Guest: Dr. Joanne Loewy
Guest Bio: She is the Director of the Louis Armstrong Center for Music and Medicine at Beth Israel Medical Center in New York City, and she led a study and published in the journal “Pediatrics”, entitled, “The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants”.
Health Professional Radio
Emily: You’re listening to Health Professional Radio. This is Emily. And my guest today is Dr. Joanne Loewy. She is the Director of the Louis Armstrong Center for Music and Medicine at Beth Israel Medical Center in New York City, and she led a study and published in the journal “Pediatrics”, entitled, “The Effects of Music Therapy on Vital Signs, Feeding, and Sleep in Premature Infants”. Dr. Loewy, thanks so much for speaking with me today.
Dr. Joanne Loewy: My pleasure.
Emily: Tell me about your new study. What kinds of music therapy were you offering to these infants?
Dr. Loewy: Well, our study focused on the use of live music interventions. And we chose to do this largely because the literature focused on recorded music, but also that the music being offered in former studies didn’t really match anything that was apparent in the womb, or that was apparent in the child’s to-be family.
Emily: I see. So, you were offering, for example, a mimicked heartbeat or a mimicked whoosh of the sound that a child would experience in the womb, or, if I’m not mistaken, a ‘song of kin’? Can you tell me about that?
Dr. Loewy: Sure. A ’song of kin’ is something that I developed from a former research project and from my many years of working in a hospital. What happens is when people are traumatised, as often mothers and fathers are when they have a baby come out too soon … is we look for something in trauma therapy called an ‘anchor’. And an anchor, just like a boat needs an anchor in waters that are out of control, an anchor helps parents be able to feel in control. These parents give over their babies to a very sterile environment, to attendant doctors and nurses, but to a place where they have a lack of control.
And so, by giving an anchor, they’re able to offer and provide an environment in which they have some control, and furthermore an environment that offers culture. So, the ‘song of kin’ then is not just to say that Debbie Boone, or Olivia Newton John are going to sing through recorded music a beautiful lullaby. What’s beautiful to one family is not indicated for another. So, the ‘song of kin’ says that the music of one’s culture, of one’s heritage that’s passed down from one generation to the next, can serve as an important anchor and provide parents with an incentive for something that they can control during this very frightening time for them.
Emily: Wow. So, what were you looking for in terms of the infant’s response?
Dr. Loewy: Well, we weren’t looking for anything. I think good research is really researching. We did a very stringent lit review, and what we found, as I said before, is that the “music” being offered by music therapists and/or other people in the field were not paying attention to the culturality. Patient-preferred music is as unique as mother’s milk …
Dr. Loewy: And as personal as mother’s milk. And we wanted to include, furthermore, both parents, father and mother. And we wanted to make the music live, so that we could change the tempo according to the baby’s vital signs. And we also wanted to create the other two elements – mimic the womb sounds, which is intrauterine whooshing, with a Remo ocean disc, and the gato box, which was calibrated to the baby’s heart rate.
And we were really looking to just see what would happen. We’ve been piloting this work for many, many years and we wanted to have evidence, whether it was positive or negative, of the effects of these sounds on heart rate, respiratory rate, activity levels, sucking, feeding, voiding – on a short-term basis, meaning in the moment of application, before, during and after – and then, each day of the fourteen days that these newborns were involved.
Emily: And were you seeing long-term effects after the music was finished, after the therapy session – was there a lasting effect on the heart rate, the feeding, and so forth, of the baby?
Dr. Loewy: Yeah, we did look at that, and we found that with some of the interventions, after – that is when the improvement showed most. So, I think, in any good study, especially in a neonatal, in a newborn, where the time can be long-term, after two weeks, it is important to combine those outcomes, both at the time of the intervention and then through the long-term.
Emily: How can, for example, a parent, who wants to apply these same kinds of techniques after the child goes home – how can they identify which specific sound is needed at a given time? How did you identify that?
Dr. Loewy: That’s a good question. I think that on one hand, we need to be careful to say that these interventions are best applied by a certified music therapist – someone that has advanced training. Because overstimulation is a worry – that’s why we have sound meters to measure decibel levels and that’s why we train. We’re coming up with a whole [indecipherable 06:13] lullaby international training that is pretty stringent.
On the other hand, we do want parents to have control and, furthermore, continuity of care, that there’s something they can take home and do with their infants, especially during times of transitions, feeds, awake, sleep. So, what we do as part of the trauma training and music [indecipherable 06:44] therapy with the parents while they are in the hospital is show them ways to enhance the coordination of vital signs. And we teach them how to en-tune [sp] to them, like kangaroo care, but even more than the skin-to-skin: put the baby on the left side over your heart.
