If music be the food for premature babies, play on

On first listen, a pacifier that plays music to your baby sounds like just another product to put in the “useless baby stuff” file along with the Diaper Genie, the Wipe Warmer, hard–soled shoes, and infant hairbrushes. But for some babies, the Pacifier-Activated-Lullaby or PAL apparently has real value.

Some babies, especially those born prematurely, have great difficulty sucking and swallowing, making feeding at the breast or bottle difficult or impossible. Traditionally, these babies have been said to have a “weak suck”; however, in most cases, it has little to do with strength. The problem is a co-ordination issue: until premature babies reach 34 weeks gestational age, their brains have not developed the ability to coordinate sucking and swallowing.

Other babies, especially those on a respirator, develop an “oral aversion” and resist having things put in their mouths. It is not difficult to imagine that being intubated, which involves having a plastic tube inserted in the mouth and down the windpipe allowing air into the lungs, might make babies weary of having things in their mouths.

When these infants are ready to start breast feeding, it can often take a while for them to get over their aversion or develop the coordination to suck and swallow properly. Since a baby’s weight gain, and therefore general health, is dependent on feeding, good breast or bottle skills are very important. Moreover, until a baby learns to breast or bottle feed, they must stay in the hospital getting their nutrition through a feeding tube.
Pacifier-Activated-Lullaby

“I wondered if babies could be taught to feed properly with the right reinforcement,” says Dr Jayne Standley, a music therapist working at Florida’s Children’s Hospital in Orlando. Dr. Standley spent ten years developing the musical pacifier and conducting studies on its ability to teach babies how to coordinate their suck and swallow skills. “Turns out they will suck in return for the music.” Standley says premature babies at 34 weeks gestational age, who would normally spend another six weeks developing in the womb, respond and learn from the device in minutes.

PAL works like this: a specially-wired pacifier is connected to a small computer that contains a CD of female-voiced lullabies. When sensors in the pacifier detect the baby sucking properly, it instantly activates the CD player rewarding the infant with music. If the baby stops sucking, the music shuts off after ten seconds. When the baby starts sucking again, the music comes back on. In this way, the babies learn to suck, a lesson that is retained when bottles and breasts are given between the PAL sessions.

So far, two studies have shown PAL’s effectiveness at improving feeding and the device was recently approved by the US Food and Drug Administration for use with newborns.

“The main study showed that most babies with PAL training were feeding at twice the rate they were before, and better than babies who did not use PAL,” says Amy Cermak, a music therapist working at Florida Hospital’s Neonatal Intensive Care Unit (NICU) in Orlando. “Even after the first treatment you can see a big change in the feeding ability.” Another study showed the PAL trained infants gained weight more quickly and were released from the NICU sooner than babies not using PAL.

“If it works on improving sucking, swallowing, and breathing skills, I could see [PAL] could have value for premature babies who have yet to develop that coordination,” says Debbie Stone, RN and lactation specialist at Toronto’s SickKids Hospital, adding that this was a “unique group of patients”. Stone says in utero, many babies often swallow amniotic fluid and suck on their own thumbs and have mastered these skills on their own at birth. “Under normal circumstances, soothers should not be used until breast feeding has been well established.”

Cermak notes that since the device can be easily programmed, it can help with several different types of feeding problems. “Some babies can suck well but have endurance problems. For these cases, we gradually decrease the sensitivity of the device.” In other words, over time the baby has to suck a little longer for the music to begin which builds up their strength. “Once you know what the goal for the baby is, you set the function keys. It’s not that hard to learn to use [PAL],” Cermak says.

Perhaps not surprisingly, PAL has also been used to help relieve pain in newborns. Music therapy has long been under study as means for relieving pain. Moreover, what clinicians call “non-nutritive sucking” has been shown to reduce signs of pain in newborns. “We have used it to decrease pain after surgery,” says Cermak. “These babies don’t have to suck so hard to trigger the music and the music plays for longer than for a feeding. They become more calm and more pacified.”

Other studies validating PAL are under review and should be published later this year. In the meantime, several other hospitals are beginning to implement PAL programs.

Article from aboutkidshealth