Baby or infant massage is an exciting part of the massage therapy profession. Recent scientific studies published in many medical journals have generated a lot of interest among health providers and hospitals. As it was correctly pointed 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 distribute it as small brochures among the pediatricians and pediatric departments of local hospitals. This is a great way to build up 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 the full term and pre-term infants. We realize that the information in the second part may go against what some of our readers learned and even currently practice. However, we will prove to our readers that practical recommendation which we will discuss in the Part II are the most clinically effective.
At the beginning we would like to separate infant massage into two major categories: application of the baby massage on full term infants and application of massage on pre-term infants. The baby massage for the full term infants is the form of additional sensory stimulation which helps to optimize mental and physical development. Additionally this type of massage is better to be conducted by parents to enhance bonding between child and mother and 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, but the important 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 requires the lighter massage”. Therefore, follow that logic – a gentle touch should be the essence of infant massage. This is a wide spread approach to baby massage of 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 definitely be a clear example of under performing on a massage therapists’ part for the pre-term infants. Thus baby massage for the pre-term infants is a completely 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.
There is a significant body of scientific sources which supports and scientifically justifies the importance of infant massage as a great tool used to enhance the normal development of the child in the 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 greatly 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 womb environment is one of the main contributing factors to weaker body defense as well as delays in the 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 great priority.
The wave of studies which confirmed weight gain in the 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 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 increase of 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 a10-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 is scientifically proven fact that infant massage conducted by trained professionals is much more effective than massage conducted by mothers even if they were trained in the basics of massage therapy. However, the mother can be trained to conduct 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 improves neurodevelopment of pre-term infants.
Recent studies which examined the impact of massage on the neurodevelopment of pre-mature babies demonstrated incredibly important findings.
It is widely known and accepted that all our information about the body and its functions including brain development are coded in the genes of DNA. Until recently we saw DNA as a written life verdict which has very little flexibility. What we got 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 the Genetics led to the development of its 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 great influence of our environment. We know now that our bad inheritance is not a doom scenario because we have the power to control genes’ expression through medical interventions by changing surrounding environment or eliminating bad habits which turn on bad genes.
From the perspective of this information, the pre-term infants face very bad reality during their first months of life. They are supposed to be in the 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 very difficult period of their life hostile environment (especially in NICU) greatly 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 important 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 quicker to the new environment and allows them to catch up with full term babies quicker.
Guzzetta et al. (2009) examined the effect of massage intervention on the development of visual system in pre-term infants. The pre-term infants received 15 minutes massages 3 times per day for 2 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 neurodevelopment of 73 newborns with the 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 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”.
3. Massage improves sleep pattern and reduces stress of pre-mature infants.
The massage therapy helps decrease stress pre-mature infants experienced in NICU because the simulation of pressure receptors during massage triggers a parasympathetic response. This decreases the cortisol (major indicator of stress) levels and increases in 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 infant). 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 greatly decreased the cortisol level. Mendes et al, (2008) made a similar conclusion in regard to 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.
4. Massage stimulates bone formation and decreases bone resorption.
According to a study conducted by Aly et al. (20004) regular massage application in the combination with exercise stimulates bone formation. Osteopenia of prematurity or bone fragility is a known source for 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 control group who received skin to skin contact only showed a decrease in the PICP, which indicated a decrease in the bone formation. Babies in the intervention group showed serum PICP increase significantly and it 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 Journal of Massage Science will be dedicated to the practical application of infant massage.
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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.
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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.
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