Use of white noise-emitting devices in infants and small children as assessed by their parents

Abstract

Introduction: Crying and anxiety in an infant are not only a defence reaction informing of a health problem, but also a signal of hunger, fatigue or difficulties falling asleep. There are many methods of reducing a child’s adaptation problems. Various positions, breastfeeding, rocking and contact with the mother’s skin are used. Currently, white noise-emitting devices are increasingly popular. White noise consists of monotonous sounds without volume changes, similar to the sounds of nature (rain, the sea), heard by the child during foetal life (the hum of large maternal blood vessels), which has a calming effect and masks the sounds of external environment. Aim of the study: The aim of the study was to assess the motives, efficacy and correctness of the use of white noise-emitting devices. Material and methods: A survey was conducted among 580 parents who used white noise-emitting devices (Szumiś, Whisbear, applications on personal electronic devices). The survey collected data on the parent population, the prevalence of the method, the reasons for choosing this method to relieve the child’s problems, the device’s efficacy and manner of use and users’ awareness of potential hazards associated with incorrect use of such devices. Results: The results indicate a widespread use of white noise-emitting devices for helping children fall asleep and reducing their anxiety or colic pain, particularly in infants. Parents made a frequent use of these devices and left them switched on for a long time in close proximity to their children. They did not notice any negative effects of their use and would recommend them to other parents. Conclusions: White noise-emitting devices may be helpful in taking care of a restless child. However, they may be recommended by medical professionals provided that they comply with appropriate technical criteria and the rules for their use have been established considering the unknown long-term impact of such devices on the child’s development.

Full text

291
Use of white noise-emitting devices in infants and small children
as assessed by their parents
Stosowanie urządzeń wytwarzających biały szum u niemowląt i małych dzieci
w ocenie ich rodziców
Department of Paediatrics in Bytom, School of Health Sciences in Katowice, Medical University of Silesia, Bytom, Poland
Correspondence: Jolanta Pietrzak, Department of Paediatrics in Bytom, Batorego 15, 41-902 Bytom, Poland, tel.: +48 32 786 14 98, e-mail: jpietrzak@sum.edu.pl
Introduction: Crying and anxiety in an infant are not only a defence reaction informing of a health problem, but also a signal
of hunger, fatigue or difficulties falling asleep. There are many methods of reducing a child’s adaptation problems. Various
positions, breastfeeding, rocking and contact with the mother’s skin are used. Currently, white noise-emitting devices are
increasingly popular. White noise consists of monotonous sounds without volume changes, similar to the sounds of nature (rain,
the sea), heard by the child during foetal life (the hum of large maternal blood vessels), which has a calming effect and masks
the sounds of external environment. Aim of the study: The aim of the study was to assess the motives, efficacy and correctness
of the use of white noise-emitting devices. Material and methods: A survey was conducted among 580 parents who used white
noise-emitting devices (Szumiś, Whisbear, applications on personal electronic devices). The survey collected data on the parent
population, the prevalence of the method, the reasons for choosing this method to relieve the child’s problems, the device’s
efficacy and manner of use and users’ awareness of potential hazards associated with incorrect use of such devices. Results:
The results indicate a widespread use of white noise-emitting devices for helping children fall asleep and reducing their anxiety
or colic pain, particularly in infants. Parents made a frequent use of these devices and left them switched on for a long time in
close proximity to their children. They did not notice any negative effects of their use and would recommend them to other
parents. Conclusions: White noise-emitting devices may be helpful in taking care of a restless child. However, they may be
recommended by medical professionals provided that they comply with appropriate technical criteria and the rules for their use
have been established considering the unknown long-term impact of such devices on the child’s development.
Keywords: white noise, Szumiś, infants, children, crying, falling asleep
Wstęp: Płacz i niepokój u niemowlęcia nie tylko stanowią reakcję obronną informującą o zagrożeniu zdrowotnym, ale są też
sygnałem głodu, zmęczenia czy trudności w zasypianiu. Istnieje wiele metod redukujących problemy adaptacyjne dziecka.
