Practice Guidelines for Music Interventions with

Hospitalized Pediatric Patients

Janice W. Stouffer, MT-BC

Beverly J. Shirk, BSN, RN, CCRN
Rosemary C. Polomano, PhD, RN, FAAN

Music therapy is an effective complementary approach that can achieve specific therapeutic outcomes in the clinical
management of pediatric patients. Growing research on music interventions has generated scientific knowledge about how this
modality benefits patients and has formed the basis for effective protocols that can be used in practice. Although it can be
challenging to translate research-based protocols into routine clinical care at the bedside, it is essential that music therapy
interventions be aligned with evidence-based information and that accepted standards be established by the music therapy
discipline to achieve the greatest benefit. The importance of partnerships between nurses and music therapists is emphasized to
enhance the success of music-based treatments. This discussion synthesizes research findings that can be used to design
pediatric practice guidelines in the application of music therapy.
© 2007 Elsevier Inc. All rights reserved.

L ISTENING TO MUSIC offers a wide range of

therapeutic effects, such as helping patients to
relax, enhancing sedation, and relieving anxiety and
pain (Barrera, Rykov, & Doyle, 2002; Cepeda,
Carr, Lau, & Alvarez, 2006; Noguchi, 2006).
Infants and children exposed to music treatment
protocols can be distracted from unpleasant symp-
toms, calmed during stressful events such as
invasive procedures, and less distressed while
hospitalized (Grasso, Button, Allison, & Sawyer,
2000; Hatem, Lira, & Mattos, 2006; Malone, 1996;
Noguchi, 2006; Standley, 2003). Despite substan-
tial evidence supporting its use, nurses are often
challenged with ways to implement music appro-
priately and therapeutically as part of routine
clinical care. Often, it is difficult to know which
patients may benefit from music therapy; to
determine suitable music selections, the best
From the Department of Orthopedics and Rehabilitation, Penn
State Milton S. Hershey Medical Center, Hershey, PA, Penn State
Shock Trauma Center, Penn State Children's Hospital, Hershey,
PA, and University of Pennsylvania School of Nursing, Hospital
of the University of Pennsylvania, Philadelphia, PA.
Address correspondence and reprint requests to Rosemary C.
Polomano, PhD, RN, FAAN, University of Pennsylvania School
of Nursing, Philadelphia, PA 19104.
E-mail: polomanr@nursing.upenn.edu
0882-5963/$ - see front matter
© 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.pedn.2007.04.011
methods of delivering music, and the optimal
timing and sequencing of music interventions; and
to establish end points for documenting the
effectiveness of therapeutic music. Partnerships
with board-certified music therapists can enhance
the success of music techniques through expert
guidance in the use of creative strategies and access
to resources and equipment. More important,
investigations of music therapy offer valuable
information to assist nurses in developing practice
guidelines for music-based treatments.
DEFINING MUSIC THERAPY
The term “music therapy” is used broadly to
encompass many different interactions with music.
Clinically, however, there is a distinction between
music therapy (a deliberate, often structured, and
systematic intervention intended to achieve a
desirable therapeutic outcome) and exposure to
music in a less controlled manner by health care
professionals unfamiliar with underlying practice
standards critical to its success (Dileo, 1999a).
Music therapy involves an interaction between a
music therapist or trained health care professional
and the patient, and the procedures that are used to
deliver music are based on scientific principles and
achievement of specific therapeutic goals. Music
techniques may involve receptive listening for

448 Journal of Pediatric Nursing, Vol 22, No 6 (December), 2007

GUIDELINES FOR MUSIC INTERVENTIONS WITH PEDIATRIC PATIENTS
Table 1. Glossary of Musical Terms
Term Definition
Consonant Sweet pleasing harmonies
Discordant A combination of sounds that is neither harmonious nor
compatible
Dynamics The loudness or softness of a musical piece
Harmony Consonant combination of notes sounded simultaneously
to produce chords or to accompany tunes
Melody The dominant tune of composition
Rhythm The organizational pattern of sound in time or the timing
of musical sound
Syncopated The strong accent of rhythm being on the weak beat or
offbeat, producing an uneven rhythmic effect
Tempo The speed at which music is played
Volume The loudness level of music (in dB)
music-assisted relaxation to reduce pain or anxiety;
expressive singing requiring a level of engagement
and focus; active instrument playing; songwriting,
composition, or both; or interactive games. These
methods often require assistance from music
therapists to help understand the properties of
music, to design the timing and length of music-
based activity, to provide resources and equipment,
and to establish realistic goals. Table 1 provides a
glossary of terms associated with characteristics
of music.
