Baby or infant massage is an exciting part of the massage therapy profession. The scientific studies published in many medical journals have generated a lot of interest among health providers and hospitals. As was correctly pointed out by Beider et al. (2007):
“The clinicians and researchers have been intrigued by the potential benefits of pediatric MT for improving psychological and physiologic states in children who have various health conditions.”
This article has two goals. First of all, we think it will be very helpful for the practitioners to have updated scientific information, which greatly justifies their work. We highly suggest printing copies of this article, including a list of references, and distributing them as small brochures among the pediatricians and pediatric departments of local hospitals. This is a great way to build up a successful massage practice in the clinical setting.
The second goal of this article is to give the therapists real, practical recommendations on what, when, and how to conduct a scientifically sound massage session for full-term and pre-term infants. We realize that the information in the second part of this article may go against what some of our readers learned and even currently practice. However, we will prove to our readers that the practical recommendations that we will discuss in Part II are the most clinically effective.
We propose categorizing infant massage into two main groups: the application of massage to full-term infants and the application of massage to pre-term infants. The baby massage for full-term infants is a form of additional sensory stimulation that helps to optimize mental and physical development. Additionally, this type of massage is better conducted by parents to enhance bonding between the child and the mother and the father (Serrano et al., 2010). In such a case, the best participation of the massage practitioner is by training the parents. Of course, there is the option of the practitioner working on the baby regularly. Still, the critical bonding component, which may have a positive psychological impact on the future family, will be missing.
We may summarize the general approach to massage of a full-term infant as: “The smaller the body, the lighter the massage”. Therefore, follow that logic – a gentle touch should be the essence of infant massage. This is a widespread approach to baby massage for full-term infants.
Though this type of baby massage should be both acceptable and encouraged to use by parents, as they gently stroke their babies with love, it would be a clear example of underperforming on a massage therapist’s part for the pre-term infants. Thus, baby massage for the pre-term infants is an entirely different professional universe, which is far away from what our readers may see in countless videos and books where the practitioner gently massages a happy baby. That will be the subject of Part II of this article.
There is a significant body of scientific evidence supporting the importance of infant massage in enhancing the normal development of children in both physical and emotional areas. Let us review the scientific data about the impact of baby massage on pre-term infants. The many controlled, randomized studies established what baby massage can do for pre-term infants. We will summarize the clinically demonstrated outcomes:
1. MASSAGE STIMULATES WEIGHT GAIN
Quick weight gain is a critical component of any pre-term infant’s development. Smaller body mass in combination with early exposure to the out-of-utero environment is one of the main contributing factors to weaker body defense as well as delays in emotional and mental development. There is a correlation between the rise in ADD and autism among children associated with an increased number of premature deliveries. Thus, quick weight gain becomes a significant priority.
The wave of studies that confirmed weight gain in pre-term infants who received regular massage therapy required a theoretical explanation and justification of this clinical outcome of massage therapy. Scientists from the Touch Research Institute, based on several studies conducted, proposed the following theory (Diego et al., 2005).
Massage therapy stimulates peripheral sensory receptors, especially pressure receptors. Such stimulation increases vagal tone (i.e., activates parasympathetic nervous system), which leads to an increase in gastric motility. At the same time, massage is shown to decrease the level of cortisol, which leads to increased insulin secretion. Thus, a combination of increasing gastric activity and insulin secretion is responsible for the greater weight gain in pre-term infants treated regularly by massage.
Ferber et al, (2002) found that over a 10-day study period, the pre-term infants who received regular massage by mothers (gained 291.3g) and professionals (gained 311.3 g) gained significantly more weight when compared to the control group (gained 225.5 g). The importance of this study lies in the scientific fact that infant massage conducted by trained professionals is more effective than massage conducted by mothers, even if they have received basic training in massage therapy. However, the mother can be trained to perform massages for cost-saving reasons. Similar results were obtained by Vickers et al (2004) and Massaro et al (2009).
Sankaranarayanan et al. (2005) found that what practitioners or mothers use during massage is also an important factor. The authors compared the effect of massage with mineral oil and coconut oil on the weight gain of pre-term infants. The massage was administered since the second day of life during the first month, 4 times per day. The study showed that babies in the group where coconut oil was used showed significantly greater weight gain velocity as compared to the group where mineral oil was used and the placebo group.
2. MASSAGE REDUCES COLIC PAIN AND JAUNDICE
Colic pain is a very stressful event for the newborn and family, which affects the baby’s sleep patterns and contributes to future behavioral problems and gastrointestinal dysfunction. Thus, control of colic pain especially first 4 months is real challenge. According to Nahidi et al., (2017), the full-body infant massage at 12 weeks significantly reduces Colic Pain, eliminates crying behavior, and restores the sleep pattern.
Infant Jaundice is frequent after birth, but it needs to be controlled asap since prolonged jaundice triggers very complex side effects on future babies’ development: poor feeding, irritability, learning disabilities, autism, etc. There are a number of studies (Eghbalian et al, 2017; Gözen, et al., 2019; Korkmaz and Esenay, 2020) that have confirmed a significant decrease in bilirubin levels in the blood of infants with Jaundice and transcutaneous bilirubin levels.
