Music Therapy as Procedural Support for Young Children Undergoing Immunizations

Children undergoing medical procedures frequently experience severe distress, which may be ameliorated through procedural support music therapy. Parent and nurse behaviors have been noted to influence child behaviors during medical procedures, yet no prior studies were found which examined the impact of procedural support music therapy on caregiver behaviors. The purpose of the present study was to examine the effects of a live, cognitive-behavioral music therapy intervention on the distress and coping behaviors of young children undergoing immunization, as well as the behaviors of parents and nurses. Participants were children between the ages of 48 and 72 months (N = 58) who underwent immunizations, as well as their parents and the nurses who administered the immunizations. Each parent completed a demographic inventory describing their child's previous medical experiences. The researcher classified children as "high distress" or "low distress" based on parents' responses to the demographic inventory. Parent/child dyads were then randomly assigned to receive music therapy (n = 29) or standard care (n = 29) during their immunization, with an equal number of high distress (n = 10) and low distress (n = 19) children assigned to each condition. Afterward, each parent rated their child's distress compared to previous medical experiences and rated the level of pain their child experienced on a scale from 0 to 10. All procedures were videotaped. Research assistants created transcripts from the videotapes of procedures. Trained observers watched the videos and labeled each child and adult behavior using the categories of the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). Child behaviors were classified as coping, distress, or neutral. Parent and nurse behaviors were classified as coping-promoting, distress-promoting, or neutral. Rates and proportions of child and adult behaviors were calculated. A series of Mann Whitney U tests revealed that, compared to children in the control group, children in the music therapy group showed significantly higher rates and proportions of coping behaviors during the preparation phase of the immunization (prior to the first needle injection) and during the procedure phase, p < .05. The two groups did not differ significantly in rates and proportions of child coping behavior during the recovery phase (after the final needle injection). Children in the control group showed significantly higher rates of distress behaviors during the procedure phase and during the recovery phase and higher proportions of distress behaviors during the procedure phase. The two groups did not differ significantly in rates of child distress behaviors during the preparation phase or in proportions of child distress behaviors during the preparation or recovery phases. Parents of children in the control group showed significantly higher rates and proportions of distress-promoting behaviors during all three phases of the procedure compared to parents of children in the music therapy group. The two groups did not differ significantly in the rates or proportions of parent coping-promoting behaviors during any of the three phases. Nurses who treated children in the music therapy group showed significantly higher proportions of coping-promoting behaviors during the procedure phase compared to nurses who treated children in the control group. The two groups did not differ significantly in the rates or proportions of nurse behavior during any other phases. There were no significant differences between groups in the lengths of phases of treatment, nor were there significant differences in parents' ratings of their children's pain. Parents of children in the music therapy group reported that their child's level of distress was less than during previous medical experiences, while parents of children in the control group reported that their child's level of distress was greater than in the past. Results indicate that a live, cognitive-behavioral music therapy intervention has potential benefits for young children, their parents, and their nurses during immunizations.