BENEFITS OF MUSIC
Music therapy has an important place in the
armamentarium of complementary and alternative
therapies. Music can have measurable benefits on
physiological and psychological outcomes in both
infants and children. Although Evans (2002)
reported that music can be most effective during
routine clinical care and may have less of an impact
when simply used sporadically with stressful
events, Walworth (2005) documented cost-
effectiveness, the need for fewer nurses available
during procedures, reduction in procedural times,
and elimination of requirements for sedation (Wal-
worth, 2005). Overall, studies show the favorable
perceptions of nurses and other health care profes-
sionals on the effectiveness of complementary and
alternative therapies and their willingness to
employ such techniques, particularly in critical
care settings (Kemper, Martin, Block, Shoaf, &
Woods, 2004; Tracey et al., 2003).
Applications of music in clinical practice must be
implemented with careful attention to proven
guidelines. Variables such as patient characteristics
(e.g., age, developmental stage, diagnosis, and
illness states), intended use, clinical setting or
449
environment, selection and properties of music, and
method of administering music stimuli influence
the expected outcomes of music interventions.
Isolated studies demonstrate specific effects in
certain populations under various conditions.
Neonates, when repeatedly exposed to music
carefully selected for its calming properties,
displayed less pain and stress behaviors during
procedures (Kar Bo & Callaghan, 2000). Premature
babies exposed to contingent music—pacifier-
activated music (lullabies)—experienced a signifi-
cant increase in non-nutritive sucking (Standley,
2000a, 2003) and weight gain (Cevasco & Grant,
2005). Parents of infants and toddlers with cystic
fibrosis reported a significant increase in enjoyment
during chest physiotherapy when music composed
and recorded specifically to accompany exercises
was played (Grasso et al., 2000). Similar applica-
tions of music with pediatric populations have
reduced preoperative anxiety (Chetta, 1981), anxiety
during cardiac catheterization (Caire & Erickson,
1986; Micci, 1984), and postsurgical pain (Steinke,
1991). Music has proven benefits in alleviating
children's apprehension and discomfort associated
with bone marrow aspirations (Pfaff, Smith, &
Gowan, 1989), and in reducing pain and anxiety
associated with injections (Fowler-Kerry & Lander,
1987) and lumbar punctures (Rasco, 1992).
Music evokes desired emotional and stress
responses that serve as distraction from unpleasant
stimuli. It can also elicit memories of life events or
hold certain meanings that can elicit emotional
responses (White, 2001). Pitch, rhythm, harmony,
and tempo are all determinants of the perceptual
processing of auditory input and neurological
responses to music (Chlan, 2000). A greater
understanding of the underlying basis for the
effects of therapeutic music has evolved from
scientific perspectives linking arousal and affect to
several complex neurophysiological processes in
the brain, which are all mediated by the thalamus,
hypothalamus, and brainstem (Thaut, 1990).
Table 2. Music Therapy Techniques
Music listening and anesthesia, analgesia, and/or suggestion
Music listening or participation in exercise or speech practice
Music listening or participation in counseling
Music listening or participation in developmental or educational
objectives
Music listening and stimulation
Music and biofeedback
Music and group activities
Note: Data from Standley (2000b).
