The LIRIC Study-Live musIc in Relational Interactions with Children: using live music to transform interactions...

Wound-dressing changes expose children to severe pain and anxiety. Interactive music-live, improvised music co-created with a trained musician who continuously adapts tempo, melody, and participation to the child's cues-may restore child-centered care. Grounded in theories of social synchrony and emotional co-regulation, it could transform triadic dynamics, yet its effects on children, parents and health professionals remain understudied. The aim of this study is to explore how interactive music shapes actions, reactions, and relationships within the child-parent-professional triad during pediatric wound-dressing procedures. A constructivist grounded-theory study was undertaken in a children's hospital. Thirty dressing sessions were observed; pain and restraint were scored, and 103 semi-structured interviews conducted with children, parents, health professionals, and the musician. Data were analyzed through constant-comparative coding and cross-source integration until theoretical saturation. Four themes emerged. (1) Interaction tempo: adults shifted between technical focus and child engagement. (2) Relational inertia: many children entered a freeze-like withdrawal, characterized by stillness and narrowed attention. (3) Musical functions: live music redirected adult focus toward the child, transformed the emotional climate, and elicited motor-vocal initiative. (4) Contextual relational leadership: when professionals synchronized clinical steps with musical cues, triadic communication flowed; when leadership faltered, competing initiatives produced dissonance.

Interactive music can re-establish child-centered dynamics during painful procedures. By pacing interventions to the child's state and supporting professional-led relational leadership, live music complements analgesia and may mitigate freeze responses. Multi-site trials combining behavioral coding with clinical outcomes are needed to determine optimal timing and target groups.

• Most studies on the effectiveness of music focus on the child-parent dyad and use receptive music; the triadic child-parent-nurse dynamic during painful procedures remains largely unexplored. • Children often exhibit fight-flight-freeze responses, yet "freeze" behaviors are rarely described in routine pediatric practice.

• This study identifies relational inertia, a freeze-like withdrawal that can hinder communication during wound dressings . • The concept of contextual relational leadership shows how profesionals can harness musical cues to align technical steps with the child's emotional tempo, advancing child-centred care.