We Work in the NICU Too!

By Rachel Ferreira, MusicWorx Intern

When I tell people what my profession is, I often get, “oh wow! That’s so cool. What is that?”. I explain my profession and why I love it. Most people assume that you can only practice music therapy with older adults or people with autism spectrum disorder. In fact there are more populations with whom we work. One population I am particularly interested in, and perhaps the most fragile, are those in the NICU.

The NICU is the Neonatal Intensive Care Unit where babies who are born with birth defects or born prematurely (before 37 weeks). While working in the NICU, the music therapist can address the following goal areas:

  • Neurological development
  • Crying
  • Feeding
  • Procedural support
  • Parenting stress

One of the challenges with music therapy in the NICU is the noises already going on. The infant is constantly listening to monitors, staff conversations, parent voices, doors opening and closing, other infants crying, etc. These intrusive sounds are combined with some common diagnoses, like:

  • Respiratory Distress Syndrome (RDS)
  • Infection
  • Jaundice
  • Gastrointestinal Issues
  • Feeding Problems
  • Low Birth Weight
  • And Neonatal Abstinence Syndrome (NAS)

The auditory chaos makes it incredibly hard for the baby to relax, heal and grow. What makes music different from the constant hospital noises is that it is a completely different sound. The music can help with breathing entrainment, multimodal neurologic enhancement, and even parent training in infant stimulation and bonding. It sometimes can even help with weight gain and earlier discharge from the hospital.

An article by Standley and Swedberg (2011) looked at infants who had received music therapy versus those who had not. Some of the treatments included multi-modal stimulation, Pacifier-Activated-Lullaby (PAL), and parent training in infant stimulation.

  • Music Multimodal Stimulation: is when the music therapist takes a series of steps to enhance an infant’s integration of stimuli. Also known as MMS, it incorporates auditory, tactile, vestibular, and visual stimulation. The music therapist gradually integrates more stimulation into the intervention to see how much the infant is able to tolerate. They then gradually decrease the stimulation when the infant physiologically indicates that it has become too much. Multiple sessions build the infants tolerance to stimulation.
  • Pacifier-Activated-Lullaby: “is a medical device that encourages and reinforces the development of non-nutritive sucking (NNS) of premature infants. This is accomplished by giving positive feedback in the form of music/mother’s voice as an auditory input in direct response to effective sucking.” -

Standley and Swedberg noticed that those who received music therapy services gained more weight per day than those who did not. They also found that those born as early as 24-28 gestational weeks and received music therapy interventions were discharged sooner than those who had not received music. Not only does the music therapist help the infant recover enough to be discharged, but they also support the family. The music therapists provide them with tools that they can use at home to work toward bonding with the infant and help the parents with their anxieties.

According to Ettengerger, Cardenas, Parker, and Odell-Miller (2017) musical interaction between parent and infant helped the parents to experience feelings of connectedness and provided a distraction from the difficult and noisy hospital environment. Throughout the research the music therapists had the parents take the state-trait anxiety inventory (STAI) test. The result was a statistically significant improvement between the pre and post test for mothers. The parents also said that music therapy was “relaxing”, “calming”, and that they experienced “tranquility”. When the parents were able to relax, or feel some kind of escape from the NICU environment, they were able to bond with their child more easily. This bonding is essential to a healthy homelife and the development of the infant.

As more research was done, Haslbeck (2012) reviewed many of the articles that were previously published. Of the studies reviewed, Haslbeck found that the majority of the articles reinforced music therapy as an effective discipline with premature infants. Most infants were able to regulate or relax during music therapy interventions. Many other positive physiological effects were also demonstrated during music therapy.  Positive physiological changes include: an increase in oxygen saturation levels and, regularity in heart rate, which leads to more energy for growth.

Music therapy in the NICU is still a young and expanding field, which means that many questions are still left to be addressed. That said, current research demonstrates many ways that music therapy can benefit the patients in the NICU, especially in areas of physiological and behavioral parameters, and their family members.

I believe that as the music therapy profession grows, so will the evidence for what music therapy services can do for this population. We will be able to help these incredibly fragile individuals grow and heal so that they may begin their lives outside of the hospital as quickly as possible. Then as we continue to gather data and evidence, who knows who we may be able to help next.


Standley, J. M., & Swedberg, O. (2011). NICU music therapy: Post hoc analysis of an early           intervention clinical program. The Arts in Psychotherapy, 38 (1), 36-40.

Ettenberger, M., Rojas Cardenas, C., Parker, M., & Odell-Miller, H. (2017). Family-centred            music therapy with preterm infants and their parents in the neonatal intensive care unit    (NICU) in Colombia – a mixed-methods study. Nordic Journal of Music Therapy, 26 (3),                  207-234.

Haslbeck, F. B. (2012). Music therapy for premature infants and their parents: An integrative       review. Nordic Journal of Music Therapy, 21 (3), 203-226.


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