Wykorzystuje się różnego typu pozycje ułożeniowe, karmienie piersią, kołysanie czy kontakt ze skórą matki. Coraz
popularniejsze są obecnie urządzenia wytwarzające biały szum, czyli monotonne dźwięki bez zmian głośności, podobne do
odgłosów natury (deszcz, szum morza), słyszane przez dziecko w życiu płodowym (szum wielkich naczyń krwionośnych
matki), mające działanie uspokajające i maskujące odgłosy środowiska zewnętrznego. Cel: Celem pracy była ocena motywów,
skuteczności i prawidłowości używania urządzeń wytwarzających biały szum. Materiał i metody: Ankietowe badanie
przeprowadzono wśród 580 rodziców używających urządzeń wytwarzających biały szum (Szumiś, Whisbear, aplikacje
w personalnych urządzeniach elektronicznych). Miało ono na celu ocenę populacji rodziców, ocenę rozpowszechnienia tej
metody, ocenę powodów, dla których opiekunowie wybrali ten sposób łagodzenia dolegliwości dziecka, oraz ocenę
skuteczności, sposobu stosowania i świadomości potencjalnych zagrożeń wynikających z niewłaściwego używania takich
urządzeń. Wyniki: Wyniki wskazują na powszechne stosowanie tego typu urządzeń w celu ułatwienia dzieciom zasypiania,
łagodzenia niepokoju czy bólu kolkowego, zwłaszcza u niemowląt. Rodzice korzystali z tych urządzeń często, włączając je na
długi czas i umieszczając blisko dzieci. Nie zauważyli negatywnych skutków ich używania i poleciliby je innym rodzicom.
Wnioski: Urządzenia emitujące biały szum mogą być przydatne w opiece nad dzieckiem niespokojnym. Warunkiem ich
rekomendowania przez personel medyczny musi być jednak spełnienie odpowiednich kryteriów technicznych i ustalenie
zasad ich stosowania, ze względu na nieznany długofalowy wpływ używania tych urządzeń na rozwój dziecka.
Słowa kluczowe: biały szum, Szumiś, niemowlęta, dzieci, płacz, zasypianie
Abstract
Streszczenie
Jolanta Pietrzak, Paulina Kurdyś, Łukasz Surówka, Anna Obuchowicz
© Pediatr Med Rodz 2019, 15(3), p. 291–296
© Medica l Commun ications Sp. z o.o. This isa n open-acc ess article distributed under the terms ofthe Creative Commons Attribut ion-NonCommercial-NoDerivatives License
(CC BY-NC-ND). Reproduct ion ispermitte d for personal, edu cational, non-c ommercial use , provided that t he origina l article isin w hole, unmodi fied, andprope rly cited.
DOI: 10.15557/PiMR.2019.0049
Received: 16.12.2018
Accepted:
05.03.2019
Published:
29.11.2019

Jolanta Pietrzak, Paulina Kurdyś, Łukasz Surówka, Anna Obuchowicz
292
PEDIATR MED RODZ Vol. 15 No. 3, p. 291–296DOI: 10.15557/PiMR.2019.0049
INTRODUCTION
During the neonatal and infant period, the child
adapts to the surrounding environment. Crying,
which is common in this period, is a defence re-
action. Crying is indicative of a health problem and is a re-
action to pain (intestinal colic, vaccinations), fatigue, hun-
ger or discomfort(1). It always worries parents and is oen
the reason for premature discontinuation of breastfeeding.
Apart from the need to identify medical causes of crying,
methods of comforting the child are sought in order to re-
duce its and the parents’ stress. Various positions, cuddling,
rocking, kangaroo care and breastfeeding are used or sweet
drinks are administered to relieve the baby’s symptoms(2–13).
Acoustic stimuli such as maternal voice, calm music(14,15)
and white noise are also utilised(1,2,16–19).
