Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

Abstract

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative musicality to improve infant development, parental well-being, and bonding. It aims at relaxing and nurturing the infant as well as promoting safety and social interaction for the parent-infant dyad. A music therapist specially trained in CMT hums or sings in an infantdirected, improvised, lullaby style continually adjusting to the individual needs, expressions, and breathing pattern of the preterm infant. Based on the principles of family-integrated care, the family is incorporated individually in the therapeutic process, namely by delivering CMT during kangaroo care (KC) and by motivating and facilitating parental vocal interaction with their infant to strengthen the parent-infant bonding. CMT aims at relaxing, stimulating, and coregulating premature infants at a time when many other interventions are still risky and can overwhelm the vulnerable patient group. CMT may be advantageous not by educating and teaching parents, but rather by uncovering the intuitive capacities of parenting that are often overshadowed by the traumatic experience of preterm birth. However, CMT can only be provided when the infants are clinically stable. CMT with parental integration is feasible when parents are available and receptive to participate. This paper presents a detailed protocol on how to use CMT to empower preterm infants and their families.

Creative music therapy for long‐term neurodevelopment in extremely preterm infants: Results of a feasibility trial

“…After receiving informed written parental consent, a qualified CMT music therapist (FH) provided individualised CMT for approximately 20 min two to three times per week until hospital discharge, either for the infant alone at the bedside or with the parents during skin‐to‐skin contact according to the CMT clinical protocol 4 …”

“…After receiving informed written parental consent, a qualified CMT music therapist (FH) provided individualised CMT for approximately 20 min two to three times per week until hospital discharge, either for the infant alone at the bedside or with the parents during skin-toskin contact according to the CMT clinical protocol. 4 When the session was conducted with the infant alone, the therapist started the session with initial touch and faded in with gentle humming and singing in lullaby style, entrained to the infant's breathing rhythm while transforming observed facial expressions and gestures into responsive, supporting and regulating musical parameters to facilitate communicative musicality. While conducting CMT during skin-to-skin contact, the therapist used a wooden vibroacoustic deep sound string instrument, an arched monochord (©NICU-Monochord by Saitenklang, Bern, Switzerland) placed at the elbow of the parents to accompany the singing and to transmit the womb-sound mimicking relaxing vibrations via bone contact to the parent-infant-dyad.…”

“…One promising approach may be Creative Music Therapy (CMT), a family-integrating, resource-and needs-oriented therapy using calm, soft and individualised live music and singing in a therapeutic relationship to relax, stabilise, and stimulate the infant and to support parent-infant bonding, parental self-efficacy and empowerment. 4 Parents are individually integrated into the therapeutic process, e.g., by providing music therapy during skin-to-skin contact to foster bi-directional relaxation and attachment. Overall, the music is individually tailored to the infant's behavioural and developmental state, infant cues and tolerance of stimulation, and parental needs on a moment-to-moment basis with sensitive listening, perceiving and therapeutic responsiveness.…”

“…For this reason, early preventive family‐integrating therapy approaches may be crucial to improve long‐term neurodevelopment in EPTs. One promising approach may be Creative Music Therapy (CMT), a family‐integrating, resource‐ and needs‐oriented therapy using calm, soft and individualised live music and singing in a therapeutic relationship to relax, stabilise, and stimulate the infant and to support parent‐infant bonding, parental self‐efficacy and empowerment 4 . Parents are individually integrated into the therapeutic process, e.g., by providing music therapy during skin‐to‐skin contact to foster bi‐directional relaxation and attachment.…”

“…Overall, the music is individually tailored to the infant's behavioural and developmental state, infant cues and tolerance of stimulation, and parental needs on a moment‐to‐moment basis with sensitive listening, perceiving and therapeutic responsiveness. The music therapist provides the musical experience as a vehicle for connectedness, emotional expression and access to intuitive parenting skills and parental resources (see 4 for more information on CMT methods).…”