Consider the benefits of music therapy for your patients

Illness, injury, and hospitalization are, of course, stressful for children. Hospitalized children are susceptible not only to obvious stressors such as pain and uncertainty but also to environmental stressors such as ambient cold, noise, and bright lights.

Stress, in general, can interfere with sleep, appetite, digestion, growth, behavior, and cognitive development. Stress can also harm the cardiovascular, neuroendocrine, and immune systems, which, in turn, may impair recovery from illness or injury and delay hospital discharge.^1,2

Music to thine ears Environmental sounds that exist without controls for volume, duration, or cause-and-effect relationships are perceived as noise. Noise contributes to poor clinical outcomes, including fatigue, hyper-alertness, insomnia, decreased appetite, and increased risk of infection. Among infants hospitalized in the neonatal intensive care unit, for example, excessive noise correlates with a decrease in oxygen saturation and an increase in heart rate and sleep disturbances.⁷

Music is an intentional auditory stimulus with organized elements, including melody, rhythm, harmony, timbre, form, and style. Repetitive listening allows the listener to identify and predict sounds.⁵

Music is ubiquitous in world cultures and is listened to by children of all ages, races, and ethnic backgrounds. (The number of music sites on the Internet-486 million-even exceeds the number of sex sites-350 million [Google search, 11/18/04].⁸) Not surprisingly, different kinds of music appeal to listeners of different ages and ethnic backgrounds, and the same person may want to listen to a different type of music under different circumstances. Nursery rhymes may be soothing to toddlers, for example, but irritating to teenagers.

Recently, specific types of music have been marketed as a way to enhance pediatric development (see "What is the 'Mozart effect'?" at the end of this article); to address cognitive problems; and to enhance the effectiveness of complementary therapies such as Reiki and massage. Although these strategies remain somewhat controversial, music has long been used as a complementary healing therapy to soothe children afflicted with pain, anxiety, and a variety of illnesses and injuries.

Physiologic effects of music In animals, music changes neuronal activity, with entrainment to musical rhythms in the lateral temporal lobe and in cortical areas devoted to movement. Steady rhythms also entrain respiratory patterns, which may positively affect cardiac autonomic stability. Listening to classical music increases heart rate variability (HRV), a measure of cardiac autonomic balance; increased HRV reflects less stress and greater resilience. Listening to noise or rock music decreases HRV (reflecting greater stress).^9,10

Among premature infants, music, particularly lullabies and classical music, appears to increase weight gain, decrease episodes of oxygen desaturation, decrease distressed behaviors, and increase nonnutritive sucking, all of which may reduce length of hospital stay.^5,11-14 In a study involving premature infants, exposure to harp music resulted in, overall, a significantly lower salivary cortisol level and a lower respiratory rate.¹⁵ While listening to music, the infants became quiet and seemed to fall asleep. A decrease in activity may reduce caloric expenditure and enhance weight gain.¹⁵