The outcomes that Rhythmix work towards and capture have emerged in the course of work in children and young people’s healthcare settings. Our intention to reduce anxiety and isolation and increase self expression is widely supported by the healthcare staff who have helped to shape and guide our work right from the beginning. They recognise both the need to address these issues as part of the care they offer and the effectiveness of live music making in meeting them. In this two part series we explore internal and external factors affecting our work in children’s wards and units and mental health units.

We’ve all felt it. You’re going through your day feeling a bit grumpy, maybe a bit ill or sad, and then a car alarm starts blaring. It get’s into your head. You get irritable, agitated, angry, distressed. We take it out on others, and you go from feeling under the weather to suddenly feeling a whole lot worse.

This is the everyday experience of a child in the pediatric Critical Care unit of a hospital. Dealing with an illness or issue that requires hospitalisation, a child is already feeling anxious, sad and upset. Then they have to contend with beeping machines echoing on plastic floors, the sounds of other people being upset or crying, hurried footsteps and the frequent ominous alarms. The sounds around a person in hospital only make a person feel less at ease on a ward. Coupled with the monitors, wires and apparatus around a hospital bed Critical Care Practitioner Janet Lee of The Alex explains “even our beds don’t look like beds and our tables don’t look like tables. There is little here to make the children feel safe”.

But Rhythmix’s Wishing Well team is making a change to handle both the internal upsets and external factors that make a hospital stay difficult, unpleasant and at times traumatic. By bringing live, interactive music making right to the bedside we are helping improve the experience for children in hospital.

Internal Factors

Amongst the internal factors making a stay unpleasant, babies born in hospital who stay for a long period of time often find it difficult to create attachments to a primary caregiver. This can lead to a lack of resilience and mental health issues in later life. Disabled children spending long periods of their early years in hospital also learn to associate adults with pain and lack of communication due to often being spoken about instead of spoken to. Additionally, family bonds can become strained as there are few opportunities for activities that normalize positive family interaction and activities.

Helping disabled children in hospital develop even very preliminary music skills can help build internal strength. Our Wishing Well musicians help children make music, and families are encouraged to respond with mirroring or complimentary sounds and communication, and encourage and praise any self-expression.

Music making can also be instigated by child or parent as a way of reducing anxiety or loneliness in the long term by providing an ever-present tool that can be used at any time. This allows children to connect to their family in a way that can be carried on at home, or in the hospital when Wishing Well musicians are not there.

A medical student from Brighton and Hove Medical School who observed our work in hospitals in 2016 as part of a placement recognised the rebuilding of internal family bonds thanks to music, explaining “When we go into a room, quite often the family seem disconnected. Parents might be on phones, children are often watching TV but as soon as we start playing music, the family come together. They physically move closer and start to connect more. Parents start to encourage the child and respond to whatever he or she is doing. Laughter breaks out and sometimes tears. The family is drawn together by music”

External Factors

On the external factors, music can distract and ease the pressure from the hospital soundscape and can distract from treatment. Children and young people frequently have medical procedures done to them such as dressing changes or injections. Some of these are uncomfortable, painful and distressing. One staff member commented in the staff survey at The Alex “They played music and engaged with child when I had to do a potentially painful procedure. The child was compliant and it made the child feel relaxed and they were calm throughout making a difficult situation much easier for child and family and staff. “

But what impact is music having in the long term on the young people’s lives? It’s hard to tell. Some of the children we work with have a very uncertain future so the best we can do for them is to have an impact on their wellbeing in the moment of the interaction. We hope that the sense of human connection and calm will stay with them but it is very difficult to collect data that supports an outcome over time with these children. They may experience a sudden change in their health condition that understandably over rides the work we have done with them an hour or two previously. At least some of our work is best evaluated in the moment.

Importantly though, we have an overwhelming amount of evidence from participants, families and staff in feedback, film and surveys that demonstrates just how effective live music making is in reducing anxiety and isolation. When a child has a complicated picture of health, and the future is uncertain, any opportunity to make a period of time better should be relished.

When the external factors such as soundscapes and procedures are distressing, and internally family bonds and communication are weak, music is the tool that can address both of these simultaneously whilst forming happy memories and musical skills.