Music may help distract kids from painful IV procedure

Music can help distract children who are about to undergo painful procedures in a hospital emergency room setting, a new Canadian study suggests.

The work found that children experienced less distress and pain while having an intravenous line inserted if music was playing in the treatment room. And health-care providers reported they found it easier to set up the IV line when their young charges were distracted by tunes.

"I would hope that people continue to use and investigate music as one means of helping children handle painful and distressing procedures," said lead author Lisa Hartling, who is director of the Alberta Research Centre for Health Evidence at the University of Alberta.

The work was published Monday by the journal JAMA Pediatrics.

There have been a number of studies that have looked at whether music can play a role in reducing the pain and anxiety children experience when they have to undergo medical procedures.

In fact, Hartling and her group conducted a systematic review — gathering evidence from 19 such studies to look for trends. They concluded that more research needs to be done to explore music's potential in different clinical settings and with different types of medical procedures.

In this study, they looked specifically at children who were having an intravenous line set up in the emergency room. A total of 42 children between the ages of three and 11 were enrolled in the trial, with half undergoing the procedure without music and half hearing music while the IV line was being inserted.

The children who listened to music had no hand in selecting the tunes they heard. The four songs used were selected by a music therapist, who deliberately chose a mix of music that included selections that might have been unfamiliar to the children.

The idea, said Hartling, is grounded in the principles of distraction.

"What we're trying to do with these kids is distract them away from what's causing them pain or distress. So her feeling was that these songs that may not necessarily be familiar to them may be more distracting, actually, than a familiar song," Hartling said in an interview.

She admitted she was taken aback by choices: The Planets Op. 32 Jupiter, a lively classical composition by Gustav Holst; Storms in Africa, by Enya; the novelty song Disco Duck and the Sesame Street theme song, Sunny Days.

"I was expecting to hear the typical kids' songs or what they would hear on kid-friendly shows or whatnot. And they were very different. I was very surprised by what she had chosen."

Assessing pain

Children in the study were asked to assess their pain using an established tool — a series of photographs showing faces in varying degrees of pain. Children were asked to point to the face that best reflected their level of pain at the time.

Those assessments were taken before the procedure began, after the first attempt to put in the IV line and after the procedure was completed.   

The children were also videotaped while undergoing the procedure. Independent observers who did not know which children heard music and which did not watched the videos and assessed their level of distress based on standard scale, noting things such as whether the children were crying, fidgeting or seeking comfort.   

Interestingly, the researchers initially saw no differences between the two groups in terms of the level of distress. But that was being influenced by the fact that some children were not distressed by the situation, the researchers said. When those children's responses were removed from the mix, the children who listened to music were judged to be suffering less distress.

The children's own assessment of their pain levels went up in the children who didn't listen to music but did not among the children who heard the tunes.   

The health-care staff conducting the procedure appeared to feel the music made their jobs easier, with 76 per cent who treated the children hearing music saying the job was "very easy" compared to 38 per cent of staff treating children who didn't listen to music while the having the IV line put in.