Recommended protocol is 2-3 times per day, a 10-15-minute full-body massage.
3. MASSAGE IMPROVES NEURODEVELOPMENT OF PRE-TERM INFANTS
Recent studies that examined the impact of massage on the neurodevelopment of pre-mature babies demonstrated significant findings.
It is widely known and accepted that all our information about the body and its functions, including brain development, is coded in the genes of DNA. Until recently, we saw DNA as a written life verdict that has very little flexibility. What we have is what we will have for the rest of our lives, i.e., we are at the mercy of our genetic code. However, a recent breakthrough in Genetics led to the development of a new branch called Epigenetics. This exciting new field gave us great hope and concerns at the same time.
According to the latest scientific data, the behavior of each gene (or gene expression) is controlled by special switches, which are methyl groups. These switches are responsible for the gene being active or being shut down, and they are under the significant influence of our environment. We know now that our bad inheritance is not a doom scenario because we have the power to control gene’ expression through medical interventions by changing the surrounding environment or eliminating harmful habits that turn on bad genes.
From the perspective of this information, the pre-term infants face an unfortunate reality during their first months of life. They are supposed to be in a well-protected womb, and instead, they are introduced to a hostile environment while their bodies aren’t ready yet. The problem with this already known fact is that during this challenging period of their life, a hostile environment (especially in NICU) significantly affects the function of epigenes, which may shut down good genes and activate bad genes. Later in life, it can affect “…experience-sensitive mechanisms (eg, learning) and could generate responses that may be unexpected or considered pathologic” (McGrath, 2009).
As several critical studies have shown, the regular application of massage starting as early as 24-48 hours has a great positive impact on the development of the brain and its function. This sensory stimulation helps pre-term babies adapt more quickly to the new environment, allowing them to catch up with full-term babies more rapidly.
Guzzetta et al. (2009) examined the effect of massage intervention on the development of the visual system in pre-term infants. The pre-term infants received 15-minute massages 3 times per day for two blocks of five days. In the intervention group, the authors recorded quicker development of the visual cortex, which was registered as maturation of visual evoked potentials and of visual acuity, as well as “…maturational changes in electroencephalographic activity”.
Procianoy et al (2010) followed the neurodevelopment of 73 newborns with similar neonatal data (35 in Intervention Group, and 38 in Control Group) during a two-year period. Babies in the intervention group received regular massages while babies from the control group received skin-to-skin contact only. Babies in the intervention group exhibited higher Psychomotor Development Index and significantly higher Mental Development Index scores than babies from the Control Group.
Ho, et al (2010) in a randomized controlled study examined the impact of massage therapy on pre-mature infants with deficits in motor activities. According to the authors, “Massage therapy might be a viable intervention to promote motor outcomes in a subgroup of premature newborns with poor motor performance”.
4. MASSAGE IMPROVES SLEEP PATTERNS AND REDUCES THE STRESS OF PRE-TERM INFANTS
The massage therapy helps decrease stress that pre-mature infants experienced in NICU because the simulation of pressure receptors during massage triggers a parasympathetic response. This reduces the cortisol (primary indicator of stress) levels and increases vagal activity (Field et al., 2008). Also, cortisol has been linked to later development of attention-deficit disorders in pre-term and vulnerable infants (McGrath, 2009).
Klemanson et al, (2006) followed 50 pre-mature infants for 8 months who received either regular massages by practitioners (intervention group of 25 infants) or only skin-to-skin contact (control group of 25 infants). The findings suggest that premature infants who received massage intervention were less likely to snore during sleep, required less feeding on waking up at night, and were more alert during the day.
Hernandez-Reif et al (2007) examined the level of cortisol in the saliva of pre-term infants and showed that 5 days of massage therapy significantly decreased the cortisol level. Mendes et al, (2008) made a similar conclusion regarding decreased stress and proper maturation of 52 infants in the intervention group who received regular massage therapy compared to 52 infants in the control group.
5. MASSAGE STIMULATES BONE FORMATION AND DECREASES BONE RESORPTION
According to a study conducted by Aly et al. (2004) regular massage application in combination with exercise stimulates bone formation. Osteopenia of prematurity or bone fragility is a known source of morbidity in pre-term infants.
The authors measured the activity of two major peptides associated with bone formation (PICP in serum and Pyd in urine). Babies in the control group who received skin-to-skin contact only showed a decrease in the PICP, which indicated a reduction in bone formation. Babies in the intervention group showed a significant increase in serum PICP, which was a clear indication of new bone formation in the body of pre-mature infants.
The second part of this article, in the next issue of the Journal of Massage Science, will be dedicated to the practical application of infant massage.