White noise is a type of monotonous sound in the form of
acoustic resonance whose spectrum is balanced across the
majority of audible frequency range, without rapid chang-
es in volume. White noise is similar to the sounds of na-
ture such as rain, snowstorm or the sea. It can also be com-
pared to the sound emitted by a quietly working dryer or
vacuum cleaner. It is believed that the child experiences
such a monotonous acoustic phenomenon already in the
mother’s womb (her heartbeat, blood ow in large blood
vessels)(13,20). These sounds are the white noise of foetal
life(13,20). Similar sounds heard during the neonatal and in-
fant period may have a soothing and calming eect; in ad-
dition, they may mask other sounds and external environ-
mental noise(13,20).
There are plush mascots available which contain white
noise-emitting devices inside such as Szumiś or Whisbear
(Figs. 1, 2). Applications for a mobile phone, tablet or lap-
top have also been developed.
From the parents’ point of view, the use of this method
seems promising; however, there are a number of medical
doubts about it. is is because there is an insucient num-
ber of studies conrming the safety of white-noise emitting
devices (concerning their impact on hearing and psycho-
logical development of the recipient, among other prob-
lems). Should the paediatrician recommend or discourage
from the use of such devices?
AIM OF THE STUDY
e aim of the study is to investigate whether and in what
situations parents use white noise-emitting devices, what
their ecacy rating is and whether they are used correctly.
MATERIAL AND METHODS
An anonymous survey was conducted using electronic means.
The survey was directed at parents who used white noise-emit-
ting devices. The subjects were selected at random. The sur-
vey was conducted from 01.01.2018 to 31.03.2018 via so-
cial media and forums and topical groups for young parents.
The survey was developed by the present authors and includ-
ed single and multiple choice questions and comprised three
parts. The questions concerned demographical data, indica-
tions and efcacy rating of white noise-emitting devices, con-
ditions of their use and their impact on the child’s behaviour.
Due to the fact that the white noise-emitting devices used by
the respondents did not have a sound intensity scale, the re-
spondents were asked to rate the volume on a scale of 1–5
(1 indicated very quiet and 5 very loud sound emission).
In total, 580 individuals took part in the study. The respondents
came from all Polish provinces. The majority of answers were
received from the Mazowieckie province (168 surveys) and
Śląskie province (107 surveys). Women accounted for 99.3%
Fig. 1. Szumiś
Fig. 2. Whisbear the Humming Bear

Use of white noise-emitting devices in infants and small children as assessed by their parents
293
PEDIATR MED RODZ Vol. 15 No. 3, p. 291–296 DOI: 10.15557/PiMR.2019.0049
of the respondents. The mean age of the subjects was 29.3
years. The largest group were individuals aged 25–30 years
(39.1%). Parents aged 31–35 years accounted for 32.1% of the
respondents. There were 19% of individuals aged 18–25 years
and 9.8% aged over 35. 64% of the subjects had one child,
30% had two children and 6% had three or more children.
The numbers of boys and girls were comparable (302 vs. 278,
respectively). The children were aged from 1 to 24 months.
49.1% of the respondents lived in a city of more than 100,000
inhabitants and others lived in smaller towns and in rural ar-
eas. There were 68.9% of respondents with higher education,
27.4% with secondary-level education and the remaining ones
had vocational education.
Based on routine screening tests, 97.6% of children had
a normal hearing. In 2.4% of neonates the result was ab-
normal, no test had been performed or risk factors for hear-
ing damage had been found. 96.2% of parents declared that
their children were vaccinated in accordance with the of-
cial vaccination schedule.
Statistical analysis was performed using Statistica version
12 software; descriptive statistics methods and Spearman’s
test were utilised.
RESULTS
The most frequently used white noise-emitting devices
were Szumiś (40.3%), Whisbear (32.8%) and recordings of
sounds imitating electrical appliances (30.9%).
e primary aim of using white noise-emitting devices was
to put the child to sleep (86.9%). In addition, parents used
these devices when the child was restless (24.3%) or during
an attack of intestinal colic (14.1%).