450
Table 3. Music Therapy Protocols for Pediatric
Populations
Patient Population Application of Music and Clinical Setting
Premature infants Research-based protocols for use in the
NICU (Standley, 2003)
Neonates Music and multimodal stimulation for
premature infants in the NICU (Standley,
1998)
Parent training for music and multimodal
stimulation for premature infants in the
NICU (Whipple, 2000)
Hospitalized children Live music interaction with pediatric
patients experiencing a variety of needle
insertions (Malone, 1996)
Contextual support model to promote
coping in children with cancer
(Robb, 2000)
Songwriting and digital video production
interventions for pediatric patients
undergoing bone marrow transplantation
(Robb & Ebberts, 2003a, 2003b)
Outpatient music-therapy-assisted chest
physiotherapy for infants and toddlers
with cystic fibrosis (Grasso et al., 2000)
Music therapy techniques for pain
reduction during debridement
(Barker, 1991)
Mechanically ventilated Music therapy interventions for infants and
infants and children children in critical care (Burke, Walsh,
Oehler, & Gingras, 1995; Stouffer &
Shirk, 2003)
Psychophysiological responses to music stimuli
that result in relaxation often involve an interplay
between centers of the brain and a sequence of
perceptual events that signal neurological
responses in the brain (Scartelli, 1989). A recent
meta-analysis revealed that music alone and
music-assisted relaxation techniques had signifi-
cant effects on arousal response (Pelletier, 2004).
Studies quantifying the role of these neurological
substances in response to music therapy have
predominantly been quantified in adults. Several
physiological measures, such as salivary cortisol
and serum cortisol, interleukin-1, and antibodies,
are useful chemical markers for assessing the
effects of music on physiological stress responses
(Khalfa, Bella, Roy, Peretz, & Lupien, 2003;
Kuhn, 2002; Stefano, Zhu, Cadet, Salamon, &
Mantione, 2004).
PRACTICE GUIDELINES FOR MUSIC
THERAPY
Music therapy is often combined with other
techniques to enhance anesthesia, analgesia, and
relaxation; to engage patients in treatments and
STOUFFER, SHIRK, AND POLOMANO
other activities; to promote interactions; and to
facilitate developmental and educational growth.
There are several published clinical guidelines
combining listening to music with many other
treatments and approaches for synergistic effects.
These techniques have certain functions and
Table 4. Template for Designing Clinical Protocols
1. Define target population (age, clinical condition, and treatment unit
or setting)
Inclusion criteria (e.g., targets; patient and family acceptance of
alternative or complimentary therapy)
Exclusion criteria (e.g., evidence of auditory-evoked seizure
disorder)
2. Describe clinical uses for music therapy interventions, including
Anxiety or pain reduction during procedures, mobilization, times of
increased stress, extended length of stay, or preoperative or
postoperative period
Music-assisted relaxation as an adjunct to other therapies such as
analgesics or sedating agents
Music-based activity as exercise (e.g., singing for respiratory
therapy, playing instruments for the use of extremities)
Promotion of emotional coping during hospitalization
3. Identify intended outcomes, such as
Decreased physiological stress responses (e.g., heart rate, blood
pressure, cortisol level)
Stimulated physiological responses (e.g., nutritive sucking, eating,
arousal, weight gain, respiratory strength)
Increased calming or relaxing effects, sedation, anxiolysis, and
analgesia or pain relief
Reduced levels of sedation
Enhanced distraction or diversion
Appropriate self-expression and disclosure for emotional coping
4. Define the roles of nurses, music therapists (if available), and other
health care professionals
Who will identify and access appropriate candidates for music
therapy?
Who will conduct patient/family education?
Who will select age-appropriate and culture-appropriate music?
Who will administer intervention and document responses?
5. Identify required characteristics of music to choose appropriate
selections
Sedative
Stimulative
6. Outline methods of delivering music and list available resources
Teaching materials for staff and patients/families
Capacity for live or interactive music
Library or compendium of prerecorded music selections
Audioequipment, if needed
Individual participation versus group music session
Appropriate times and locations for music interventions
Sequencing and duration of music sessions
7. Establish parameters for end points of therapy using physiological,
behavioral, or self-reported measures, as appropriate
8. State documentation guidelines
Specify criteria for documenting procedures and response to therapy
Determine the location of information in patients' medical records
9. Assure proper care, maintenance, and cleansing of equipment (e.g.,
headphones, instruments, and other equipment should be cleansed
with a bactericidal, tuberculocidal, or viruscidal agent according to
the institution's infection control procedures)
GUIDELINES FOR MUSIC INTERVENTIONS WITH PEDIATRIC PATIENTS
indications, and utilize prescribed procedures that
have proven benefits for achieving defined out-
comes (Standley, 2000b) (Table 2). For example,
music listening or participation in counseling can
be used with hospitalized children to initiate and
maintain counseling interactions to reduce physio-
logical and emotional distress and to promote
verbalization and interpersonal interactions. Music
therapy protocols used in research studies can be
adapted for use in clinical practice. Examples of
investigations that provide detailed descriptions of
methods and procedures for implementing music
therapy interventions are presented in Table 3.