SOMI provides therapists with a solid scientific foundation for practicing massage therapy, grounded in medical, scientific, and clinical data. Join the growing family of Medical Massage Practitioners: https://www.scienceofmassage.com/seminars/
Aly H, Moustafa MF, Hassanein SM, Massaro AN, Amer HA, Patel K. Physical Activity Combined With Massage Improves Bone Mineralization in Premature Infants: a Randomized Trial. J Perinatol, May;24(5):305-9, 2004.
Beider S., Mahrer N.E., Gold, J.I. Pediatric Massage Therapy: An Overview for Clinicians. Pediatric Clinics of North America, Volume 54 (6), December 2007.
Diego M, Field T, Hernandez-Reif M. Vagal Activity, Gastric Motility and Weight Gain in Massaged Preterm Neonates. J Pediatr, 147:50-55, 2005.
Eghbalian, F.; Rafienezhad, H.; Farmal, J. The Lowering of Bilirubin Levels in Patients with Neonatal Jaundice Using Massage Therapy: A Randomized, Double-Blind Clinical Trial. Infant Behav. Dev. 2017, 49, 31–36.
Ferber SG, Kuint J, Weller A, Feldman R, Dollberg S, Arbel E, Kohelet D.Massage Therapy by Mothers and Trained Professionals Enhances Weight Gain in Preterm Infants. Early Hum Dev., 2002 Apr;67(1-2):37-45.
Field, T., Diego, M., Hernandez-Reif, M., Dieter, J. N. I., Kumar, A. M., Schanberg, S., Kuhn, C. Insulin and Insulin-Like Growth Factor-1 Increased in Preterm Neonates Following Massage Therapy. Journal of Developmental & Behavioral Pediatrics, Volume 29(6), December, pp 463-466, 2008.
Gözen, D.; Yılmaz, Ö.E.; Dur, Ş.; Çağlayan, S.; Taştekin, A. Transcutaneous Bilirubin Levels of Newborn Infants Performed Abdominal Massage: A Randomized Controlled Trial. J. Spec. Pediatric Nurs. 2019, 24, e12237.
Guzzetta A, Baldini S, Bancale A. Massage Accelerates Brain Development and Maturation of Visual Function. J Neurosci, 29(18):6042-6051, 2009.
Hernandez-Reif M, Diego M, Field T. Preterm Infants Show Reduced Stress Behaviors and Activity After 5 days of Massage Therapy. Infant Behav Dev, Dec;30(4):557-61, 2007.
Ho, Yuen-Bing 1; Lee, Robert S.Y. 2; Chow, Chun-Bong 2; Pang, Marco Y.C. 3. Impact of Massage Therapy on Motor Outcomes in Very Low-Birth weight infants: Randomized Controlled Pilot Study. Pediatrics International, 52(3):378-385, June 2010.
Kelmanson IA, Adulas EI. Massage Therapy and Sleep Behavior in Infants Born With Low Birth Weight. Complement Ther Clin Pract., Aug;12(3):200-5, 2006.
Korkmaz, G.; Esenay, F.I. Effects of Massage Therapy on Indirect Hyperbilirubinemia in Newborns Who Receive Phototherapy. J. Obstet. Gynecol. Neonatal Nurs. 2020, 49, 91–100.
McGrath, J.M. Touch and Massage in the Newborn Period: Effects on Biomarkers and Brain Development. Journal of Perinatal & Neonatal Nursing, Volume 23(4), October/December, p 304-306, 2009.
Massaro AN, Hammad TA, Jazzo B, Aly H. Massage with kinesthetic stimulation improves weight gain in preterm infants. J Perinatol, May;29(5):352-7, 2009.
Mendes EW, Procianoy RS. Massage Therapy Reduces Hospital Stay and Occurrence of Late-onset Sepsis in Very Preterm Infants. J Perinatol, 28(12):815-820, 2008.Nahidi, F.; Gazerani, N.; Yousefi, P.; Abadi, A.R. The Comparison of the Effects of Massaging and Rocking on Infantile Colic. Iran. J. Nurs. Midwifery Res. 2017, 22, 67.
Procianoy RS, Mendes EW, Silveira RC. Massage Therapy Improves Neurodevelopment Outcome at Two Years Corrected Age For Very Low Birth Weight Infants. Early Hum Dev., Jan;86(1):7-11, 2010.
Sankaranarayanan K, Mondkar JA, Chauhan MM, Mascarenhas BM, Mainkar AR, Salvi RY. Oil Massage in Neonates: an Open Randomized Controlled Study of Coconut Versus Mineral Oil. Indian Pediatr., Sep;42(9):877-84 2005.
Serrano, M. S.C., Doren, F.M., Wilson, L. Teaching Chilean Mothers to Massage Their Full-Term Infants: Effects on Maternal Breast-Feeding and Infant Weight Gain at Age 2 and 4 Months. Journal of Perinatal & Neonatal Nursing, 24(2), April/June, p 172-181, 2010.
Vickers A, Ohlsson A, Lacy JB, Horsley A. Massage For Promoting Growth and Development of Preterm and/or Low Birth-Weight Infants. Cochrane Database Syst Rev., (2):CD000390, 2004.
Category: Pediatric Massage