August 12, 2015/Nursing/Clinical Nursing

Once Upon a Time in the NICU

Reading provides auditory stimulation for infants


If you walked through Hillcrest Hospital’s 35-bed NICU, you probably would see a parent or volunteer reading a rhyming book to an infant. A couple years ago, the Cleveland Clinic regional hospital adopted a NICU reading program. The goal is to improve family bonding, decrease parental stress levels and increase appropriate auditory stimulation in premature infants.


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“There is so much brain development that goes when babies are in the NICU,” says Victoria Kunkel, MS, OTR/L, a NICU Clinical Specialist at Cleveland Clinic Children’s. “We want to provide a positive sensory experience, whether it’s touch or auditory.”

Why the program started

The NICU started its reading program to combat the disruption in sensory stimulation that occurs with infants born prematurely. Exposure to the maternal voice in the normal uterine environment provides a unique source of sensory stimulation. When babies are born early and spend time in a NICU, that stimulation is disrupted: The low frequency sounds transmitted through fluid are replaced by high frequency, noncontingent sounds in the NICU, including alarms, pagers and the voices of many caregivers. The bonding process between parent and baby can be delayed by days, months or weeks depending on the medical acuity of the infant.

Another reason Hillcrest Hospital began its NICU reading program is to compensate for potentially reduced stimulation in its private rooms. A study conducted at St. Louis Children’s indicated that infants in private rooms may lack appropriate stimulation and sound exposure. “The study found that single private rooms have many benefits in terms of providing family-centered care,” says Kunkel. “But if parents are not able to be in the room because of jobs, transportation issues or other children, then their babies might not get the right amount of stimulation, which can impact speech and language development.”

How the program works

Hillcrest Hospital’s NICU reading program is made available to all families and infants upon admission. Parents are provided a program description and a list of book suggestions, which they subsequently bring into the NICU. The books are simple rhyming books with a few words on each page. Parents are encouraged to read to their babies two or three times daily for five minutes beginning at 28 weeks gestation. The time increases as the infants get older. If parents are unavailable, then volunteer caregivers read. Reading usually takes place when babies first wake up, are getting ready to go to sleep or immediately after a feeding when they are calm and awake.


The hospital rolled out its reading program using a “train the trainer” approach. Kunkel met with members of the Nursing Practice Council, educating them on the program and sharing evidence on positive developmental and bonding outcomes for infants and families in the NICU. Three members of the council then trained the nursing staff at the bedside during a two-week period. These nurses, in turn, talk to families about the reading program and its potential benefits.

Plans to expand

While Hillcrest Hospital has no data to support the success of its reading program, Kunkel is confident it makes a difference. “There is evidence to suggest that a reading program in a NICU will have a positive impact on both parents and infants,” she says. Kunkel cites a 2011 study in Montreal that shows parents who read to premature babies better coped with difficult, extended stays in the NICU and those parents were three times more likely to continue reading aloud to their babies after discharge.

Kunkel is currently working with Cleveland Clinic’s Child Life Services team to establish a budget to provide books to families rather than ask them to supply the books themselves. In addition, the goal is to expand the reading program to Cleveland Clinic’s two other NICUs in Northeast Ohio at main campus and Fairview Hospital and to measure outcomes after the program is established systemwide.

“We want everyone to be educated on sensory development in our preterm babies and to provide interventions based on what’s important at different times in their development,” says Kunkel. The NICU reading program is just one component of creating a nurturing environment for the littlest patients at Hillcrest Hospital.


Photos ©Russell Lee

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