When designing practice guidelines, it is
important to consider the intent of music interven-
tions such as audioanalgesia, relaxation, distrac-
tion, sensory or environmental stimulation, or
stimulation of physiological responses. Practice
guidelines should be tailored to the target popula-
tion(s), and realistic therapeutic goals and desired
outcomes should be defined. Criteria for music
selections and appropriate methods for delivery
(e.g., timing and time sequencing of music inter-
ventions) are essential. The responsibilities of
nursing staff in monitoring and documenting
therapeutic responses should also be outlined.
Table 4 provides a template for designing clinical
protocols for music therapy interventions. Impor-
tant, the development of practice guidelines for
music therapy must be aligned with accepted
standards defined by the extensive body of
research and experts in the field of music therapy.
Patient Selection
Music interventions have been used with many
hospitalized pediatric populations in a variety of
clinical settings such as neonatal and pediatric
intensive care units, newborn nurseries, and
general medical–surgical units (Standley, 2000b).
Although research has demonstrated that diverse
patient populations benefit from music therapy, the
receptiveness of the patient, family, or both to
music interventions is of utmost importance. Child
teaching (if the child is able to understand) and
family teaching should center on: (a) the under-
lying principles of the specific technique used; (b)
goals of music therapy; (c) clarification of
expectations; and (d) explanation of the roles of
nurses, music therapists, and the patient and
family. Fact sheets are available on the American
Music Therapy Association (AMTA) (2006) Web
site to help health care professionals communicate
accurate information about music therapy.
451
Prescreening for hearing impairment, although
obvious, is sometimes overlooked and can impede
the success of music interventions, especially with
premature infants, neonates, and critically ill
children. Many states require that newborns be
screened for hearing acuity prior to discharge from
the hospital (American Speech–Language–Hearing
Association, 2006). Anatomical, developmental,
and other factors contribute to differences among
patients in their hearing capacity (Cassidy & Ditty,
2001; Darrow, Gfeller, Gorsuch, & Thomas, 2000).
Screening guidelines for hearing loss in infants
have been developed by the Joint Committee on
Infant Hearing (American Academy of Audiology,
2000). Several different methods can be used to
detect hearing loss, and standardized criteria for
defining hearing impairment have been established
by the American Academy of Audiology. Stach and
Santilli (1998) provided a useful summary of
technology for hearing screening. Before music
interventions are performed in the context of both
research and applications in clinical care, hearing
levels should be assessed by a trained audiologist,
especially with infants and children who are unable
to communicate or are developmentally delayed.
Adaptive music therapy techniques are indicated
for children with hearing impairment, and guide-
lines and protocols are provided by Darrow et al.
Music Selection
Properties of Music
Music can either stimulate or depress physiolo-
gical responses, depending on the properties of
musical selections and combinations of music with
other stimuli. In general, stimulative music is
characterized by a faster tempo, a louder volume,
a more irregular or syncopated rhythm, and wider
jumps between notes of the melody line, and/or
includes more instruments such as brass, drums,
and distorted electric guitar, whereas sedative music
usually has a slower tempo, a softer volume, a
regular and steady rhythm, and minimal jumps
between notes of the melody line, and is played on
instruments such as strings, acoustic guitar, or
piano. Case studies of children with severe head
injury support the careful use of music as structured
stimulation and orientation during their emergence
from coma (Rosenfeld & Dun, 1999).
