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Massage therapy and infants

 

Researched and written by: Angela Shears

Date: 10/14/2006

 

What is massage?

Why use massage with infants?

Infant massage in other parts of the world

Infant massage in the United States—direct benefits to the infant

Infant massage benefits the massage “therapist”

Infant massage therapy use in hospitals

Infant massage therapy—a story from someone who sees the results everyday

Psychological Research

Study 1

Study 2

Study 3

Study 4

Study 5

Study 6

Conclusions

Sources

 

What is massage?

 

Massage, in general, is a “healing” therapy where the muscles and other soft tissues of the body are manipulated to improve health and well-being.  Swedish massage is probably a technique that is familiar to most people. It involves different strokes and pressure techniques that are supposed to enhance blood flow to the heart, remove wastes from tissues, stretch ligaments and tendons, and ease physical and emotional tension. 

 

During a massage, electrical signals are transmitted to the area being massaged and throughout the body. 

The signals that are produced

v      heal damaged muscles.

v      stimulate circulation.

v      boost immune system activity.

v      reduce pain and tension.

v       induce a calming effect.

v      stimulate the release of endorphins—natural pain-killers and mood elevator.

v      reduce levels of stress hormones.

Massage is thought to support healing, boost energy, reduce recovery time after injury, ease pain, and enhance relaxation, mood and well-being.  (http://www.umm.edu/altmed/ConsModalities/Massagecm.html)

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Why use massage with infants?

Infant massage in other parts of the world

Infant massage is common to many parts of the world such as Nigeria, India, Fiji, and New Zealand.  In these countries, infants are usually given two massages (with oil) per day:  one massage following the infant’s daily bath and prior to sleep time.  In India, specifically, the daily routine of massage is thought to contribute to the “precocious motor development” of Indian infants.  The massage stimulates respiration, circulation, digestion and elimination.  The infant is also more relaxed, and therefore, he/she sleeps more soundly.  Massage is also thought to help relieve gas and colic; it also helps heal the infant during illness by easing congestion and pain.  (http://www.zerotothree.org/massage.html)

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Infant massage in the United States—direct benefits to the infant

Infant massage is a more recent advent in the United States.  It is quickly becoming recognized as a beneficial therapy for infants.

In healthy infants, massage facilitates bonding between the parent and the infant, fostering the development of warm, positive relationships.  It has been observed to reduce stress responses to painful medical procedures that the infant might have been exposed to such as inoculations, teething and constipation pain, and colic.  The infant seems to sleep better.

            Infants who have a disability or illness also benefit from massage.  Blind and/or deaf infants become more aware of their bodies.  Premature infants and infants with cerebral palsy develop more organized motor activity.  Premature babies also gain weight.  (http://www.zerotothree.org/massage.html)

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Infant massage benefits the massage “therapist”

Infant massage not only benefits the infant, but it also benefits the one giving the infant a massage.  You already know that in helps in bonding between parent and child, but the parent reports feeling good when they massage their infants. 

Depressed mothers become more aware of their infant’s wants and needs and feel the infant is easier to soothe after massage therapy. 

Elderly massage volunteers were found to be less anxious and depressed and in a better mood following giving massage to infants.  Their actual stress levels decreased.  Their lifestyles improved; this evidenced through their increase in number of social contacts, fewer trips to the doctor and fewer cups of coffee.  Their self-esteem even increased.  (http://www.zerotothree.org/massage.html, written by Tiffany Field)

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Infant massage therapy use in hospitals

Infant massage therapy is being used in hospitals.  At Vanderbilt Medical Center, massage therapy is used by nurses in the neonatal intensive care unit (NICU).  The nurses have found it to reduce the stress of medically stable infants and help them sleep deeper and longer.  (http://www.mc.vanderbilt.edu/reporter/?ID=2139)

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Infant massage therapy—a story from someone who sees the results everyday

Massage therapists see the benefits of massage on infants firsthand.  Carolyn Molloy, a certified infant massage instructor in the Perinatal and Nenonatal Units at St. Luke’s Hospital in Kansas City, Missouri, tells of her positive experience with infant massage therapy.  She explained the importance of massage therapy by using the two terms negative touch and positive touch. 

Negative touch is any touch that is painful, invasive or uncomfortable to the baby.  This type of touch is usually experienced during medical procedures that are performed by someone other than the parent(s) or caregiver(s) of the child. 

Positive touch, in contrast, is any loving, nurturing, soothing, or comforting touch.

According to Malloy, a balance between negative touch and positive touch needs to be achieved to prevent long-term problems.  She feels that an overabundance of negative touch without positive touch to balance it out may cause the baby to develop tactile defensiveness or touch aversion.