50% of the respondents chose white noise-emitting devic-
es, since traditional methods of comforting the child turned
out to be ineective. 58.6% of parents learnt about white
noise-emitting devices from the Internet and one third from
friends. Among the subjects, 27.0% bought this type of de-
vice based on a fashion for using them and 20% received it as
a present. 80.3% of parents had previously used other acous-
tic methods of putting the child to sleep or comforting it such
as lullabies or classical music. Other parents (19.7%) decided
to use white noise-emitting devices in the rst place.
Data regarding the manner of use of white noise-emitting
devices by the respondents are presented in Tab.1.
e devices were most oen used over the rst six months
of the child’s life (31.2%). In the rst month, the devices
were used by 10.9% of parents. In 17.6% of cases the devic-
es were used over the rst 3 months of life. 17.0% of the re-
spondents used the devices for one year, while 23.3% of par-
ents used them for longer.
Among the surveyed parents, 24.7% used the devices 3 and
more times daily, 24.1% used them 2 times a day and 23.1%
switched them on sporadically. Other respondents used
such devices once a day or a few times a week. e time of
a single sound session was up to one hour (29.5% of the re-
spondents), up to 30 minutes (24.5%) or shorter (35.9%).
Others (10.1%) switched on the device for more than one
hour at a time.
More than half of parents (48.1%) placed white noise-emit-
ting devices in the child’s cot; 39.8% of devices were put on
a night table next to the cot.
The subjects set the volume of the devices to low (35.9%)
and medium (31.6%). Based on Spearman’s test, no rela-
tionship was demonstrated between the placement of the
device and the volume set (rs=0.009).
Assessed parameter Number of parents
n = 580 %
Period of use
Over the first month of life 63 10.9
Over the first 3 months of life 102 17.6
Over the first 6 months of life 181 31.2
For a year 99 17.0
For longer 135 23.3
Frequency of use
Once a day 95 16.4
Twice a day 140 24.1
3 or more times a day 143 24.7
A few times a week 68 11.7
Sporadically 134 23.1
Time of single session
Up to 5 minutes 65 11.2
Up to 15 minutes 143 24.7
Up to 30 minutes 142 24.5
Up to an hour 171 29.5
More than one hour 59 10.1
Device placement
In the cot 279 48.1
On the night table 231 39.8
>2 m from the cot 70 12.1
Volume level set
1 104 17.9
2 208 35.9
3 183 31.6
4 62 10.7
5 23 3.9
Tab. 1. Data regarding the use of white noise-emitting devices
by the respondents
No Yes
0% Does the child
fall asleep
quicker?
Does the child
calm down?
Does the child
stop crying?
Does the child
start crying?
Is the child
restless?
Is the child less
responsive
to acoustic
stimuli?
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Fig. 3. Children’s behaviour during the use of white noise-emit-
ting devices

Jolanta Pietrzak, Paulina Kurdyś, Łukasz Surówka, Anna Obuchowicz
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In the third part of the survey, parents were asked about
their child’s behaviour during the use of white noise-emit-
ting devices (Fig.3).
When asked a yes/no answer about a positive inuence of
white noise-emitting devices (falling asleep quicker, calm-
ing down, stopping crying), the majority of the respondents
(over 80%) chose the afrmative answer.
The majority of parents did not notice any negative effects
of using white noise-emitting devices. Almost all of them
(94.0%) chose the “no” answer to questions regarding signs
of fear and anxiety, crying or parents’ subjective impression
of hearing deterioration in the children.
Among the surveyed parents, 82% would recommend this
method of soothing children to other young parents.
DISCUSSION
Crying and anxiety in a child, even aer all potential somat-
ic causes have been excluded (gastrological, allergic, cardi-
ac, neurological and other) always raise negative emotions
in parents. Even though it is believed that approximately
20% of infants cry frequently for no apparent reason over
the rst 4 months of life, parents of a crying child may feel
anxiety, depression, helplessness and even anger and frus-
tration(1–5). Parents may be afraid that they are hurting their
own child by not being able to help it and experience a feel-
ing of guilt and shame(5). is may have a negative impact
on parental bonds and parental perception of the child(5).
e caregivers are oen not able to cope with the problem
on their own and need the help of qualied healthcare pro-
fessionals(4,5).
