baby based on knowledge from the social worker that mom is fragile, this is the first baby, father is in jail). Milieu care is a mainstay (Abrams et al, 2000) for future referrals and illustrates the effectiveness of how music therapy complements aspects of care already effectively in place. The following referral areas were developed at Mount Sinai Beth Israel and correlate with the Criteria for Referral. The referral form is filed in the chart and provides necessary support that music therapy has been indicated.

Music Therapy Referral Criteria

I. Bonding: Parents and infants (identified by the team) that are in need of collaborative experiences may be referred. Incorporating Brazelton's Neonatal Behavioral Assessment Scale, musical focus will emphasize infant-parent attachment. Music and soft singing with skin -to- skin contact will be encouraged. Melodic (3-5 note) vocalizations will be modeled and simple lullabies will be encouraged for use by mom/dad/caretaker. The parent-infant dynamic will be strengthened as the use of soft sounds (repeated sung phrases) will be patterned for use during times of sleep, transitions, and/or separations.

II. Irritability/Crying (Intense high pitched): Music (lullabies and toning) will be offered as a means to contain the sound environment for the infant in distress. Toning will be provided as a blanket of steady sound to comfort and sustain a homeostatic environment. Tones enable the infant to trust his/her surroundings and offer an atmosphere of predictability. Human voice sounds made through vocal tones provide an atmosphere of safety, which induces sleep and assists in relaxation.

III. Respiratory Difficulties: The Gato box and breath sounds can be useful in helping the infant synchronize and regulate the rhythm of his/her breath. The Gato box provides a predictable rhythm that mimics the sound of a human heart.

The infant can entrain to the provided rhythm, which can lengthen and ease the meter of the breath. The breath voice is soothing and provides a flowing release of oxygen, which can enhance the breathing process. The ocean disc provides an inter-uterine sound environment that provides safety and familiarity, stimulating the infant's breathing process.

IV. Feeding/Sucking/Weight gain: Comfort sounds may be a catalyst for inducing gurgles and vegetative sucking. Soft, rhythmic sound scaping prior to feeding may assist in the infant's coordination with sucking, swallowing and breathing. Nutritive sucking with rhythmic reinforcement may help infants maintain steady mouth motion, which can be further sustained through melodic holding during feedings.

V. Sedation/ Sleep/Pain: Music therapy can provide an environment of safety during painful procedures. Tonic tones that match the pitch of the infant's cry, entrained with the meter of the breath , can ease and alter the experience/perception of pain. Using the Attia (et al) infant pain scale, the music therapist can assess the level of pain and distract the infant from attending to the painful stimuli. Music can assist the infant in reconstitution at post-procedure time. Music therapy can be used in conjunction with (complementary) or as an alternative pharmacological sedation, depending upon the MD order.
For the infant who appears overstimulated and/or is in need of sleep, simple lullabies containing <5 note melodies can provide an aural atmosphere of nurturance. Altering the tempo and meter of the lullaby can help the infant relax and shift gradually into a sleep state.

VI. Self Regulation: Central to the infant's development is his/her ability to self regulate. Simple, consistent rhythms and melodies can help the infant organize and acclimate to the environment. Predictable, ordered aspects of music provide structure that assist in the development of self-nurturing behavior, physiological organization and neurological pathways.

Referral Form
For a downloadable copy of the Referral Form, please contact info@musicandmedicine.org.  

More pages on NICU Music Therapy at Beth Israel:

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