Musical Interaction in Children's Hospitals

Musical Interaction in Children's Hospitals

Drawing by Cianna 6

April 2019 207 patients

There are three basic types of infection control isolation in a hospital. One is simple contact which can be cleaned with soap and disinfectant wipes. Another is Special Contact which involves C-diff and needs a special soap to clean. If I go into one of these rooms I have to gown up and be extra careful not to touch anything. The third category is airborne or droplet. Gowning up, in this case, involves a face shield to include protection for the eyes. Unfortunately, there is no protection for a guitar which means I cannot bring it into these rooms. So if a child I am working with goes on droplet isolation I have to stop seeing them. Older patients may understand the need, but young ones have no idea. They only know that I no longer visit, and so in effect, I have stopped being their friend.

It becomes even more difficult in a current situation I am dealing with, where the mother, the only caregiver, does not speak English. I met this family over a year ago when the boy was one. Language is no barrier when you’re having fun and this child loved the guitar. He would pull it over to him and start strumming on the strings. Week after week for months we would play music together. He was so good at handling the guitar that I got him a ukulele. But he had just gone on droplet, so I had to give it to mom and discontinue my visits. I’d see her in the hallway and I think she understood, but it was difficult for her because there was little support and no visitors for this child. I’d also get to say hi in clinic, but they were momentary pass-bys.

Then, last week, he was off all forms of isolation. At this age (2 now) he is so full of new memories that at best he has forgotten me. I’ve worked with older children where the relationship completely changes because I’ve “ignored them” for too long. Now I’m back in the boys room and he is very hesitant to interact, as he is so used to being alone. I sing some songs and show him the touch guitar, which he shies away from. Mom offers me a chair, so I sit by the bedside and continue singing. He finally tries the touch guitar and likes how it makes sound. He then becomes more relaxed and playful. The moment I know I’ve broken through is when he starts showing me his trucks. Now we are playmates again and we alternate between revving truck engines and singing songs. I also show him how the trailer attaches to the cab (as it keeps coming off) and how it can be wound up to drive across the floor.

The session was a bit long in order to rebuild trust. A most difficult part of this is finding the right time to leave without disappointing him again. Fortunately, he starts getting tired, so I hand him some stickers hoping that will help as a distraction. He is a bit dejected, but does say bye. Hopefully we will be able to continue our re-found friendship and he can enjoy being the happy, playful boy he should be.

March 2019 174 patients

A 5-year-old is in bone marrow transplant, which means I get to see him every week for at least a month, and then usually in clinic for another year. He has a unique sense of play and music. While constructing his intricate lego characters he is asking questions and making comments about the pieces. They are not your ordinary buildings and large scale designs, but rather copies of animations he sees on youtube. (As a side note, it is curious how youtube is a major input of what children know these days, and therefore very difficult to keep up with). Many times he is making faces with layered masks, and he delights in how they intersect. So there is the banter that most good sessions will have. But then, out of the blue, he will start singing while concentrating on his handiwork. He has a beautiful perfectly pitched voice that will sometimes even go into falsetto. Most of his songs are from what he’s heard on youtube, though I think he may also be improvising with stories of his own. So I get to follow his melodies and jam along and we come up with some surprisingly nice duets that you would not expect for someone who is just 5. And no matter how long I spend with him, he always questions me when its time to go and I have to convince him that I will return next week to do this again.

Feb 2019 174 patients

I’ve been singing “Wheels on the Bus” to pre-schoolers for 30 years. Usually the part where the baby cries “wah, wah, wah” gets the children to smile or giggle.
This last week I got a very different unique response. The two-year-old I was singing to handed me her bottle and was not satisfied until I actually took it (and pretended to drink from it)! So instead of laughing at pretend crying, this child attempted to comfort me the same way her mom would for her. I was quite impressed.

My Tuesdays with oncology patients go through phases, depending on the severity of the situation and also how many children need to spend at least a month in their rooms for bone marrow transplant. This month I’ve had to spend extra time with them, including a 5-year-old who I first met in clinic, but is now in Intensive Care and has not woken up for two weeks. The parents really appreciate the attention and I try to reassure them that a sleeping child can hear conversations and singing which get assimilated into their dreams. Since each child and family I’ve worked with expect me every Tuesday, those days have been extra long this month.

Dec 2018 100 patients

When I have a list of bedside patients I prioritize the order of visits with a few criteria. Usually I will see anyone on contact precautions later, as one of my infection control practices. Nurses may also let me know of someone in immediate need. A prime determiner, though is if I hear crying. This time it turned out to be a 2-yr-old who was getting an IV placed. They were working on a second attempt when I arrived, and she was not happy about it. But as soon as I strummed the guitar the mood changed. She forgot about the technicians and looked over at me. For a little while I was able to keep her attention. This means she wasn’t struggling, which makes IV placement easier. That worked for a short time, until a bit of pain reminded her what was going on. A change of songs with some silly sounds helped again, but now they had to move the placement to the foot. No fun at all, and her screaming returned. Most of that response is from fear which makes small pains feel worse, and just from being restrained - which no-one likes. So all I can do is sing gently in the background and let her vent her frustration. But she is relaxing and becomes calmer, and the IV gets placed successfully. Once again, the music is the center of her focus. The Techs leave, telling me that the music made the situation easier. Now it is just us two musicians (and mom, who has been laying by the child’s side and comforting her the whole time). The girl points to the touch guitar in my bag and lets me know she wants to play it. Now we are jamming! She’s not very good with words yet, but that does not stop her from heartily strumming the plastic guitar and mouthing the words to twinkle twinkle and itsy bitsy. I’m there for about another 20 minutes, and when I sing a cartoon song she wants to switch to her tablet so she can watch that show. We wave good-by, I get a kiss thrown at me, and I move on from a girl who has already forgotten her trauma, to another child (who is probably just bored and wants some company).

Nov 2018 202 patients

Sometimes a child is too sick to interact and just needs to sleep. Most times that means I will move on to the next child. There are instances, though, that would mean missing a patient who really appreciates music time. An 11-year-old girl who has put a few stickers on the guitar over the years, and for whom I’ve learned a couple Spanish songs is such a person. I passed her by a few weeks in a row before deciding that she needs the music awake or not. So with her mom’s permission I have spent the last few weeks sitting at her bedside, singing songs to her dreams. From personal experience I know that sounds get incorporated into what our mind is doing while we sleep. My hope in this situation is that she sleeps deep and enjoys her dreams so she can wake refreshed and happy.

Sept 2018 155 patients

We waved to each other as she was leaving the week before we actually met. Her Grandmother had also heard me working with another patient that day, and mentioned how much this 3 yr-old girl loved visits from the music therapist at the hospital she transferred from. Turns out the woman who runs an art program from Sunshine Day Camps had worked with her at the other hospital, and also recommended me to her. She was not feeling good and therefore was in one of the few clinic beds situated under a large window which revealed a very rainy day. I kept my distance while singing a few songs of rain. She was curled up in her blanket while watching and listening. Her grandma requested “Somewhere Over the Rainbow”, so I retrieved the lyrics out of my bag and the girl let me put it on her bed to read. She then began having some fun. At first it was her feet grabbing my paper to make it magically disappear. Next it was strumming the guitar with her toes. (That’s a move I’ve seen before which allows the child to react to the guitar while keeping some distance.) So I made up songs about toes on guitars and we laughed and enjoyed ourselves. Grandma said this was the first time that day she relaxed and responded to anyone, and later was talking to the nurse about how long she lasted without needing pain meds. And so begins a journey at a hospital which enCourage Kids supports that will take many art and music sessions to help this girl pull through.

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.