One morning this week, I joined my friend and fellow children’s librarian, Nancy, at the pool for water aerobics. During the class, another exerciser, Jen, pointed out that while the older exercise instructors often move TO the music and coordinate their exercises with the beat, the younger instructors generally use the music as background only.  She wondered aloud (not knowing anything about MGOL and my connection to it) if this could be due to the contrast in musical upbringing; the older adults had learned nursery rhymes as young children and were able to “hear the beat” in rhyming patterns. In addition, many adults had participated in mandatory music classes while in elementary school where using rhythm instruments and tapping along to the beat was common.

Through library programs, I have observed that many of today’s young mothers do not have a repertoire of nursery rhymes. Their elementary schools may not have had regular music classes with exposure to rhythm and moving to the beat (affecting the younger exercise instructors, too!).  Perhaps, Jen wondered, that is why there is such a difference in the way music is used during the exercises according to instructors’ ages.

The conversation went from the value of sharing nursery rhymes with young children to the sad fact that many parents today don’t know nursery rhymes to young mothers living in poverty and premature babies. We talked about the fact that babies born prematurely as young as 24 weeks can now survive with a lot of medical intervention. But during that time as their brain is growing quickly, wouldn’t it be great if parents could share nursery rhymes with them?

AHA!  Another path for MGOL!  I started envisioning a MGOL program for parents with premature babies. It would last 15 to 20 minutes and take place in the NICU unit. It would not involve any props. It would simply be a MGOL facilitator leading the parents in songs and rhymes that they could sing/recite to and with their babies. It could include tickle rhymes and touching rhymes in addition to songs and lullabies.

For those parents who want to stay by their baby’s bedside but don’t know what to do or say, this type of a program could give them useful activities. In addition, it would help the bonding process by enabling positive physical touch between parent and child in whatever way would be possible given the medical intervention being used at the time.  I imagined a NICU unit with a parent sitting next to each baby, all singing softly and reciting rhymes with their child.

Shinichi Suzuki developed the successful Suzuki method of teaching violin to very young children when he realized that “Japanese children can speak Japanese!” Even though Japanese is a difficult language to learn, all healthy children were able to learn to speak Japanese without formal education in their earliest years of life. Because of this, Suzuki realized that the newborn’s brain is able to gather information and build upon it based on the child’s experiences. And the more joyful the experience, the easier it is to learn from. Suzuki developed a method for teaching children how to play musical instruments based on these observations, and called it the mother-tongue approach. (This is very similar to the “Listen, Like, Learn” approach of Barbara Cass-Beggs.)

Parents were asked to choose a piece of music and play it during pregnancy so the fetus could hear the piece while in the womb. After the child was born, parents continued to listen with their baby to that piece of music every day, so the child became very familiar with it and knew how it was supposed to sound. The parent then learned to play the instrument they wanted their child to learn, in order to be able to understand what the child was expected to do and share the experience. Once the child began learning, the music lessons and practice sessions were always to be accompanied by parent responsibility, loving encouragement, and constant repetition.

None of my children were born prematurely. But I know that premature babies often require additional medical treatment, therapy, or tutoring when they are in school due to being born so early (Lewit, et al. 1995). Perhaps a MGOL program for preemies could help with this, using the Listen, Like, Learn approach with nursery rhymes and lullabies to build synapses in the brain, setting the scene for easier learning later on in life. Because of the adaptable nature of MGOL, I could create a version that could be used in a neo-natal unit. I could recruit retired librarians and Head Start teachers to be trained and then to run MGOL preemie programs in local hospitals. I was psyched!

