Music therapists, once marginalized, come into the mainstream at children’s hospitals

Joanna Bereaud rolled her cart down the hospital hallway. A patient was waiting for her treatment — delivered by maraca and drum.

Bereaud, a music therapist at Boston Children’s Hospital, carries a guitar on her back and more instruments in her cart: xylophones, an ocean drum, a rain stick, metal chimes, a kid-sized tambourine.

In her 15 years there, her quiver of instruments has grown, and so has her role in the hospital. Music therapists, once marginalized as volunteers, are now on staff, helping with a wide range of tasks: They show up at scary needle-prickings and before big surgeries; they help kids speak, regulate their walking gait, and even go to the bathroom; they sing with families as they prepare for a child to die.

The profession has grown at Children’s, and across the country, too. There are now 6,000 credentialed music therapists practicing in the US, 15 percent of whom work in medical or surgical settings, according to the American Music Therapy Association.

Music therapy in children’s hospitals has grown over the past decade, particularly in the neonatal intensive care unit, said association spokesman Al Bumanis. Research has shown music therapy helps patients in a range of settings, including reducing preoperative anxiety, improving motor control, and helping premature babies develop.

Children’s started its program in 1996 with just four hours a week of music therapy by students at Berklee College of Music. Now four certified staff work 130 hours per week in the Longwood Medical Area hospital and its satellite sites.

Bereaud, 44, has a bachelor’s in music therapy from Berklee. Her path to the profession was deeply personal: She grew up in Poland with a twin brother, Karol, who had cerebral palsy. He had trouble speaking whole sentences, but when her family played music, the rhyme and rhythm helped him memorize verses and sing along, she said.

“I saw how music was such a link between his disability and being able to express himself,” Bereaud said. Karol, who died at 14, inspired her to use music to help other kids like him.

When Bereaud started working at Children’s as a Berklee student, music therapy was restricted to just one type of patient, those awaiting bone marrow transplants. Now any patient can request music therapy. With support from an outside grant, she and other staff treated 9,000 patients and families in 2015, according to the hospital.

Music therapists have become more integrated into medical teams: After the 2013 Boston Marathon bombings, for instance, Bereaud was called in to play keyboard and sing songs while a young survivor had dressing changes to remove metal shards from her body.

Bereaud specializes in working with younger patients, including babies in the neonatal intensive care unit, where she helps parents compose songs to sing to their kids. Even when the child is sedated or can’t yet talk, she said, she can often see the melodies’ soothing effect: On the hospital monitors, their heart rates and breathing regulate.

The songs also help calm families, she said. Using an iPad, she has beamed in relatives from as far away as Ireland to join the music.

One recent afternoon found Bereaud rolling down the hallway with her cart to see 2-year-old Ana Miranda. Ana has a rare immune disease and is awaiting a bone marrow transplant, said her mother, Maria Miranda.

Ana, whose first language is Portuguese, struggles to speak English. Bereaud’s job, besides bringing some cheer to the sanitized hospital environment, was to help Ana communicate with hand gestures and words.

That job was made more difficult by hospital protocols: To avoid passing germs to Ana, Bereaud had to enter the room wearing gloves and a mask. So Ana couldn’t see her lips as she modeled words.

Ana, hesitant at first, started whacking a large ocean drum with two tiny maracas. As Bereaud strummed a guitar and sang, Ana began to repeat phrases like “more music” and “I like to drum.” By the end of the lesson, she was pelting out a drum solo and squealing with joy.

“She has a very small vocabulary,” Miranda said, “but she has such a way to communicate with music.”

Bereaud was one of two music therapists on duty that day. Elsewhere in the hospital, Dana Osterling, who also earned a music therapy bachelor’s at Berklee, moved through the halls with a guitar looking for someone to make music with. After a few dead-ends — her patients’ rooms had signs that said, “I’m sleeping” — she opened the door of a patient she didn’t know.

Sean Bowler, who’s 20, had arrived at the hospital for spinal fusion surgery. He sat back in a chair with his feet up, his head immobilized by a brace.

“Do you have any songs you’d like to sing?” asked Osterling, pulling out her guitar. She didn’t know his favorite country song, but the two found common ground with a made-up song about shaking, aimed at getting Bowler to participate on the tambourine. Bowler tapped his foot as he shook along to the song.

Nine out of 10 music therapy visits at Children’s look something like that — one-on-one visits to the bedside. The musicians often improvise songs, matching the rhythm of the patient’s tapping, or weaving in their names and their families’ names.

In her two years on the job, Osterling has fielded some unusual requests: Once, a parent called her to help her kid urinate before a surgery. She wrote a song that went like this: “I gotta go to the potty, I gotta go to the potty … and listen to it flushhh.” The song worked: Music helps the body relax, Bereaud explained.

Osterling, who’s 27, has also been called to the bedside for one of the most difficult tasks: helping a family say goodbye to a dying child.

One such patient, 12 years old, had been off of treatment for a long time, Osterling recalled. When the girl’s twin sister came to the hospital to say a final goodbye, the family asked Osterling to join the family in song.

Osterling led them in a rendition of Katy Perry’s “Roar.”

“It was a really beautiful moment,” Osterling said.

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