Research has shown that stimulative music,
compared to sedating music, elicits different
responses in blood pressure and heart rate. Preterm
infants presented with both sedative and stimulative
452
Table 5. Characteristics of Recorded Sedative Music
1. Melody performed on electric piano
2. Melodic line moving in stepwise increments (the melody consists of
notes that fall closely together on a scale) with minimal interval jumps
3. Arpeggiated chordal accompaniment played on classical guitar or
piano keyboard (playing multiple harmony notes of a chord one at a
time rather than simultaneously)
4. Midrange tunes with avoidance of high frequencies
5. Tempo of no faster than 60–72 beats/minute
6. Smooth and consistent rhythm, without sudden changes
7. Soft to moderately loud volume, approximately 65–70 dB
Note: Data summarized from Stouffer and Shirk (2003).
music while in isolettes showed higher and more
variable mean systolic blood pressure measure-
ments with music intended to stimulate. Conver-
sely, greater variations in average heart rate were
observed with sedative music (Lorch, Lorch,
Diefendorf, & Earl, 1994). Other studies found
that neonates in intensive care units exhibited signs
of decreased physiological stress when certain
music was played while they were lying in their
isolettes (Collins & Kuck, 1991; Standley &
Moore, 1995).
To decrease anxiety in children, several musical
guidelines have been proposed by Robb, Nichols,
Rutan, Bishop, and Parker (1995). Music should
reflect a tempo of 60–72 beats/minute. Changes in
dynamic levels should be predictable and gradual,
and remain within a soft to moderate volume range.
Similarly, rhythms should be regular, without
sudden fluctuations in tempo. Melodies are most
effective when pitches are low versus high. Finally,
music selections should reflect consonant, not
discordant, harmonies with accompaniments that
are pleasing to the ear and possess a soft tone
quality on strings, voice, or piano. Recorded
versions of songs selected by children or their
family for their calming properties that have been
adapted by music therapists offer greater assurance
that the music is within the parameters of sedative
music (Table 5).
Music Preferences
Although debate still exists as to whether
sedative qualities of preferred familiar music are
superior to preselected music, emphasis on music
preferences remains high. Davis and Thaut (1989)
contended that “each individual may have a unique
biological system that reacts to a given stimulus
with an idiosyncratic but consistent physiological
response and perceived psychological experience”
(p. 170). Therefore, the success of music interven-
tions may be greatly enhanced by determining
STOUFFER, SHIRK, AND POLOMANO
patients' preferences, familiarity, cultural context,
past experiences, and perception of musical struc-
ture, dynamics, and tempo. Both empirical and
research-based information indicate that the effec-
tiveness of music interventions can be more
positive if specific music selections are based on
preference rather than preselected (Christenberry,
1979; Grasso et al., 2000; Keller, 1995; Rider,
1997). Familiar music and recognizable melodies
incorporated into the hospital setting offer a
safe and comforting environment for children
(Kallay, 1997; Loewy, MacGregor, Richards, &
Rodriquez, 1997). Additionally, preferred music
can reestablish a sense of control in an environment
that may be unfamiliar to a child (Davis, Gfeller, &
Thaut, 1992).
Humpal (1998) surveyed music educators, music
therapists, and early childhood educators, and
subsequently compiled a list of songs thought to
be familiar to and favored by children aged
≤ 6 years. A comparison of these findings with a
list of 42 perceived favorites of the general U.S.
population generated through the Music Educators
National Conference matched only 25% of songs
identified by those who work specifically with
children. These findings support the need to
determine the music preferences of individual
children, particularly given that approximately
75% of songs that educators thought were popular
selections were not familiar to young children.
Popular music selections identified from the
literature must be evaluated in the context of
culture, ethnicity, and religious background. For
infants and children who cannot choose their
favorite tunes, it is important to rely on parents or
primary caregivers to provide this information. Pain
and anxiety were reduced among children in an
emergency department whose parents selected
familiar music when the child was unable to
communicate (Berlin, 1998). Favorite titles selected
by parents, which were tracked from experience
with music therapy in a pediatric intensive care unit,
included the following: Jesus Loves Me; Twinkle,
Twinkle Little Star; You Are My Sunshine; Barney
Song (I Love You); Itsy Bitsy Spider; Brahm's
Lullaby; Rock-a-Bye Baby; and Jesus Loves the
Little Children (Stouffer & Shirk, 2003).