When I returned home from the pool, I went straight to the computer and learned that the idea of using music, rhymes, and lullabies with preemies is not new. An online article, “The Importance of Prenatal Sound and Music,” explained that babies in utero could hear their mother’s voice via bone conduction when she read aloud, spoke, or sang. Later on, those babies indicated preferences for the songs and stories they had already heard.  (Exactly what Suzuki claimed!) Research indicated that newborns can differentiate between a recording of their own mother’s prenatal womb sounds and a recording of another mother’s sounds (Righetti, 1996). Dr. Henry Truby, director of langauge & linguistics research at the University of Miami, was quoted as saying, “the elements of music, namely tonal pitch, timbre, intensity and rhythm, are also elements used in speaking a language. Music can thus be considered a pre-linguistic language which is nourishing and stimulating to the whole human being, affecting body, emotions, intellect, and developing an internal sense of beauty, sustaining and awakening  the qualities in us that are wordless and otherwise inexpressible.” (Verny & Kelly, 1987)

 After reading studies about the importance of music on fetuses, Dr. Fred Schwartz began to study how music might affect preemies. He wrote:

“… stimulation with the Transitions(tm) womb sound music was helpful in the care of mechanically ventilated, agitated premature babies with low oxygen levels. Significant increases in oxygen saturation as well as decreased levels of agitation were found with the use of music (Collins & Kuck, 1991).”

Another study showed that when lullaby music was played in the neonatal intensive care unit (NICU), there were less episodes of oxygen desaturation (Caine, 1991). Preemies were calmed when exposed to lullabies in utero (Polverini-Rey, 1992). Some studies showed a doubling of daily weight gain when premature babies in the NICU were given music therapy (Caine, 1991; Coleman, Pratt & Abel, 1996). Additional studies showed that using music with premature babies resulted in a 3- to 5-day earlier discharge from the NICU (Caine, 1991; Coleman, Pratt & Abel, 1996; Standley, 1996).  Parents believed that music would decrease stress, improve sleep, and decrease crying of infants hospitalized in the NICU (Polkki et al., 2012).  When this belief was tested, both nurses and parents reported that music could, indeed,  decrease stress in the premature infant (Allen, 2013).

A literature review published by the University of Alabama at Birmingham – School of Nursing examined six studies which took place between 1986 and 2002 regarding reactions of premature infants who had someone sing to them, look at them, and rock them.

One study showed that premature infants who received the intervention had increased heart rate, decreased oxygen saturation, and an increased alert state “during the intervention and for 30 minutes after the intervention.” (White-Traut, et al. 1993)  A subsequent study including a tactile component showed increased alert states, heart rate and respiratory rates during the intervention (White-Traut, et al. 1997). The infants also gained more weight per day than the routine-care group (Malloy, 1979).  The female babies who had been part of the intervention were discharged an average of 11.8 days earlier than the females in the routine-care group (Standley, 1998).

In a study where a live female spoke directly to the infants vs. the routine-care babies, the investigators found that the experimental group babies were more alert during the intervention and demonstrated “higher levels of five of eight feeding-readiness behaviors during the intervention.” The actual feeding volume and duration of feeding were not significantly different from the routine-care group, however (White-Traut, et al. 2002).

The conclusion of this literature review stated that, “the findings of many studies suggest that music interventions may have positive effects on preterm infants in the NICU including increased oxygen saturation levels, reduced heart rates, reduced arousal and behavioral stress responses, increased levels of quiet alert or quiet sleep states, improved parent-infant interaction, improved weight gain, and reduced length of hospitalization.” Due to inconsistencies in some of the studies, however, a recommendation was made for future research.

A more recent study (Arnon, 2011), examined the results when music therapists worked with mothers of preterm infants in neonatal intensive care units for three days a week for an hour. Each session was comprised of four parts: verbal expression, music expression, lullabies and relaxation, and closing.  The intervention groups had significantly higher breastfeeding rates both following hospital discharge as well as at a 60-day follow-up visit. Whether this was due to parent relaxation or infant response has yet to be determined.

After just one day of online exploration, I am certainly not an expert on the effects of using music in the NICU. However, it is clear to me that the medical world realizes that using music with premature infants is a valuable treatment (Field, et al. 2006). We also know that having a premature infant is scary for the parents; having musical interactions and rhymes to recite can help to relieve parental stress (Loewy et al. 2013) and increase ability to cope (Whipple, 2000).  Since “the relationship between the child and mother in the early period determines the child’s future social functioning,” reducing a parent’s stress and increasing direct involvement with the infant is essential (Bieleninik & Gold, 2014).

