Singing, sharing, soothing – biopsychosocial rationales for parental infant-directed singing in neonatal pain management

Abstract

Infant-directed singing is a medium for parents and infants to communicate in a mutual relationship. Parental infantdirected singing is a multisensory, biopsychosocial communication that applies to ill and vulnerable hospitalised infants. The primary musical features of infant-directed singing are ideal for emotional coordination and sharing between parent and infant without the risk of over-stimulation. In this article, we suggest that parental infant-directed singing is regarded as a nonpharmacological emotion regulation intervention, which may modify the painful experience for both the infant and the parent before, during and after painful procedures in the neonatal intensive care context. Parents have the biopsychosocial resources to alleviate their infant's pain through infant-directed singing, if they are empowered to do so and coached in this process. A music therapist specialised in neonatal music therapy methods can mentor parents in how to use entrained and attuned live lullaby singing in connection to painful procedures. Pain and the vast amount of painful procedures early in infancy, combined with early parent-infant separation and lack of parental participation in the care of the infant during neonatal intensive care, place arduous strain on the new family's attachment process and on the infant's and parents' mental health, both from a short and long-term perspective. Therefore, we argue with biopsychosocial rationales, that live parental infant-directed singing should be promoted in neonatal pain care worldwide. Consequently, parents should be welcomed round the clock and invited as prescribed pain management for their infant.

Study protocol: parents as pain management in Swedish neonatal care – SWEpap, a multi-center randomized controlled trial

“…Combined parental soothing behaviors that provide rhythmic (holding/rocking/vocalizing) or orogustatory/orotactile (feeding/pacifying) stimulation that keep the parent close to the infant, are effective in a painful context [58]. Consequently, in the SWEpap study, we include parental live lullaby singing, which is an unexplored but promising biopsychosocial, multimodal and multisensory pain alleviating adjuvant, especially in combination with SSC and breastfeeding [37]. Newborn infants are highly responsive to social and affective communication.…”

“…In live parental infant-directed singing, the parent is attuned to the moment-to-moment psychological experience of the infant [43,59]. The mainly "physical" parent-driven interventions with SSC and breastfeeding are therefore accompanied by a relationship-based intervention, the live parental lullaby singing, which may assist in modifying the painful situation for both the infant and the parent before, during and after the painful procedure [37].…”

“…Just like oral sweet solutions, swaddling, containment or facilitated tucking, positioning, non-nutritive sucking and recorded music stimulation, are nurse-initiated pain alleviating interventions where parents can be included but parental presence is not required [32,36]. Among the non-pharmacological approaches, the biopsychosocial perspective strongly supports parent-driven interventions [37]. In the parent-driven non-pharmacological interventions, the parent herself/himself is a mediator for pain relief [36].…”

Music therapy for preterm infants and their parents during NICU stay and beyond: current recommendations for clinical practice in Poland

“…According to research conducted to date, using live or recorded music, together with other types of music-based interventions, has a measurable positive physiological and behavioral impact on infants and their parents' outcomes during hospitalization. However, the effect is short-term (for more details: Ullsten, Eriksson, Klässbo, & Volgsten, 2018;Stegeman, Geretsegger, Phan Quoc, Riedl, & Smetana, 2019).…”

State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review

“…Parents who are present during painful procedures report lower distress and more satisfaction with care (9) and feel empowered in their caregiving role (14). Parents need and want to participate actively in their infant's pain management, and they should be educated and guided through various means, not just verbal information, to mitigate their infant's pain (15)(16)(17)(18)(19)(20)(21)(22). Coaching parents to better meet their infant's attachment needs during times of pain may lead to more efficacious interventions (23).…”