There are certain reasons why Molloy feels infant massage therapy is becoming more important.  Premature births are on the rise due to the higher use of fertility drugs.  These drugs result in more multiple birth.  Also, the overall stress of life in today’s world could be a contributing factor to more pre-term labor.  Premature babies experience many more medical procedures than other infants because they are usually required to stay in the hospital longer before they are released to go home.  This produces an overabundance to negative touch.

Molloy views massage as the logical solution to the problem of this overabundance of negative touch.  Infant massage therapy reduces tactile aversion that the baby may have developed while in the hospital.  (http://massagetherapy.com/articles/index.php?article_id=543, written by Carolyn Guenther Malloy)

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Note:  All the above information was found through research (“googling”) on the internet.  Do psychologists come to the same conclusions?  Let’s look at several studies that explore the effects of infant massage therapy. 

 

Study 1

Field, et al. (1996) attempted to discover the potential benefits of massage therapy for healthy infants with depressed mothers.  Low socioeconomic status (SES) adolescent mothers were first evaluated to determine if they were depressed or not.  The depressed mothers and their infants were place into one of two groups:  the massage-therapy group or the rocking group.  The massage therapy group was massaged twice a week for 6 weeks by a research assistant while the rocking group was rocked twice a week for 6 weeks by a research assistant.  The demographics of each group did not differ significantly.  The infants were monitored to keep track of their sleep/wake behavior; weight; formula intake; temperament; and cortisol, norepinephrine, and epinephrine, and serotonin levels.  Cortisol, norepinephrine, epinephrine, and serotonin are hormones that are related to stress.  The massage-therapy infants gained more weight despite a lack of difference in formula intake from the rocking group.  Their temperament also improved.  Their levels of norepinephrine, epinephrine, and cortisol decreased while serotonin levels increased, suggesting that the infant’s stress level decreased.  These finding indicate that depressed mothers may be able to help their infant’s development through the use of massage therapy.

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Study 2

Jones, et al. (1998) did a study to find a relationship between the right frontal EEG and massage therapy in infants of depressed mothers.  Depressive symptoms in infants of depressed mothers have been found to be associated with right frontal EEG asymmetry.  The mothers were first assessed to see if they were depressed.  If the mother was depressed, the infant was brought in to undergo massage therapy.  The amount of EEG asymmetry was measured before, during, and after the massage therapy.  The right frontal EEG asymmetry significantly decreased during and after the massage, suggesting a decrease in depressive symptoms.  Further research is needed to determine the long-term effects of right frontal EEG asymmetry.

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Study 3

Many mothers experience postnatal depression.  Onozawa, et al. (2001) tried to observe the effects of infant massage therapy on the infant-mother interaction.  The mothers experiencing postnatal depression and their infants were split into two groups:  one group which received massage classes and attended support group meetings and another group that only attended the support group meetings.  The weekly massage class taught mothers how to observe and respond to the body language of their infant and adjust their touch (massage) accordingly.  During the weekly support group sessions, practical problems and coping strategies were discussed.  The parents were observed in a play-interaction two times during the course of the study (once at the beginning and another time at the end).  These video tapes were observed and scored on a variety of dimensions related to infant-mother relationship.  The mothers in the massage group experienced greater decreases in depression levels than the mothers in the support only group.  This seems to indicate a benefit for the depressed mother who is acting as the “massage therapist” for the infant.  This study had several limitations though.  Due to drop-out, the sample size was small.  Also, during massage class, the mothers were instructed on how to read their baby’s body language and how to massage their infant; therefore, it cannot be certain whether the decrease in depression can be attributed to the body-language instruction or the massage instruction.

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Study 4

            Field, et al. (2004) explored the effects of moderate and light pressure massage on infant development during the first month of life.  Mothers were first instructed on how to massage their infant with moderate pressure or light pressure.  These mothers would then take these techniques home and massage their infant every night before bedtime.  The infant’s weight and length were measured before and after massage therapy.  The Brazelton Neonatal Behavior Assessment Scale (BNBAS) was given to infants to assess their neurological reflex development.  Also, their sleep-wake behavior was observed.  Infants in the moderate-pressure massage group were increasingly alert while the infants in the light-pressure massage group were more excitable, agitated, and fussy.  The moderate-pressure infants exhibited a greater weight gain and greater increase in body length.  Moderate-pressure massage therapy seems to be an effective method to enhance weight gain and development in infants.

