Music therapy and children in hospitals

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Monica Logan | 02/12/2020

It is estimated that about 750 children aged 0-14 are diagnosed with cancer each year in Australia, with almost half of the children being aged 0 - 4 years at the time of diagnosis. For those children and their families, diagnosis triggers long and regular stays in hospital and a whirlwind of activity in which time to be a regular kid is often forsaken. Hospital music therapists can help give sick children an opportunity to ‘play’, making them better able to deal with the challenges of survival.

Music therapy can help minimise trauma and disruption to a child's life in hospital

At children’s hospitals, music therapy can be an effective way to help minimise the trauma and disruption to a child’s life that hospitalisation often brings. Because the context of their work is ‘play’, music therapists are often the key to getting a sick child to ‘comply’ with instructions - for example, about taking medication or completing repetitive tasks to help the child strengthen and rehabilitate after surgery.

For example, strumming a guitar or shaking a percussion instrument can be an effective - and child-friendly - upper-body exercise. Sometimes music therapists work around songwriting, to help a child to process feelings which might be difficult to talk about. In neonatal units music therapists work with parents and babies to support a positive hospital experience in a time of high stress. Music therapy may also help children by reducing anxiety, fear, anger, agitation, distress and sadness. It can assist with coma arousal, too. Some hospitals have extensive music libraries and can lend instruments or recorded music to patients and offer therapeutic music lessons.

What we know about music in children's hospitals

“There is increasing evidence (from research in positive psychology) that suggests focusing exclusively on what is wrong with people is not as powerful as building on people’s strengths. Although it is necessary for some team members, such as surgeons, to focus on intervention, treatment is not only about fixing what is broken, but needs to be balanced with nurturing what is best. Music is increasingly being seen as a health resource that re-establishes connections with what is strong about a person, beyond their diagnosis. Psychological empowerment can result from encouraging people to share existing preferences for music. This returns the psychological control to the ‘sick’ person who is able to express what has been ‘well’, resulting in improvements in confidence and self-belief. Moving from sharing music listening to active participation in music making increases possibilities for self-expression by focusing on the child’s future, as well as existing, resources. The importance of playful, age-appropriate experiences has been shown to limit developmental deficits that can result from illness during childhood. Music encourages play that is meaningful and emotional and strengthens the relationships between children and their family who support them to grow, even during illness.”

Dr Katrina McFerran, University of Melbourne

 

CASE STUDY

Bedside music - how music therapy helps sick children in hospitals

“When they get diagnosed with cancer, children don’t always have time to process what’s happening to them,” says Louise Miles senior music therapist on the Oncology Unit at Perth’s Princess Margaret Hospital for Children.

“Things happen so quickly for them. They become the centre of a world in which everyone is very much focused on how sick they are. As music therapists, we work from a wellness model. The child has a cancer diagnosis, but that’s not all of who they are. Within their limitations, they can learn to make music, just like any other child. Music making can give them a sort of quarantined activity that’s unrelated to the fact that they’re unwell.

When Louise first met Jack*, then 6 years old, she encountered an already “introverted and shy young man” whose experience of cancer and its treatment had made him even more so. Jack was about to undergo specialist, high-risk surgery to remove a tumour in his brain.

“He had lost much of his expressive language capability at that time due to the position of his tumour so we used a lot of songwriting as a way of enabling him to express himself,” recalls Louise. “Music is such a familiar language for children and it gives them a chance to work through things at a kind of distance. The biggest thing to remember about children under stress is that play is preferable to talking. Writing a song that’s about ‘a little girl and the things that happen to her’ gives a child a safe way of communicating deeply personal things that can be tricky to talk about.”

After surgery, Louise used what she knew about Jack’s love of music to reconnect. “I knew he enjoyed participating in music at school and was approaching the age when he wanted to start to learn a musical instrument. So that became my starting point after surgery: playing the keyboard with him and, later, helping him to learn to play the xylophone. In our first session barely a word was spoken but Jack was able to participate in quite complex improvisations on the keyboard. What stood out for me from those early sessions was his determination to keep playing and creating despite other difficulties. Music therapy can be very powerful in helping sick children form an awareness of their own strengths and develop resilience. That’s important as they prepare for what’s coming next.”

Jack’s playing led to guided songwriting. His first song, ‘the garden song’ was used by others in the care team at the hospital to help monitor his post- surgery speech and language function as he travels his journey of recovery from cancer. The instrument playing is also a non-threatening way to support use of upper limbs in this rehabilitation.

As the hospital’s senior occupational therapist, Ranita Sidhu is a big fan of the benefits of music in the care of sick children: “I think it lends itself especially to engaging and communicating with pre-verbal and young children in a special way through the use of rhythm, tone, intonation and all the gifts that lie within music. It is intrinsically healing. When it’s used skillfully and therapeutically it really is magic.”

Three years on and Jack is still using music and his sessions with Louise to help him cope with his loss of function and his awareness of being different from his peers. Music gives him an opportunity to be playful with his siblings and mum or dad as some light relief from the seriousness of his treatment.

“His mum once told my colleagues that music is the one thing that Jack looks forward to about coming to hospital. I watch the gains he’s making through music with things like memory, speech and cognition and I feel good about the role the music therapy plays in that. He’s learning the guitar now and I’m helping him with things like the positioning of the instrument, given his physical limitations, so he can play. These days, his sessions also seem to be giving him an important outlet for processing his hospital and treatment experience. He’s a much more outspoken young man than the shy child I first met!”

*Not his real name