Infant massage is an age-old healing practice employed across the globe. It has been promoted as a method to alleviate stress and foster bonding, especially for infants undergoing painful procedures, exposed to the demanding NICU environment, and separated from their parents. This article examines current research on infant massage, particularly in the NICU, to provide an updated literature review on this topic.
Introduction to Infant Massage
Infant massage involves structured touch of the skin and is a tradition in many cultures that starts right after birth. The way infant massage is done varies around the world, including how long it lasts, how strong it is, whether oil is used, and how involved parents are. Neonatal intensive care units (NICUs) can be hard on newborns because they often don't get enough human touch. Infants are defined as children between 0 and 12 months old, a period of rapid development.
The Science Behind Infant Massage
Massage provides tactile stimulation, which is a crucial source of sensory input that promotes development and well-being. Early psychological and sensory input is vital in facilitating an infant’s development. Infant massage encourages bonding through eye-to-eye contact, smiling, soothing vocal sounds, loving touch, caressing, and mutual interaction. Massage can also enhance oxygen and nutrient flow to cells and improve breathing patterns and lung health (respiration).
Benefits of Infant Massage
Physical and Emotional Benefits for Babies
Infant massage has numerous physical and emotional benefits. It enhances oxygen and nutrient flow to cells, improving breathing patterns and lung health. Regular massage can reduce stress, improve nervous system function, and enhance self-regulation and body awareness in infants. Parents have reported improvements in muscle tone, joint mobility, gastrointestinal issues, and response to therapies like physiotherapy. It is especially helpful for premature babies, babies born addicted, and HIV+ babies.
Benefits for Parents
There are also benefits for parents and the development of parenting skills. Mothers who learned and performed infant massage during a hospital stay experienced reduced anxiety and a stronger attachment with their child. Improved attachment was also seen in studies by Guröl and Holditch-Davis et al. Furthermore, the incidence of depression was reported as 12% in mothers and 6% in fathers in the postnatal period. These effects could be attributed to the hormone oxytocin, which is secreted as a result of physical contact. Both mothers and children had increased levels of oxytocin during the infant massage.
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Mental Well-being and Reduced Stress
Infant massage improves mothers’ mental well-being and reduces anxiety, depression, and stress. Mothers who continued to massage their children post-discharge showed sustained reductions in anxiety and stress. These effects were not limited to mothers and extending also to fathers, who reported experiencing less stress when attending infant massage courses. These effects could be attributed to the hormone oxytocin, which is secreted as a result of physical contact. Both mothers and children had increased levels of oxytocin during the infant massage.
Infant Massage in the NICU
Addressing a Stressful Environment
A NICU is a highly medically adverse environment, and that’s stressful for the babies. Typically, these babies are kept in a separate environment where it’s dark and quiet, because stimulation is considered distressing to them.
Reducing Negative Stimulation
It’s all done to help them grow and thrive, but for a newborn, it’s still negative stimulation that can lead to agitation and discomfort. There are needles and tubes; even a diaper change can be negative because they aren’t actually ready to be having diaper changes yet.
Improved Measurements and Comfort
Researchers embarked on a study, being sure to follow the babies’ signals and adjust or stop the massage accordingly. Along with recording improved measurements in heart rate, respiratory rate and oxygen levels, the babies appeared more comfortable following massage therapy.
Early Therapy
Therapy was started within the first few days of life. Significant decrease in heart rate, blood pressure and respiratory rate at the end of the sessions was found.
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Systematic Review of Infant Massage Effects
Purpose and Methodology
To determine the current state of knowledge about infant massage, a systematic literature review was performed according to the PRISMA guidelines. A systematic literature review compiles existing research in a specific area in a predetermined way and can form the basis for evidence-based health care. Because data from controlled studies are considered the most robust, only articles that used randomized controlled trials (RCTs) and clinically controlled trials (CCTs) were included in the sample. Additional inclusion criteria consisted of peer-reviewed articles written in English and published between 2017 and 2021. The databases CINAHL, PubMed, and PsycINFO were searched, and the studies that fulfilled the inclusion criteria were selected. Online searches were performed up to January 2022.
