Working with the Smallest of Patients: Music Therapy in the NICU

For centuries almost every culture around the globe has used music to help soothe and teach children. From singing lullabies to helping a child get to sleep to singing the ABC song to learn the alphabet, there are countless examples of music being used to foster learning and growth in children of all ages. But, how can music be used to promote development in the smallest and most fragile of patients in the Neonatal Intensive Care Unit? Well, I’m glad you asked! Let me tell you about music therapy in the NICU.


Music Therapy in the NICU

During the prenatal and neonatal periods, a baby’s brain is growing more rapidly than at any other point in their lifetime (gaining over 250,000 nerve cells per minute!). Babies born prematurely have to leave the safe space of the mother’s womb. This causes the brain to go through this critical period in an environment not designed for optimum neurodevelopment. As NICU Music Therapists, our goal is to provide a musical experience that is appropriate, meaningful, and purposeful while avoiding overstimulation to promote neurodevelopment.

Interventions implemented by music therapists in the NICU are on a continuum based on developmental needs. A music therapist can modify them in the moment to adapt to a baby’s tolerance. Music therapists in the NICU go through additional post-graduate training through the National Institute for Infant and Child Medical Music Therapy. There they learn to assess and identify behavioral and physiologic signs of overstimulation as well as overall tolerance of stimuli.



Babies are excellent communicators when one knows what signals to look for. Sometimes a baby will grimace or sneeze as a sign of overstimulation. Sometimes they might give a full-on ‘stop sign’ hand with all five fingers splayed to tell us that it’s just too much. In those instances, a music therapist knows how to decrease the level of stimuli. This is to prevent overstimulation while still providing a positive experience. Because of the extreme sensitivity and fragility of these infants, it is imperative that a music therapist implements the intervention. While our adult brains are able to filter out everything that’s happening around us (sounds, lights, touches, smells), a premature infant’s brain is unable to filter these things. They can interpret the combination of all these stimuli as incredibly stressful.

Once a baby is able to tolerate stimuli and achieve a robust, quiet alert state, a music therapist’s intervention may look a lot more like play time. But, don’t get me wrong, a music therapy session helps address a large number of developmental skills during a session that simply looks like ‘fun.’ From using high contrast picture cards to promote visual tracking, playing shakers to promote fine motor skills, or engaging a baby with an ocean drum during tummy time, many developmental skills can be addressed through music therapy.

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Video Example

There are also other infants with a wide range of other diagnoses and of varying postmenstrual ages. In the video below, you can see how a music therapist is using the ukulele. She’s working on reaching and use of both arms on one of our NICU units.

Music therapists use other interventions in the NICU which include Procedure Support, Heartbeat Recordings, Parent Recordings, and the Pacifier-Activated Lullaby. Check back later for a deeper look into these interventions.


Music Therapy in the NICU Follow-Up Program

Because infants who were born premature are at risk for developmental delay, follow-up after discharge is important. Sounds of Love in Early Childhood is one such follow-up program. The video below gives a look into how these music therapy groups promote long-term developmental milestone acquisition.


Music Therapy is an essential part of developmental care in the NICU and in follow-up. For more information, please email


Caitlin Pennington is a board certified music therapist. She is part of the NICU team at Nationwide Children’s Hospital.

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  1. Laurel Grummitt on May 8, 2019 at 7:58 am

    My daughter was15 oz. Now 19. I have to think her love of music and beautiful voice has come from musicf in the nicu. Acting out songs helped her motor skills. Born with congenital CMV she may be losing her hearing. We have audiology appt next week. She has had no symptoms of CMV until 12 when she was told she had the hearing of a forty year old. I cant help but think the music therapy can do nothing but help her through what she may face now. Thank you for what you do.

    • L. Samuel Gracida L. Samuel Gracida on May 10, 2019 at 9:49 am

      Thanks for your message, Laurel! We are happy to hear that your daughter benefitted from music therapy and also sad about her current hearing problems… Is she currently seeing a music therapist? Or are you thinking about finding one? We can help connect you with someone if you wish!

  2. […] elderly, specially those with dementia, it can help kids with burns, also children with autism, and premature babies in the NICU. And so much more! There is even one population you wouldn’t think of when you think of music […]

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