Written By:
Jayne M. Standley, Jane Cassidy, Roy Grant, Andrea Cevasco, Catherine Szuch, Judy Nguyen, Darcy Walworth, Danielle Procelli, Jennifer Jarred, Kristen Adams
Published in: Pediatric Nursing
May-June 2010; Vol 36
I pulled this goodie out of my archives. I found it in a random search a while back and was so fascinated by the title I couldn't help but read it. I mean who doesn't love music, right? Henry Wadsworth Longfellow said "Music is the universal language of mankind." Confucius said, "Music produces a kind of pleasure which human nature cannot do without." So how does music relate to the field of speech-language pathology? I hope by sharing this article with you, together we can discover how music can be used to promote positive outcomes in feeding therapy with infants.
First a little background:
Non-nutritive sucking is sucking for purposes other than feeding, usually on a pacifier, finger or toy. It is generally faster than nutritive sucking which is used for the purpose of feeding. Non-nutritive sucking is "theorized to contribute to neurological development by facilitating internally regulated rhythms." Non-nutritive sucking is beneficial in the following ways: 1) it helps to reduce of stress and physiological reactions in infants who are exposed to painful experiences in the NICU, 2) it decreases the patient's heart rate, 3) it increases the patient's ability to absorb oxygen, 3) it helps to promote weight gain, 4) it helps the infants to calm themselves, leading to increased energy conservation, 5) in conjunction with gavage feedings it decreases the length of the patient's stay in the hospital, 6) it helps to promote earlier transition to bottle feedings. In addition, music has been proven to have some of these same positive benefits on infants as well including: 1) decreased stress, 2) decreased length of hospital stay, 3) increased oxygen saturation, and 4) increased weight gain.
The purpose of this study:
The authors of this study set out to determine the effect of a pacifier-activated lullaby system (PAL) on "the cessation of gavage feeding of premature infants due to oral feeding achievement." In other words, they wanted to see how music used as a positive reinforcement for non-nutritive sucking could effect the feeding skills of premature infants. Specifically they wanted to: 1) determine if the number of trials with PAL affected feeding outcomes, 2) to determine if age of exposure to PAL made a difference in feeding skills.
Methods:
In this study there were 3 groups: 32 weeks, 34 weeks, and 36 weeks. Each group was divided by gender, then randomly assigned to one of the following categories: "no-contact", "1 PAL trial", or "3 PAL trials". There were a total of 68 participants. Infants receiving PAL trials were offered Wee Soothie pacifiers embedded with computerized chips that activated the PAL system in response to the infants' suck. The settings were placed so that even the weakest sucking response activated the PAL system. Trials lasted 15 minutes each and occurred at the same time each day 30 minutes prior to feeding. In addition, the music stayed on for 10 seconds unless reactivated by additional sucks. Data was gathered from nurses notes who were blind to the purpose of the study. The authors then looked at the number of days the infant required gavage feeding (defined by the period from birth to the last day of gavage feeding), the total number of days the infants remained in the hospital, and total amount of weight gain from birth until discharge from the hospital.
Results:
For infants who were 32 weeks results showed:
-increased duration of gavage feedings
For infants who were 34 weeks results showed:
-decreased duration of gavage feedings
-decreased the length of hospital stay
-more trials with PAL produced better results
For infants who were 36 weeks results showed:
-infants who were not nipple feeding before the trial began nipple feeding after 1 trial with PAL,
therefore the researchers were unable to compare the effect of multiple trials of PAL on this age
group.
Overall, there was not a significant difference in weight gain of the infants who participated in the trials in any age group.
Discussion:
The researchers believed that the trials were most successful at 34 weeks because this is the age at which the infant is most neurologically ready to nipple feed. Therefore, if PAL is to be successful, it should be implemented specifically at 34 weeks of age. However, many of the babies had to be dropped from the trials in the 34-36 week age group because they became successful nipple feeders and were discharged from the hospital. Therefore there was a bias in the data concerning the length of hospital stay. However, this study does indicate potential in using this type of treatment to promote successful nipple feeding in infants.
Clinical Implications:
If PAL is used, it should be used starting at 34 weeks of age. Treatment should last 15 minutes and should be provided 30 minutes prior to feeding. Lullabies in the patient's native language should be used if possible. Patients who are appropriate candidates for this type of treatment would include pre-term infants with no known abnormalities that could interfere with feeding such as Down Syndrome, cleft palate, hydrocephalus or neurological disorders. Patients cannot be on a trach/vent and should demonstrate readiness for trials with oral feeds.
Comments from me:
I found this article fascinating and wonder how music could be used in other aspects of speech-pathology to promote progress with our little ones. The authors of this article suggested that lullabies be played in the infant's native language to provide input for language development. Is there research out there to suggest that music has a positive affect on language development? Does exposure to certain genre's of music impact language development (i.e. classical verses pop)? Every day I use music/singing to promote positive feeding experiences with my little ones and to help them tolerate oral motor stimulation and feeding therapy. But is there research that really backs up the use of music during other types of feeding therapy as a way to facilitate positive outcomes?