Study Selection Process
The searches yielded a total of 122 articles among the three databases; 35 articles in CINAHL, 78 articles in PubMed, and nine articles in PsycINFO. After the duplicates were removed, the title and abstract of 112 articles were reviewed. Articles whose title and abstract did not meet the inclusion criteria were excluded (e.g., the article focused on another type of massage, such as cardiac massage, massage on the mother, or reflexology; review articles; or articles that did not examine the outcome in PICO). After this initial review of the title and abstract, a total of 19 articles were reviewed in their entirety; however, one article was excluded since it did not examine infant massage, and two articles were excluded since they did not examine the outcome in PICO. The 16 articles were read in their entirety and independently critically reviewed several times according to the review template.
Study Characteristics
The studies included 15 RCTs and one CCT, and the study quality was judged to be medium (n = 9) or high (n = 7). The studies were conducted in the following countries: Iran (n = 7), Turkey (n = 4), China (n = 2), India (n = 1), Taiwan (n = 1) and USA (n = 1).
Effects of Infant Massage on Specific Outcomes
Pain Relief
The effects on pain were examined in seven studies that included a total of 717 children. Pain during blood sampling was examined in five studies, postoperative pain was examined in one study, and colic pain was examined in one study. In the five studies that examined pain during sampling, pain during massage was reduced compared to controls; in four of these studies, the difference was statistically significant. The gestational age of the children in the studies varied, with both premature and full-term children being examined.
Reduction of Jaundice
Bilirubin levels were measured in six of the included studies to evaluate the effect of infant massage on reducing jaundice. The six studies examined a total of 455 children; in five of these studies, children with jaundice were examined and treated with phototherapy. However, Gözen et al., assessed healthy children to determine whether and to what extent they developed jaundice with or without massage. In the studies examining children with jaundice, a significant difference in serum bilirubin levels was found after massage. Some relate this to an increase in the frequency of bowel movements. In the only study on healthy children, Gözen et al. found that children who received massage had a significantly lower transcutaneous bilirubin increase. Premature and full-term children were examined in the six studies. Different types of massage were performed among the six studies. Mainly, full-body massage had a duration of 5-15 min per session, with two to three sessions per day.
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Weight Gain
Four of the included studies examined the effects of infant massage on weight gain in a total of 244 children. A significant weight gain following regular massage was shown in all four studies. Liao et al. reported that massage with medium-chain triglycerides (MCT) oil had a significantly better effect of weight gain on days five to seven of massage compared to both the group that received massage without oil and the control group. The gestational age of the children in the studies varied.
Infant Massage Programs and Techniques
Combination of Techniques
Infant massage programs often use a combination of techniques from traditional Swedish massage, East Indian massage, reflexology, and conditioned relaxation response. Certified infant massage instructors teach new parents how to massage their baby, what oil to use and why, how to explore their infant’s cues, how to perform strokes for all areas of the body, and how to modify the massage for a growing child.
Therapeutic Massage
Therapeutic massage physical therapy programs provide an opportunity to meet one on one with a physical therapist who is a certified infant massage instructor. These sessions are for children of any age with special needs.
Key Categories of Benefits
When we talk about the benefits of infant massage we see 4 main categories - Stimulation, Relaxation, Relief and Interaction.
Role in Reducing Violence and Abuse
The CDC identifies nurturing parenting skills as one of the most important protective factors for lessening child abuse and neglect, with approaches that enhance parent skills and promote healthy child development having a demonstrated effect on prevention.
Neonatal Touch & Massage Certification (NTMC)
NTMC Hands-On Training is an advanced level course designed to further your skills as a nurse or therapist (OT, PT, SLP) and promote the health, well-being, and development of both the infants and the infant-parent dyads you serve. You will learn how to promote infant comfort, movement, alignment and a parasympathetic response while fostering the infant-parent relationships. Skills include integration of neonatal touch, massage, positioning, handling, myofascial trigger point release (therapists only), skin to skin holding and other neuroprotective, developmental, family-integrated caregiving activities that you can implement the next day!