Lullaby for Pain Management in the NICU

By Kimberly Woodman

There has been a substantial amount of research conducted within the last 20 years relating to the use of music within the NICU context, both by music therapists and other medical professionals. Researchers have shown that music may be beneficial for decreasing stress symptoms, crying, and the length of NICU stays. Furthermore, music may be used to increase vital signs, coordinate sucking and feeding behaviors, and weight gain. These outcomes indicate that music therapy may be an incredibly beneficial intervention for premature infants. Researchers have also sought to identify whether recorded or live music is most effective in producing positive outcomes, with live music showing a greater effect on both physiological and behavioral characteristics of the infant and social bonding behaviors between infant and parents (see Ullsten, Eriksson, Klässbo & Volgsten).

A 2017 study by Ullsten, Eriksson, Klässbo and Volgsten looked at the use of live lullaby singing for managing pain relating to venepuncture in two premature infants. Lullaby singing was chosen specifically because of its repetitive and predictable structure, as these and other features have been shown to be more effective than infant-directed speech at helping infants regulate their stimulation levels.

Both infants acted as their own controls within the study, each experiencing one venepuncture with standard care alone and one venepuncture with standard care plus the live lullaby singing protocol. The procedures and interventions were video recorded and then subjected to microanalysis using qualitative measures that identified the layers of effects from the treatment (either standard alone or standard with live lullaby singing), as well as a quantitative microanalysis of the two infants’ responses using the validated Behavioral Indicators of Infant Pain (BIIP) assessment tool.

For both infants, there was greater physiological stability throughout the procedures that included the live lullaby singing. The venepunctures that employed live lullaby singing also were shorter in total duration for both infants and required only one needle puncture as opposed to two punctures in the standard care protocols in order to get enough blood for the necessary testing.

The results of this study are promising; however, the major limitation is the sample size of two infants. It would be beneficial to see this type of study conducted with a larger sample of premature infants in order to provide stronger data about this type of intervention. I would also like to see more controlling of possible confounding factors, such as the presence or absence of one or both of the parents during both procedures, the structure of the prelude music leading into the lullaby, and the environmental factors such as outside noise and interactions with the nurse performing the procedures.

This study, combined with other available research findings, does suggest that live lullaby singing could be very beneficial in helping to manage procedural pain in premature infants. The authors of the paper also discuss a potential strength of this approach in involving the parents or caregivers in the actual singing. It would be interesting to see a study examining whether or not having the lullaby sung by a parent or primary caregiver has any impact on the effect of the intervention as compared to having the lullaby sung by the music therapist.


Ullsten, A., Eriksson, M., Klässbo, M., & Volgsten, U. (2017). Live music therapy with lullaby singing as affective support during painful procedures: A case study with microanalysis. Nordic Journal of Music Therapy, 26(2), 142-166. doi: 10.1080/08098131.2015.1131187