Adaptations of Music
Adapted music recordings ensure a smoother
transition from song to song and maintain consis-
tency while being easier to administer in routine
practice. For prescribed selections and presentation
GUIDELINES FOR MUSIC INTERVENTIONS WITH PEDIATRIC PATIENTS
of music to achieve their greatest benefit on
physiological outcomes, requirements for sedation,
and emotional responses, the developmental stage
of infants and children must be considered. Stouffer
and Shirk (2003) presented a strong case for the
involvement of trained board-certified music thera-
pists to assist nursing staff with applying principles
of music therapy. Music therapists are consulted to
help determine appropriate selections and varia-
tions of music for achieving intended outcomes.
More important, music therapists offer expertise in
establishing tempo, rhythm, range, and instrumen-
tation for adapting and administering music, as well
as for establishing controls for extraneous variables
such as ambient noise. Music applications should
be performed in accordance with acceptable
evidenced-based guidelines, as opposed to ran-
domly playing prerecorded tapes and CDs.
Methods for Delivering Music
Therapeutic music can be administered in a
variety of ways, and many effective methods for
music interventions are cited in the literature.
Hospitalized patients with cancer who are exposed
to live singing with guitar reported significantly less
physical discomfort and reduced tension and
anxiety than patients listening to prerecorded
music (Bailey, 1983). Interactive music therapy
increased coping behaviors among hospitalized
children in isolation on oncology units as compared
to control and reading conditions (Robb, 2000).
Many creative approaches involving interactive
music that facilitate more participatory involvement
of children in music therapy have provided
significant benefits over general interventions
involving simply listening to music. Improvements
in children's ratings of mood and parents' percep-
tion of play performance were observed in
hospitalized children with cancer (Barrera et al.,
2002). Even songwriting has been used to help
children with cancer cope by becoming more
relaxed, by feeling more in control, and by
experiencing better mood (Robb & Ebberts,
2003a, 2003b).
Parents and primary caregivers should be active
participants in planning and implementing music
interventions during routine clinical care. Research
with infants in a neonatal intensive care unit
(NICU) involved parent training in music and
multimodal stimulation, which decreased infant
stress behaviors, whereas parents demonstrated
more appropriate actions and responses to their
infants (Whipple, 2000). Music combined with the
453
voice of the mother can also be considered an
acceptable variation of music therapy (Brackbill,
Adams, Crowell, & Gray, 1966; Kagan & Lewis,
1965; Standley & Madsen, 1990; Standley &
Moore 1993).
Presentation of Music
Protocols for presenting music to newborns and
premature infants have been evaluated (Cassidy &
Ditty, 1998). The most frequently used modes
include free field (played openly in the environ-
ment); the use of equipment such as chairs that
provide vibroacoustic stimulation (simultaneous
auditory and tactile; e.g., Somatron recliner);
listening aided by ear muffs, earphones, and
headphones; or live music. Although live sessions
with a music therapist are most effective, this may
not be possible in settings or institutions without
access to these trained professionals. Therefore,
audiotaped musical selections can be used. The
decibel level of musical stimuli should be within the
range of 35–85 dB, with most audible levels
between 60 and 80 dB. The use of headphones has
several advantages, particularly in critical care
settings, including the following: improved hearing
at the acceptable decibel level, attenuation of
ambient noise, binaural presentation of stimuli,
and lack of effect on other patients.
Evidence-based information is available to guide
the sequencing, duration, and frequency of music
interventions, but no hard and fast rules apply. For
short-term sedative or calming effects, exposure to
audiotaped music is most often about 20–30 min-
utes per session (Caine, 1991; Cassidy & Standley,
1995; Chlan, 1998, 2000). Still, wide variations in
the length and frequency of exposures are reported
across studies, clinical settings, and patient popula-
tions. Limited information on the lasting or carry-
over effects, if any, of music sessions is available.