Since time immemorial, ways of comforting an anxious or
crying child have been sought. Intuitive methods used for
centuries (e.g. taking the child for a walk in a pram or giv-
ing it a warm bath) have found scientic explanation and
are still recommended in caring for a restless child(1).
Rhythmical rocking of an infant induces the secretion of
endorphins by stimulating the vestibular system, which re-
duces the duration of anxiety and crying and relieves pain
caused by infantile colic, for example(17,21).
Research results emphasise the benecial eects of breast-
feeding on soothing a child and on pain reduction dur-
ing procedures such as injections (e.g. vaccinations), n-
gerstick or heel lance for diagnostic blood collection(7,12,22).
e mechanism involved is of multifactorial nature. It in-
cludes the sucking reex, skin-to-skin contact, warmth,
rocking, the sound of the mother’s voice, maternal scent
and the eects of endogenous opioids contained in breast
milk(7,12). In addition, it has been found that olfactory stim-
ulation by the smell of the mother’s milk also has a soothing
eect(23). A similar and in some studies even stronger anal-
gesic eect is observed when sugar solutions are adminis-
tered to the child via the oral route(8–11).
Appropriate positioning of the infant has also resulted in
reducing the child’s anxiety and crying. In a method called
THB (The Happiest Baby) conditions of foetal life are
reproduced: the child is placed on the side with its head
downwards and it is wrapped tightly with a diaper cloth
(but loosely enough to allow movement in the hips and
avoid overheating). Monotonous sounds are played and the
child is rocked in a rhythmical fashion(2,24).
Skin-to-skin care (SSC), also called kangaroo mother care
(KMC), is a method that has been used for a few decades
at neonatal wards and has been recommended for everyday
infant care: for soothing anxiety and crying and helping the
child fall asleep(6,8,9,13,25).
Chirico et al. conducted an interesting study investigating
the sensation of pain during blood drawing in preterm in-
fants who were listening to their mother’s recorded voice.
e child’s behaviour, heart rate, blood pressure, O2 satu-
ration and adverse reactions such as apnoea or vomiting
were assessed. e study results showed this method to be
eective(26).
A positive eect of listening to music was also demonstrat-
ed (a melody hummed by parents or calm classical music)
in similar situations for soothing pain and crying in pre-
term infants and relieving infantile colic(13–15,20,21).
White noise is an acoustic phenomenon whose spectrum
is balanced across the majority of audible frequency range,
without rapid changes in intensity, monotonous, repeti-
tive and usually similar to the sounds of nature such as the
sound of the sea, stream or rain. e child is subjected to
white noise already in the womb: it can hear its mother’s
rhythmical heartbeat, ow of blood in large vessels and the
sounds of uterine and gastrointestinal tract movements(17,20).
is results in the child becoming accustomed to these phe-
nomena(27). erefore, such noise comforts the neonate/in-
fant, reduces the duration of crying, relieves pain, includ-
ing iatrogenic pain, helps the child fall sleep and prolongs
sleep duration(17,19,20,27,28). e use of white noise masks other
sounds and noises of the external environment(13,19).
e inuence of white noise on children falling asleep start-
ed to be investigated in the nineties of the previous century.
Spencer et al. demonstrated positive eects of white noise in
80% of infants(18). e impact of such sounds on shortening
the period of adaptation of a neonate to the external world
during the postpartum period has been investigated multi-
ple times. is includes, for example, early breast sucking,
which translates into a longer duration of natural feeding.
Very promising results were achieved(20,28). In a multicen-
tre, randomised, controlled clinical trial, Sezici and Yigit
checked whether using white noise-emitting devices reduc-
es the time of crying and increases sleep duration in chil-
dren suering from colics. eir assumptions concerning
the eects of white noise compared to other methods such
as rocking, for example, were conrmed. e study revealed
that white noise caused a statistically signicant reduction
in crying and the time it took the children to fall asleep,
particularly when the method was used for many days(17).
