Why hospitals are prescribing music therapy to babies with complex needs

Emily and Reg Booy sing softly to their baby, Annalyn, who was born nearly three months before her expected due date, in the neonatal intensive care unit of a Vancouver hospital.

Their rendition of You Are My Sunshine is altered slightly, according to a music therapist’s direction. They swap out the word “never” to sing, “You’ll always know, dear, how much I love you.”

And they replace “Please don’t take my sunshine away,” with a new line: “And I love you more every day.”

“It just makes it a little more hopeful,” Ms. Booy explains.

The Booys are part of a pilot project at B.C. Women’s Hospital and Health Centre, one of several Canadian hospitals providing music therapy for babies with complex medical needs. The program personalizes songs – from folk tunes to Metallica hits – and encourages parents to sing them to their infants as lullabies. Research suggests music helps parents bond with babies who have had a harrowing start to life, and may benefit the babies’ health and brain development. Similar programs, inspired by one in the United States, are being offered to the youngest of hospital patients in Vancouver, Toronto, Montreal and London, Ont.

“A lot of these babies have already gone through this unpleasant experience, and their brain development is not optimized,” says Sandesh Shivananda, medical director of the hospital’s neonatal program. “We have to use whatever is available to normalize their life, and normalize their development.”

In Vancouver, the six-month pilot project, launched in April, is part of the hospital’s efforts to provide what Dr. Shivananda calls “developmentally supportive care,” which counters the painful procedures, disruptive lights and sounds and other noxious stimuli to which babies in intensive care are often exposed.

For Annalyn, this includes visits each week from a music therapist who sings and sometimes plays guitar while Mr. and Ms. Booy do physiotherapy exercises with her or try to soothe her after a medical procedure.

The therapist, Carol Wiedemann, often performs customized versions of music the couple would listen to at home, such as songs by the Beatles (Hey Jude becomes Hey Annalyn), and encourages the parents to join in. The music is modified according to how much stimulation the baby can handle. For example, the therapist may forego the guitar and simply sing or hum, or slow the song down.

The Booys say the sound makes everyone in the hospital room feel calmer, and routine tasks such as physiotherapy exercises feel more playful and less clinical.

Dr. Shivananda says the American Academy of Pediatrics has cited a 2013 study as evidence for using music therapy in neonatal intensive-care units (NICUs). That study found live music, especially “songs of kin” – lullabies selected and performed by parents – improved premature infants’ vital signs and feeding. It boosted their oxygen saturation levels, reduced their heart rates and increased their calorie intake. It also reduced parents’ stress and anxiety.

But why would lullabies produce such physiological responses?

The human body is a “symphony of sounds” controlled by the brain, explains Joanne Loewy, one of the authors of that 2013 study and director of the Louis Armstrong Center for Music and Medicine at Mount Sinai Beth Israel in New York.

“The brain hears and feels the vibration and rhythm of music … and it gives a cue, a neurologic cue, to the breathing rate and to the experience of heart rate,” she says.

In a traditional NICU, babies are exposed to unpredictable sounds, from the comings and goings of staff to beeping machines, adds Toronto-based music therapist Cheryl-Lee Campbell, who has worked with infants in intensive care. She says music helps babies’ brains find order.

“If they have a regulated rhythm, and a regulated beat, a regulated melody, it gives them something to latch onto that isn’t that chaos,” Ms. Campbell says.

However, she cautions, babies can become overstimulated very easily, which may lead to distress, crying and disrupted sleep. Thus, it is necessary to recognize how much music, if any, a baby can tolerate. Ms. Campbell says she may start with gentle humming, and if the baby turns toward her, she would continue and perhaps add more notes. But signs to stop include an increase or a drop in the baby’s heart rate, or turning away.

Dr. Loewy developed the “song of kin” intervention, now used in hospitals around the world, during decades of practising music therapy and studying how babies respond to their parents’ singing. When parents chose and sing songs that are meaningful to them and sung in their own language, they communicate their values, emotions and culture through the music, she explains.

In Toronto, Holland Bloorview Kids Rehabilitation Hospital is looking to expand its own pilot program, introduced in 2018, which involves music therapy for infants and their families. During weekly sessions, parents and caregivers are encouraged to convert a song of their choice into a soothing lullaby, altering the tempo, softening the sounds and personalizing the lyrics. They are then encouraged to sing and record it, often incorporating sounds of their baby and the baby’s siblings.

Back at B.C. Women’s Hospital, new father Matthew Arnold has composed his own song for son Owen, who was born with a heart condition at 29 weeks gestation. It includes the lines: “Owen, Owen, he’s sleepin’ and a-growin’ …/Nurse, Nurse, you’re always first /RT [respiratory therapist], RT, oxygen to my arteries...”

Along with the medical care Owen receives, Mr. Arnold credits these kinds of parental interactions for his baby’s development and growth. “Knowing that we’re here and that he’s loved every day gives him some will to keep going,” he says.