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Study 5

Premature infants experience an increased amount of separation from their mothers due to extended hospital stays.  Ferber, et al. (2005) investigated the effects of massage therapy on the mother-infant relationship.  Mother and infant were placed into one of three groups.  The mothers group was the one in which the mothers performed the massage therapy.  The staff group was the group in which a female research assistant performed the massage therapy.  The control group infants did not receive massage.  Each infant received a massage daily for a 10-day period.  The mothers and research assistant were given training beforehand on proper massage technique.  After completing the massage therapy, each mother and infant pair were observed in a play situation.  These interactions were than coded according to the Coding Interactive Behavior Manual, a global rating system of parent-child interactions.  The infants and mothers in the mothers or staff group had improved mother-infant interactions and increased the social involvement of the infant.  This helps establish a more direct benefit of massage; the “therapist” did not matter.  This study is limited due to small sample size and homogeneity of the sample.  Still, massage therapy could be an important intervention for pre-term infants.

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Study 6

Dieter, et al. (2003) looked at the effects of 5 days of massage therapy on weight gain and sleep/wake behavior of infants.  This had previously been studied in longer time-frames.  Infants with low SES mothers were placed in one of two groups—the massage group or the control group.  For five days, the infant was massaged daily.  Each daily massage was made up consisted of three segments, lasting 15 minutes each.  A therapist performed the massage therapy on the infant.  Weight gain and volumetric intake were measured and sleep/wake patterns were observed.  The two groups had no significant differences in demographics or daily formula intake.  The massage group experienced more weight gain.  The infants in this group also slept less by the end of the group training, altering the distribution of sleep/awake states of premature infants.  The results of this study suggest that massage therapy is a cost-effective treatment for premature infants.  It also suggests that the dose-response ratio may be lower than was thought; therefore, a lesser number of days of massage therapy may be needed to produce the same effect.

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Conclusions

All of these studies seem to agree with the information found on the internet.  Massage therapy does have various benefits for the mother and the infant.  Massage therapy induces the bonding process between mother and child.  Massage therapy causes increased weight gain and more organized sleep patterns in normal and premature infants.  It even helps in the social development of the premature infant. 

The websites may agree with the studies because the authors of these online articles are using the research literature to make their claims.  For example, one of the authors of the online articles also was a co-author on several of the research papers that were included in this review.  Also, several websites cited research journal articles in their lists of sources.  This is a good thing for consumers who are just “googling” the subject of infant massage therapy. 

Most websites did not mention the limitations of the studies while the research articles usually did.  One of the limitations of the different studies was small sample size.  These studies did produce “significant” results, but they still need to be replicated (repeated with a different and perhaps larger sample) in order to strengthen their claims.  Some studies may just need to be improved by changing the design. One of the studies (Onozawa, et al., 2001)  was not sure if the effect should be attributed to the massage training or the body-language training.  Another study needs to be done so the effects will not be confounded with multiple variables.  For example, a study could just test the benefits of massage instruction alone or the benefits of body-language training alone. 

Malloy’s story about her experience with massage therapy could be slightly biased, considering that she is a massage therapist  herself.  She would want others to view massage therapy in a positive light because if they did not, she would be out of a job.  Biases like these should be considered when looking at information on the internet.  Even journal articles should be critically examined for biases.

The weakness of the information found on the web seems to lie in the weakness of its source material.  Also, in order for the websites to more accurately portray the results of the studies, the methodologies and limitations of the studies should be stated in terms the consumer can understand.  Thus, the consumer could make an even better decision about the benefits or lack thereof of infant massage therapy.

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Sources

Dieter, J. N. I., Field, T., Hernandez-Reif, M., Emory, E. K., Redzepi, M.  (2003).  Stable preterm infants gain more weight and sleep less after five days of massage therapy.  Journal of Pediatric Psychology, 28, 403-411.

 

Ferber, S. G., Feldman, R., Kohelet, D., Kuint, J., Dollberg, S, Arbel, E., et al. (2005).  Massage therapy facilitates mother-infant interaction in premature infants.  Infant Behavior and Development, 28, 74-81.

 

Field, T., Grizzle, N., Scafidi, F., Abrams, S., Richardson, S., (1996).  Massage therapy for infants of depressed mothers.  Infant Behavior and Development, 19, 107-112. 

 

Field, T., Hernandez-Reif, M., Diego, M., Feijo, L., Yanexy, V., Gil, K. (2004).  Massage therapy by parents improves early growth and development.  Infant Behavior and Development, 27, 435-442.

 

Jones, N. A., Field, T., Davalos, M. (1998).  Massage therapy attenuates right frontal EEG asymmetry in one-month-infants of depressed mothers.  Infant Behavior and Development, 21, 527-530. 

 

Onozawa, K., Glover, V., Adams, D., Modi, N., Kumar, R. C. (2001).  Infant massage improves mother-infant interaction for mothers with postnatal depression.  Journal of Affective Disorders, 63, 201-207. 

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