Musical Interaction in Children's Hospitals

Musical Interaction in Children's Hospitals

Drawing by Cianna 6

Aug 2018 267 patients

Waiting rooms are a unique experience at LOH and on a busy day there can be a number of different interactions. Sometimes I’m still in the hallway when I see a patient I’ve worked with before. On this day it was an older teen boy. We spend a little time chatting and even though he is non-verbal he appreciates someone talking with him as a person with intelligence and feelings. He wanted a song so I pull out the guitar and though focused on this one patient, I’m still aware of and acknowledge others passing by and watching. I then move into the waiting room and edge closer to a watching two-year-old. Everything is done slowly with mellow playing so as not to startle anyone. The room seems full of two-year-olds with a few even dancing to the music. I squat down and give each one a chance to touch the guitar, strum the strings and help play a song. One slightly older boy is hanging around the fringes, obviously interested, yet reluctantly shy. I sit down and lay the guitar on my lap, showing him how to use a finger to strum or a hand to use the guitar like a drum. He finally comes over and after a few hesitant tries he begins some nice strumming with his left hand. Now he does not want to stop. As I tell older schoolchildren, metal strings are harder than finger skin; there’s only so many times you can strum before the finger gets raw. Having worked with OT over the years I know to encourage use of the weaker arm, and after a few attempts get him to continue the strumming with the other hand. He would still be playing if the therapist had not come out to start his session.

Then three school-age sisters, whom I worked with on the inpatient floor over the past month, arrive. We head to the back table and each one vies for their turn at playing. They’ve all learned how to change a note while keeping the beat, and each wants to spend as much time demonstrating their expertise. The parents have already succumbed to the need of buying both a guitar and a ukulele for the girls to play at home. A few other children gather round and so the frog percussion comes out to give everyone something to play. I apologized to the receptionists for the cacophony that has ensued, and they are all quite understanding. All in all it a long journey from one end of the waiting room to the other.

Dec 2017 151 patients

I started providing music for hospitalized children while getting a diploma in music performance with a private grant for a Long Island childrens hospital in 1987. I learned Twinkle Twinkle for the interview and found rapport with children of all ages. So I became 'Artist in Residence' in the Child Life department and started making rounds on the various floors twice a week. That meant I saw extended stay patients often; using music to engage them while developing an encouraging relationship. One day I enter the oncology floor and a 4 yr old boy sees me at the other end of the hall. He runs to greet me and I squat down to return his hug. He shows me a sticker, which I compliment, and before I know it he has placed it on the nice flat clean guitar front. I was a bit taken back, yet all I could do was graciously accept it, since he was so pleased to have it there. Of course that meant this initial sticker has to stay, being used as a reference point for our continued relationship. Now other children see it there and want to place their own.

Each child becomes a part of the guitar and the stickers are adding a colorful dimension which engages younger ones. Also, this sticker collage, having been 'designed' by their peer age over 25 years, has a relevance and a familiarity to new patients. (Familiarity in a potentially scary environment is a major tenet of my work.) There is the exploration aspect with toddlers reinforcing word associations and school age children finding object relationship. Interestingly it's also a reference for requested songs; indicating what the next song should be about by pointing to an image is easier than remembering and naming known songs. I'm working with a 4 yr old boy for whom I have to make up a dozen songs in Spanish every week because stickers is our common language. A few times song lyrics were asked to encompass groups of chosen stickers. On top of all that the guitar has become a great conversation starter with older teens.

So the over 400 stickers covering the guitar was unintentional, but has become a great tool in engaging patients, which in turn elevates their emotions.

Oct 2017 174 patients
The ER was relatively quiet at Wyckoff when I arrived, but one of the doctors asked if I would visit the child in a treatment room. She was a sobbing 4 yr old whose parents were trying to comfort. I usually keep my distance when a child who does not know me is upset, so I tried singing at the doorway. She initially looked, but a familiar song was of no help. Something else I try is handing the guitar to a parent which usually amuses the child, but not this time. Sometimes you have to know that you are not helping and it's time to move on. Which I would have done except that the IV team arrived at that moment. This is when I can step into the background and instead of attempting to interact with the child just add a bit of soothing ambiance to the room. They lay her down and begin examining her arms for a good blood vessel to access. She is on her side and looks up at me. Amazingly she keeps her focus on the guitar, ignores the needle going into her arm and actually relaxes enough for the team to do their job quickly. Sniffling as she leaves the room she has nonetheless overcome her fear and is now ready to receive medicine that will make her feel better.

June 2017 175 patients
Interesting dilemma with a 4-year boy this month. First met him months ago and we had a few fun sessions together. He then went on droplet isolation which meant we had no interaction for over a month, and a child who doesn't understand isolation can feel forgotten. When I next saw him he was feeling miserable and didn't want any company, just wanting to lay in bed snuggled up to mom, who was always there for him. After that I decided if we couldn't interact I could still sit in a corner of the room and play, which he found acceptable. The second week I tried singing too, but that made him whine uncomfortably. The following week he began crying when I started to leave, so that guitar doodling session was extended. He nodded when mom asked if he liked the music. We then had a few times together when he was more responsive, but would get very mad when I did not understand his song request. Problem was it was in Spanish with a whiney tone and sometimes with a bobo in his mouth. But when I finally figured out what he wanted we had a great time singing. Last time he had the plastic guitar slung on his shoulders while he rocked, or we played with his toys. I'm working on my Spanish, so I can still say something even if I don't understand. He does get very frustrated when I don't. As I was gathering my stuff to go, he had crawled on his mom's lap and then showed me a bear which will repeat anything you say. We have fun with making it say his name and other sounds and I hand it back to him. He starts getting mad again. With mom's Spanish I realize he wants to give it to me. I try leaving it on the light above the bed, but he will not be happy unless I take it. So I hide it behind the Wii and make like I'm leaving with it. The aid comes out a few minutes later with it because he got up and searched the room and found it. Our re-found friendship demanded that I go home with it. But I can't take such a cool bear from a 4 year old. After discussing it with the nurses (while we all have fun with it echoing everything we say) we decide his nurse can slip it back to mom while he's not looking. Will he be mad at me next time for refusing his gift or can we just continue having musical fun? One way or the other I'm so happy to see him recuperate and enjoy life, and honored by his distinguishing me with such a gift.

