Eating it up: A language diet in the NICU

December 22, 2021 | by Kate Gawlik, RN
Categories: Healthy Driven Moms

Pictured above: When mom Kareli Palacios Andrade is with her son Daniel, she is encouraged to read to him at a whisper.

The Newborn Intensive Care Unit (NICU) at Edward Hospital has a bustling calm to it. Driven by best-practice research, noise levels are kept to a minimum at the bedside to promote neuroprotection in the preemies.

Preemies cannot neurologically process sound; loud noises can cause apnea and bradycardia in preemies. They hold their breath and drop their heart rates when noise levels get too high.

As babies get older, it is important that their auditory development is a positive experience. In the NICU, this concept is being enhanced with a new Language Diet program.

Parents can record themselves on a digital audio recorder—either talking, reading books or singing—and the small recorders are placed near the baby when the parents are not in the unit. This program was spearheaded by the Edward Hospital speech-language pathologists.

"Babies have always been surrounded by the voices of the nurses who take care of them as well as their parents when they are visiting. Preemies now have more time to listen to their parent's voices in an appropriate way that fosters development," says Bob Covert, M.D., medical director of the Edward Hospital NICU. "We, as a unit, operate by evidence-based practice and we embrace current research that builds on our protocols and standards."

Research-based program

Edward’s speech-language pathologists applied for a grant with the Little Giraffe Foundation to start the Language Diet program.

The speech-language pathologists dedicated to the NICU (Mary Fantozzi, Tara Kehoe and Rachel Montgomery), say “We wanted to bring this program to our NICU as a way to create a language-rich environment for babies by allowing them to be exposed to their parents’ voices even when they cannot be here. We are excited to see the response from families and staff as we have introduced this program.”

Current research recommends that infants begin to experience positive auditory exposure for about 20 minutes per day after 28 weeks’ gestation. Over time, auditory exposure should continually increase to a minimum of three hours for infants after they reach term equivalent age, or 40 weeks. Research has found audio recorders can be used after 32 weeks’ gestation in addition to in-person interaction.

Research also has shown that infants in NICUs with private rooms, like at Edward Hospital, experience limited language exposure. To address this, many NICUs have begun using audio recorders. The benefits of these devices, especially with parent voices, in the NICU include increased autonomic stability, decreased stress and improved neurodevelopmental outcomes.

Speaking and singing

Kareli Palacios Andrade embraced the program, saying it set aside some of her fears when leaving the NICU every night. Her son, Daniel Jaimes, was born at 23 weeks and now is 39 weeks. “When I am not here, Daniel can still hear my voice and I know it helps him. It also makes me feel calm and connected to him all the time,” Palacios says.


Pictured above: Daniel Jaimes, born at 23 weeks, started listening to recordings of his mom’s voice at 32 weeks’ gestation as part of an auditory development program in the NICU. The audio recorder is placed near the baby and played at 45 decibels.

When a baby reaches 32 weeks’ gestation, the nurses play the recorded messages with the volume at a whisper, less than 45 decibels, when the parents are not at the bedside. This allows the babies to “eat up” their parents' voices in a safe way.

The recorders are typically played after hands-on assessments, during a baby's nasogastric feeding and while sleeping. Parents are encouraged to talk and sing to their baby at a whisper when they are at the bedside during appropriate times.

"We have heard everything from singing 'Itysy Bitsy Spider' to reading books to a mom reminiscing about her own childhood. We even had a dad repeatedly tell his son, 'Luke, I am your father,” in a recording," Dr. Covert says. "Parents are excited about the program and we welcome their involvement in unit practices that benefit NICU patients."

Some babies are born needing special care. At Edward-Elmhurst Health, we’re fully equipped to care for newborns who require special attention, such as premature infants, infants on ventilators and newborns with congenital conditions.

Edward Hospital provides a Level III NICU—with the capabilities to treat the sickest and most fragile newborns of all gestational ages, including those with a variety of congenital and surgical conditions. Elmhurst Hospital provides a Level IIe Special Care Nursery with extended capabilities to care for low birth weight and premature infants, as well as infants on ventilators, at 30 or more weeks gestation.

Learn more about the NICU and Special Care Nursery at Edward-Elmhurst Health.

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