Dr. Loewy: And we show them how, by touching their heart on their chest, they can experience their own heartbeat and the baby regulates to that, that is normal. Second, turn off the VCR or the CD, turn off the radio, put away your iPod and your digital phone, and sing to your baby. And furthermore, as baby’s breathing, sing in the rhythm that the baby is breathing.
So, these are ways. And then we do the whoosh sounds of baby lying over the chest with the naked parents, blanket over the baby’s back but the skin-to-skin, and it’s just a whoosh sound, and entrained or calibrated to baby’s breaths. These are some of the aspects of music therapy that they can take home.
Emily: Wow. Do you have any idea how many hospitals – how often do parents who are with a child in a neonatal unit encountering music therapy sessions like this?
Dr. Loewy: One more time …
Emily: [laughs] How prevalent is this practice in the hospitals when parents have a premature baby? Where are they getting these services?
Dr. Loewy: Well, it’s growing. This training we’re doing is international. So, I’d just say since the study has come out, every week, we’ve been starting to train people. We’re in the grandparenting phase with the training. I’ve been invited around the world to different NICUs [sp] to help them launch and get started.
Dr. Loewy: We’re excited about it.
Emily: That is really exciting. In your career, as you work, with individuals, are there any remarkable moments that stand out that have spoken to you and you thought, “Yeah, this is really … there’s something going on here that people need to know about?”
Dr. Loewy: Well, we’ve been able to see the effects of the music therapy in enhancing the quiet alert state, you know, where … it used to be thought, “Leave the baby alone in the incubator.”
Dr. Loewy: “Don’t make any noise. Let the cells grow. Don’t touch.” Now, we know touching and making the right kinds of sounds can actually enhance neuro-biologic growth in the brain, that music can enhance the quiet alert state, can prolong sleep patterns, that the suck is a rhythm. And then if we entrain with that suck with music, it can actually strengthen the suck because that’s what rhythm does.
Dr. Loewy: It can actually prolong the amount of time that the newborn infant is able to suck. But I think, most importantly, we’re seeing what’s been so obvious – that’s mentioned in the Bible, it’s mentioned by the Greeks. It’s mentioned again and again and again, that music can enhance the relationship between an infant and their parents.
Dr. Loewy: We see it in the animals and we see it in studies of detachment. So, what better place than to do this in the sterile neonatal intensive care unit, but then to provide for the continuity of care in the home.
Emily: Absolutely. You don’t sound surprised by these findings at all.
Dr. Loewy: In reality, these findings are not earth-shattering.
Dr. Loewy: The numbers are not going from a heart rate of two hundred stress to a heart rate of one-thirty three relaxed.
Dr. Loewy: They’re very subtle changes, but I think the reason why people are interested in this study is because we have a large number of babies, we have a large number of hospitals. We have many music therapists offering the intervention, and the way we collected the data is scientific – it is evidence-based. And because the vital signs didn’t go all over the place, weren’t huge, it’s believable.
Dr. Loewy: It shows really in a scientific way that: one, it’s not over-stimulating; two, it does no harm; three, it actually does some good. It brought down the stress of the parents. It helped the vitals become integrative; the heart rate with the respiratory rate. The symphony of sounds in this very young body can become integrated and stabilised, so the baby can learn to self-regulate.
So, the surprise really was how much press and how many people [laughs] are starving for this kind of research that validates the importance of music.
Emily: Yes. Would you argue that it is necessary?
Dr. Loewy: I would argue, with that much data, that the brain of the growing baby that has music has better neural activity. I would argue that the parents that use music as part of their play and work with babies are going to have stronger attachment. And I would argue that the baby will fare better with what we call their transitional object, which is something familiar that they can anchor themselves to, which is the music relationship.
So, we see it in schools – the kids that are in band and orchestra or chorus, generally, most often have better grades, higher SATs. I don’t even care about that stuff. Who cares about SATs and grades? What we see is an emotional connection, because when you sing or you play music with someone and you’re attuning to someone, you become part of a team. You become more motivated. You become a player with many players. It’s sort of the ant farm of life.
When you’re learning music, you’re coordinating yourself with others. So the emotional and social growth is critical to developing brains. We see that again and again in research.
Emily: Um-hmm. Absolutely. This is all very fascinating. And I would say that you’re down-playing the importance of the research that you’ve done and I really appreciate your openness to discuss it with me.
You’re listening to Health Professional Radio. This is Emily, and my guest today has been Dr. Joanne Loewy. She’s the director of the Louis Armstrong Center for Music and Medicine at Beth Israel Medical Center in New York City, and she led a recent study published in the journal, “Pediatrics,” entitled, “The Effects of Music Therapy on Vital Signs and Sleep in Premature Infants”.
Dr. Loewy, thank you so much for joining me today.
Dr. Loewy: It’s been my pleasure. Thanks for all the great questions.