Sept 158 patients
The mom told me this 7 yr boy was full of energy and liveliness two weeks ago. He had just come home from school with a 100 on his history test. When I saw him in PIC he was laying still with electrodes glued to his close cropped scalp. At that point there was no explanation as to why he collapsed, but later they discovered it was encephalitis. He had a Buzz Lightyear next to him in bed, so I gently sang "You've got a friend in me" from Toy Story. His eyes started moving to track me, and I showed him my Buzz & Woody stickers. He seemed to recognize the characters. I then showed him the spiderman stickers and sang the song. He was moving and responding to the music and both the mom and grandma were thrilled, saying they had not seen this much response since the episode. I continued singing and at one point helped him strum the guitar to link the tactile sensation to hearing and seeing. The music therapist, was watching the interaction and also expressed her appreciation. The fact that he could respond was a joy to the family, though unfortunately the boy's recovery will be a long process. This turned out to be the only patient I saw that morning, but made the hour long trip there well worth it.

Feb 116 patients
- verb: impart vigor, strength, or vitality to
- heighten or intensify - make lively
- to give someone more energy
- to make something stronger and more effective
It's a very applicable term to what goes on in some music sessions. This month a very lethargic 3 yr boy was carried into the treatment room and the doctor requested that I join them. As she talks to the mother I engage the boy who is slumped in her arms, by singing one of his favorite shows; 'Thomas the Train'. I then show him my Thomas sticker and he reaches out to turn the guitar to the back and points at a car while saying the word (with a bobo in his mouth). We explore the back for more car stickers and he becomes very focused. So I begin to sing 'Let's go riding in the car car' and do motions and sounds for all the steps needed to drive a car. Now he's sitting up, mom has removed the bobo, and he starts smiling and then laughing at the antics needed to drive a car. He has completely forgotten we are in an exam room. The doctor then requests 'Edelweiss' and she and the mom both sing along. The boy is now both relaxed and alert. They are able to lay him on the exam table while I continue to engage him with various songs. At the end he asks for his ipad to watch favorite shows, and is content. The doctor is very appreciative at how this is the first time he hadn't cried and struggled during the exam, and mom is grateful to have her boy energized and happy again.

Jan 78 patients
As I was about to knock on a door, the father walks up the hallway and asks if he can help me. I explain who I am and that I'd like to do some music with his son. He looks in the room at the 11 yr boy playing video games and says, "good luck with that!, there's no getting him away from the game console." I go in, say hi, and ask what he is playing. Then we talk about how almost all the music he hears is from games, and all of it without knowing who the groups doing the music are. I tell him about circuit bending orchestras that tour with only the sound that comes from game toys and consoles. He is fascinated. I tell him that I'm better at cartoon songs than game music, and he asks for a few. All in all we interacted for about 20 minutes with his game in pause. The father was amazed and very thankful. Even without noticing it, Music is an integral part of our lives.

June 113 patients
A few weeks ago L mentioned a specific child to me that was confined to her room for isolation. This 4 yr child spoke only Chinese. So I walked in and sang my two Mandarin songs and the mom and girl sang along. Then we moved into animal sound and lala songs, and at this point the child started helping me strum. This turned into duo improvising where I would copy her as she explored different ways to make sound on the guitar. All the while, for at least half hour (I do lose track of time in these sessions), she is laughing and singing her own words. The mom was very happy, telling me the girl was sad and bored all morning. I leave, hoping the good feeling will last and permeate the rest of her day.

Parents have told me many times that this is the first time their child has smiled or laughed in days. Yesterday, for the first time, a mother told me her child had not sat down all morning, as he sat for 20 minutes mesmerized.

Attached is a drawing made by a 6 yr child while I was singing to her. It does make a difference in their lives, and I love when they show it with smiles, laughter, and art.

July 146 patients
The month started with a continuation of the story about the 4 yr Chinese girl from last month. As an oncology patient she gets private time in the playroom. I arrived at the end of that session, and as we had become good friends over the past few weeks, she happily accepted the offer of going back to her room. So she grabs my hand and leads me there, mom in tow with the medicine machine pole. All sorts of music making and fun ensue and she has turned from shy into a talkative child, having picked up many english words over the weeks. The hardest part is telling your playmate that you have to leave, even after an extended session, but an exchange of stickers (Minnie Mouse is now on my guitar) and a hug from mom helps alleviate her sadness.

The next room is a 7 yr CP boy whom mom is having difficulty feeding because he is agitated. I make up a song about mashed peas and potatoes and his flailing slows. By the end of the session he is completely relaxed and mom was able to feed him, She told me it is the first time in days he has been that comfortable. 

In the PICU is a 3 yr asthma patient who immediately wants to help play guitar. He directs who plays which instrument and we jam. At one point I am squatting on the floor to sing at his level. He comes over and slips under my arm and the guitar strap and we rock out a few four armed tunes. Another very difficult room to leave.