Karakoç et al. found that white noise is an eective, non-
pharmacological method of pain relief, crying time reduc-
tion and improvement in vital signs of hospitalised neonates

Use of white noise-emitting devices in infants and small children as assessed by their parents
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subjected to blood drawing and vaccinations(16). Simi-
lar results were observed in a group of preterm infants(13).
e present study shows that white noise-emitting devices
are oen used by parents with higher education in partic-
ular in everyday care of children of various ages. Such de-
vices are mainly used to help the child fall asleep (86.9%)
or calm it down (24.3%). It is surprising that only14.1% of
parents use white noise-emitting devices to relieve pain in
intestinal colic.
In the context of informed care over a child, the statement
of more than half of the respondents that they chose such
a device when other methods of soothing the child’s anxi-
ety proved ineective is a positive nding. What is charac-
teristic for the contemporary times is acting upon informa-
tion found on the internet and following trends, such as the
one for having white noise-emitting devices, which is con-
rmed by the results of the survey.
e knowledge of the right manner of use of white noise-
emitting devices is a very important issue. Canadian authors
demonstrated that too high intensity, long duration of sin-
gle exposure or too close placement of the device may have
a negative impact on the child’s hearing (hearing damage,
impaired development of the hearing system and speech)
(19). ey suggest that this type of devices should be placed
as far away from the child as possible, the lowest sound in-
tensity should be applied and time of use should be as short
as possible. ese conclusions were based on objective study
of volume (in decibels) and the distance between the de-
vice and the child (in centimetres). Unfortunately, the de-
vices used by the respondents from the present study (both
Szumiś and online applications) do not have volume lev-
els expressed in decibels provided. Therefore, the pres-
ent authors had to use a scale of 1–5 to investigate this as-
pect of white noise inuence on the child. e majority of
the subjects prefer using quiet or moderately loud sounds.
Unfortunately, half of the respondents put the device near
the child, usually in the cot. e duration of a single session
is 15–60 minutes with a trend to prolong this time to as much
as a few hours. ere is also the worrying fact of using such
devices at least twice a day by nearly half of the respondents.
82% of the respondents, who believe that the device is use-
ful in taking care of their child, would recommend this
method of soothing children to other parents. In the era
of long working hours, in situations where grandparents
do not participate in childcare and considering the wide-
spread use of new equipment and technologies, improving
the comfort of parents’ and children’s lives with white noise-
emitting devices seems to be justied. However, these de-
vices need to be medically safe (limited volume level and
operation time, preferably with an automatic switch).
Parents should be informed of the correct manner of use of
the devices by instruction manuals and medical profession-
als. e problem is all the more important since more than
half of the respondents learnt about white noise-emitting
devices from the Internet, while in one third of cases it was
friends who recommended this method to the respondents
without making them aware of the potential risks of us-
ing such devices. us, a new task has emerged for general
practitioners taking care of children as part of health pre-
vention education.
e Canadian study mentioned above includes recommen-
dations for parents regarding the use of white noise-emit-
ting devices(19). Such recommendations, developed by pae-
diatricians, neonatologists and paediatric ENT specialists,
should be provided to all users of the devices.
CONCLUSIONS
1. White noise-emitting devices may be useful as one of
the methods for calming down infants and helping them
to sleep.
2. Medical professionals may recommend white noise-
emitting devices on condition that they are compliant
with appropriate technical criteria (standardised volume,
operation time meter) and the rules for their use have
been established.
3. e long-term eects of using white noise-emitting de-
vices placed too close to a child are unknown; therefore,
a safe distance should be kept and the time of operation
should be limited. Users should be made aware of this
aspect of the use of the device in particular.
Conict of interest
e authors do not report any nancial or personal aliations to per-
sons or organisations that could adversely aect the content of or claim
to have rights to this publication.
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