Sound-Based Vagal Stimulation in Pediatrics: Rest and Restore Protocol as an Adjunct Intervention for Infant Feeding Challenges

The information presented in this case study was submitted by the identified provider and reviewed by the Unyte Clinical Team. Modifications to the text have been made solely for the purpose of enhancing comprehension and clarity for the reader’s benefit, and were carefully applied while ensuring the accuracy and integrity of the original submission. Unyte Health makes every effort to use updated terms and inclusive language, this case study retains the author’s original descriptions to be most sensitive to the client’s identity and preferences.

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About the Provider

Name: Doreen Hunt
Organization Name: Children’s Therapy of Woodinville
Disciplines/credentials: Occupational Therapist, MA, OTR/L
Modalities: Rest and Restore Protocol (RRP), Safe and Sound Protocol (SSP), Integrated Listening System (ILS), Sensory Integration, SIPT

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Client Background

Name: Luke (pseudonym)
Age and Gender: Boy, 3 to 4 months old (11 weeks old at initial presentation; 14 weeks old at start of listening therapy delivery)
Program Delivered:

• Rest and Restore Protocol (RRP)
  • Introduction
  • Level 1
  • Level 2
  • Level 3

Born full-term with no initial complications, Luke is his parents’ first child. His early medical history includes a sublingual frenotomy at seven weeks old for tethered oral tissue, as well as mild plagiocephaly and a right cervical rotation preference.

At 11 weeks old, Luke presented with significant feeding difficulties, including inefficient feeds, poor weight gain, and gastroesophageal reflux disease (GERD) symptoms. He had become increasingly fussy after feeds, with frequent spit-ups, arched-back crying, color changes and breath-holding.

While Luke demonstrated adequate pacing and suck-swallow-breathe coordination at the breast, his intake remained low, and he experienced difficulties with bottle-feeding due to poor coordination and timing. Rapid fatigue required the adult bottle-feeding him to manage the flow through constant external pacing.

He was healthy and lived in a safe, supportive home environment, but his mother was completely exhausted and overwhelmed with worry. To maintain his intake, she had been triple-feeding — breastfeeding, bottle-feeding expressed breast milk and pumping — consistently since birth. The family had already sought assistance through lactation consultation, craniosacral therapy, and weekly pediatrician weight check-ins to monitor his poor weight gain. 

The overarching clinical goals were to improve Luke’s oral-motor control and feeding efficiency; increase both his breast and bottle intake; and decrease his GERD symptoms.

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Implementation of Rest and Restore Protocol (RRP)

The mother and her infant son were friends of the provider’s family. Upon learning how much the family was struggling, Doreen Hunt reached out to suggest they bring Luke to the clinic. They were open to trying anything.

At his second appointment, when Luke was 14 weeks old, Doreen played the RRP Introduction over a speaker in a small treatment room for 15 minutes, allowing the whole family to listen together. Both parents commented that the RRP music felt “calming and pleasant.”

While she had successfully used the Safe and Sound Protocol (SSP) with infants in the past, this was Doreen’s first time using RRP with a baby. She delivered psychoeducation to Luke’s parents about “the extensive neural connections of the vagus nerve, especially related to the skills necessary for the act of eating and how we can reach the vagus through sound input safely delivered to an infant ambiently through a speaker,” and how this might support improved feeding and reduce Luke’s reflux.

She also educated the parents on how RRP is specifically designed to support healing, restoration and homeostasis by promoting deep relaxation, recovery, autonomic balance, interoception and self-regulation.

Following their initial clinic visit, the family integrated RRP into their daily routine and played the music over a speaker for 15 minutes once per day, typically in the morning. The parents started the music five minutes before feeding and allowed it to continue playing during the morning feeding.

Luke tolerated all Levels of RRP. His mother and/or both parents listened to RRP alongside Luke each morning, co-regulating with their infant son while simultaneously receiving the beneficial vagal input. The family continued this routine for four months, listening for a total of 19.5 hours.

Response 

Both parents initially commented on how calming and pleasant the RRP music felt when it began playing in the treatment room, but the immediate clinical response was “remarkable.” After listening to roughly 10 minutes of RRP, Luke began feeding from a bottle. Within minutes, his feeding coordination noticeably improved.

A feeding therapist, monitoring with a stethoscope at his neck, confirmed the change in his swallowing pattern, leaving all four adults in the treatment room in awe. Following this session, Luke demonstrated a permanent shift in his feeding capabilities: he transitioned from requiring adult-managed liquid flow pacing to independently pacing his own feeds without difficulty, while his overall suck-swallow-breathe coordination improved.

With this increased physiological stability, Luke was able to move away from an adapted feeding position (elevated sidelying on his mother’s lap) to being comfortably cradled in his mother’s arm. In this more natural and nurturing position, Luke and his mother experienced enhanced attunement and sustained eye contact — an interaction that supports bonding and attachment.

Luke never regressed, and his feeding remained more organized onward. More positive outcomes were observed over the course of the RRP intervention:

• Luke was now able to maintain organized suck-swallow-breathe coordination during 100% of his feeds, eliminating the need for external pacing by an adult.
• Within the first week of listening to RRP, his reflux episodes stopped.
• His parents could comfortably hold Luke upright against their shoulders to burp him, a position that had previously caused him to cry and fuss.
• He went through a significant growth spurt and continued to gain weight.
• His newfound feeding stability allowed his grandmother to successfully bottle-feed him.
• He began communicating hunger and satiety cues, as well as demonstrating his specific stress cue of raising his eyebrow.

His mother shared that she felt “so much calmer from the music and with the improvements in Luke’s eating.”

Discussion

Doreen shared the following reflections on the clinical use of RRP and sound-based interventions:

“I have long sought to deepen our understanding and expand our clinical experience with specialized sound-based interventions for infants struggling with feeding challenges. The vagus nerve — with its vast network of neural connections throughout the body — plays a crucial role in the oral-motor coordination required for the suck-swallow-breathe rhythm. Increasingly, research and clinical observation suggest that enhancing vagal input can also support gut function and ease common issues such as infant reflux. These connections have made the use of acoustic vagal nerve stimulation an especially meaningful area of exploration in our work.

“It was beautiful to witness this mother-infant dyad finding each other again — Luke peacefully cradled in his mother’s arms, able to look into her eyes as she fed him with ease. RRP brought health, growth and restoration to his challenged nervous system. He [has been] flourishing in his growth and development ever since the specialized sound intervention.

“I believe that the acoustic vagal nerve stimulation is equally beneficial for the mother/caregiver of the infant, to decrease worry/anxious feelings and to improve co-regulation with her infant. If a mother is breastfeeding, decreasing anxiety can benefit her milk flow for her infant as well.

“I wish for more professionals who work with this young population to be aware of this very beneficial intervention tool that is not invasive and easy to incorporate into an infant’s treatment plan.”