Reciting nursery rhymes with children has many benefits. Hearing words that begin and end with the same sounds helps children brains to recognize syllables (Maclean, et al. 1987).  They learn that language has patterns and rhythms while listening to pitch, volume, voice inflection and the rhythm of the rhymes. Parents can learn nursery rhymes quickly since most rhymes are short, easy to sing, and easy to repeat. Children are exposed to a wide range of vocabulary words. Because of the repetition, children learn to expect what is coming next.  Children develop narrative skills by listening to nursery rhymes that have a beginning, a middle, and an end. Math skills grow as children recognize sound patterns and sequences. Math vocabulary develops when reciting rhymes with numbers and counting.

Doing fingerplays along with rhymes builds fine motor skills. Mouth and tongue muscles get exercise when children make the different sounds in the rhymes. Tickling rhymes and other rhymes that involve physical contact between parent and child help the bonding process while aiding the child’s social and emotional development.

Studies have shown that “pre-reading rhyming skills are the best predictor of later reading ability that we have” (Goswami, 2006).  Knowledge of nursery rhymes and the subsequent phonological awareness/phonemic awareness is a an accurate predictor of early reading ability (Bradley & Bryant, 1983; Tummer & Nesdale, 1985; Maclean, et al. 1987; Harper, 2011; Dunst, et al. 2011).  In addition to opening up the world of knowledge and imagination, being able to read gives children the ability to rise above the circumstances of their birth. “Reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health.” (Baker, et al. 2007)

Given what we know about the healing power of music, the powerful effect of nursery rhymes, the value of reading and the importance of parent-child bonding, finding a way to adapt MGOL and bring it into NECU units could be a worthwhile and exciting adventure. If you are interested in joining this adventure with me, please let me know by emailing info@mgol.net with a subject line of “MGOL for preemies”.

 Resources:

Allen, K. (2013). Music Therapy in the NICU: Is there evidence to support integration for procedural support? Adv Neonatal Care, 13(5)

Baker D.W., Wolf M.S., Feinglass J., Thompson J.A., Gazmararian J.A., Huang J. (2007). Health Literacy and Mortality Among Elderly Persons. Arch Intern Med. 167(14), 1503-1509. doi:10.1001/archinte.167.14.1503. 

Bieleninik, L, & Gold, C. (2014). Early intervention for premature infants in neonatal intensive care unit. ACTA Neuropsychologica 12(2), 185-203.

Blumenfeld, H., & Eisenfeld, L. (2006, January/February). Does a mother singing to her premature baby affect feeding in the neonatal intensive care unit? Clinical Pediatrics, 65-70.

Bradley, L. and Bryant, P.E. (1983). Categorizing sounds and learning to read: a causal connection. Nature, 301, 419-421.

Bryant, P.E., MacLean, M., Bradley, L.L. and Crossland, J. (1990). Rhyme and alliteration, phoneme detection, and learning to read. Developmental Psychology, 26, 429-438

Caine, J. (1991). The effects on music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates in a newborn intensive care unit. Journal of Music Therapy, 28(4), 180-192.

Coleman, J. M., Pratt, R. R., & Abel, H. (1996). The effects of male and female singing and speaking voices on selected behavioral and physiological measures of premature infants in the intensive care unit. Presented at the International Society for Music in Medicine symposium at San Antonio, 10/96.

Collins, S. K., & Kuck, K. (1991). Music therapy in the neonatal intensive care unit. Neonatal Network, 9(6), 23-26.

Dunst, C.J., Meter, D., & Hamby, D. (2011). Relationship between young children’s nursery rhyme experiences and knoweldge and phonological and print-related abilities.  Center for Early Literacy Learning 4(1), 1-12.

Lewit, E. M., Baker, L. S., Corman, H., & Shiono, P. H. (1995). The direct cost of low birth weight. The Future of Children, (The David and Lucille Packard Foundation)  5(l), 35-56.

Malloy, G. B. (1979). The relationship between maternal and musical auditory stimulation and the developmental behavior of premature infants. Birth defects: Original article series, 15(7), 81-98.

Neuman, S.B. (2004). Learning from poems & rhymes. Scholastic Parent & Child, 12(3), 32.

Polkki T, Korhonen A, Laukkala H. (2012). Expectations associated with the use of music in neonatal intensive care: a survey from the viewpoint of parents. J Spec Pediatr Nurs. 17:321–328. [PubMed]