Controlling Environmental Noise
Noise in the environment must be considered
when planning music therapy interventions because
background noise can interfere with the effective-
ness of music stimuli even when earphones are
used. Loud noises, including persons talking or
laughing and music that is too loud or too fast, can
contribute to increased stress levels, especially in
critical care units (Lewandowski, 1992). Ambient
noise levels can have negative effects on blood
pressure (McLean & Tarnopolsky, 1977) and
the vasoconstrictor angiotensin II (Dengerink,
Wright, Thompson, & Dengerink, 1982). The
454
Environmental Protection Agency and the Interna-
tional Noise Council recommend a 45-dB limit for
daytime noise in clinical areas; however, a review
of studies related to noise pollution in health
care settings estimated that sound levels in various
areas of hospitals range from 10 to 47 dB higher
than the recommended level (Cabrera & Lee,
2000). This upper limit was determined from
tests both in operating rooms and in critical care
areas. Cabrera and Lee emphasized the importance
of first measuring ambient noise levels and then
controlling for or masking extraneous noise
with adjustments in the decibel levels of music
therapy interventions.
RESOURCES FOR DESIGNING PRACTICE
GUIDELINES
Resources to help design or adapt practice
guidelines for music interventions are available
for nurses. Klein and Winkelstein (1996) provided a
guide for the use of therapeutic music with pediatric
populations that emphasizes the importance of
considering the developmental stage of patients
when selecting music interventions and achieving
desired outcomes. They also encourage nurses to
seek advice from music therapists to employ more
formal music therapy techniques. Partnerships with
board-certified music therapists, if available, can
greatly support these efforts and ensure that
procedures are aligned with accepted standards
established by the music therapy discipline.
Although not all institutions employ board-certified
music therapists, nurses can obtain resources from
the AMTA (2006) Web site. The AMTA national
office staff provides clinicians with a current list of
local qualified music therapists free of charge by
e-mailing the organization at findMT@musicther-
apy.org. A number of journal publications specific
to music therapy, such as Music Therapy, Journal
of Music Therapy, and Music Therapy Perspec-
tives, provide up-to-date research and clinical
information on the application of music interven-
tions and music therapy. The AMTA also compiles
reference guides and texts with scholarly research
on the therapeutic use of music and highlights
REFERENCES
American Academy of Audiology. (2000). Joint Committee
on Infant Hearing year 2000 position statement. Principles and
guidelines for early hearing detection and intervention programs.
Retrieved on July 7, 2006, from. http://www.audiology.org/NR/
rdonlyres/FCBA163D-8A22-4854-A73C-ED694EF8ED23/0/
jcihearly.pdf.
STOUFFER, SHIRK, AND POLOMANO
books that include chapters relevant to pediatric
populations (Dileo, 1999b; Maranto, 1991). A list
of extensive research-based references published
by the AMTA can be found on their Web site. Two
excellent textbooks published by leading experts
on music therapy summarize the state of research
and practice with premature infants and evidence-
based practices with pediatric populations (Robb,
2003; Standley, 2003).
IMPLICATIONS FOR PRACTICE
Although questions regarding “best practices”
for music interventions (e.g., musical selections,
mode of presentation, and the duration and
frequency of sessions) still remain, establishing
networks with the music therapy community is a
way to bolster the use of music as a complementary
and alternative approach to calming, relaxing,
distracting, sedating, and relieving pain. To date,
no convincing data indicate any deleterious effects
on patient outcomes. Even with critically ill
children, reports of auditory-evoked seizures or
any other negative side effects associated with
exposure to controlled music interventions are rare
(Zifkin & Andermann, 2001). More work is needed
to refine research-based approaches and to apply
them in routine clinical practice. Although some
complementary and alternative therapies have not
been subjected to scientific scrutiny, the field of
music therapy has expanded into a discipline based
on scientifically derived practices and proven
benefits. The use of music in clinical settings has
moved beyond the limited framework of intermit-
tent entertainment, unstructured diversion, and even
purposeful use of randomly chosen music selec-
tions, to a more systematic and methodologically
sound application in practice.
ACKNOWLEDGMENTS
The authors are grateful to the Children's Miracle
Network, Children's Hospital, Penn State Milton S.
Hershey Medical Center, and The Arthur Flagler
Fultz Research Fund of the AMTA for their
grant support.
American Music Therapy Association (AMTA). (2006).
Retrieved on September 15, 2006, from http://www.music
therapy.org.
American Speech–Language–Hearing Association. (2006).
Status of state universal newborn and infant hearing screening
legislation and laws. Retrieved on September 18, 2006,
GUIDELINES FOR MUSIC INTERVENTIONS WITH PEDIATRIC PATIENTS
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