Procedures such as cast application and removal, pin removal, and suture removal are often a source of anxiety for young children. But playing soft music in the cast room can be a simple and inexpensive way to decrease anxiety in young children, according to a team of researchers from Rainbow Babies and Children’s Hospital in Cleveland, Ohio. The results of their randomized, prospective study were presented by Allison Gilmore, MD, at the annual meeting of the Pediatric Orthopaedic Society of North America.

Measuring stress in children
Because their facility had a single cast room with two beds, researchers randomized by day rather than by patient, resulting in a smaller number of patients in the music group than in the no-music group. Of the 69 children in the Institutional Review Board-approved study, 28 heard soft lullaby music in the cast room, while 41 had no music.

The mean age of children in the music group was 5.6 years (range 6 months to 10 years); the mean age of those in the no-music group was 5.9 years (range 18 months to 10 years).

The team used two calibrated pulse oximeter probes to determine a child’s heart rate. Once placed, the probes were kept on the patient’s finger and later attached to the second machine in the cast room. Heart rates were measured at 15-second intervals for 1 minute in the waiting room, in the cast room, and after the procedure; during the procedure, heart rates were recorded at 15-second intervals for 2 minutes.

A single investigator received all consents and performed all pulse oximeter placements and heart rate recordings.

Soothing music works throughout the procedure
Lullaby music was chosen because of its universal appeal to young children. Volume was kept to a low ambient level to avoid distraction during interviews and to avoid distress in younger children.

Researchers found that the heart rate for children in the music group actually dropped as they went from the waiting room to the cast room, while it rose among the no-music group. Additionally, the music group experienced a lower increase in heart rate during the procedure. In the no-music group, seven children registered heart rate increases greater than 40 bpm from the waiting room to the procedure, while no children in the music group registered such an increase.

After the procedure, the patients’ mean heart rates decreased by 16.6 bpm in the music group, and 19.1 bpm in the no-music group (P=0.3).

“Both subgroups showed significant differences between the music and no-music groups for heart rate changes between the waiting room and before the procedure,” reported Dr. Gilmore.

The team did not find significant heart rate differences between the groups when they compared entering the cast room to performing the procedure, nor when they compared performing the procedure to post-procedure. They surmised that the major advantage to playing soothing background music was to decrease the patients’ anxiety upon entering the cast room—a benefit that appeared to carry over to the procedure itself.

“This may translate to an improvement in child cooperation, patient safety, and family satisfaction,” said Dr. Gilmore. Based on those findings, the facility now uses music therapy in the cast room when young children are being treated.

The study was conducted by Dr. Gilmore, along with Raymond W. Liu, MD; Priyesh Mehta, BA; Suzanne Fortuna, CNP; Douglas G. Armstrong, MD; Daniel R. Cooperman, MD; and George H. Thompson, MD.