The benefits of infant massage

16 November 2018

First published September 2012

What are the benefits of infant massage?

Introduction to infant massage

Infant massage is advised and encouraged by professionals as a method of achieving numerous physical and psychological benefits for infants and parents, ranging from accelerating weight gain in premature infants to helping mothers themselves ward off postnatal depression.

Fathers, too, can benefit. At a time when infants may be exclusively breastfed, infant massage provides a perfect opportunity for them to bond with their new offspring.

The practice is believed to date back at least 3,000 years. In some parts of the world, especially in south Asian countries such as India and Bangladesh, it is performed routinely by mothers who have seen the practice passed down from one generation to another.

Despite its long history, however, the provision of infant massage training in the UK is at best fragmented and more often, the benefits are ignored entirely.

Inevitably, enthusiastic parents desperate for advice and guidance turn to those healthcare professionals on hand to help them steer a course through the first difficult few months.

Yet budgetary constraints often mean these professionals, however keen they are to help, often find themselves unable to do so. In the UK, infant massage is not a practice that has an established place in initial health visitor training, nor is it culturally a traditional practice. Consequently, there is rarely dedicated post ­qualification training in how to advise parents on massage, as it is not top of the priority list when budgets are being cut among more established practices.

This supplement is designed as a learning tool for professionals involved in infant massage. It outlines the evidence that currently exists, provides handy tips to be passed on to parents who are getting started and looks at the oils used.

 

The benefits of infant massage

Community practitioners should be aware of the wide range of situations where their clients - mothers and fathers and infants - can potentially benefit from massage. When describing the benefits of infant massage to parents, one of the most impressive aspects of it is the sheer variety of physical health and psychological benefits it can bring. These range from improving weight gain1 to helping teenage mothers to bond with their child.2

During the early weeks of life, when sufficient weight gain is vital for newborns to flourish, massage can be an important catalyst, according to research.3 Consequently, when advising mothers with underweight infants, massage should be one of the options discussed.

A 2010 study found that when mothers were instructed how to massage their infants for ten to 15 minutes a day, the infants gained more weight within the first two months than those with the same birth weight who were not massaged.3

Exactly how massage increases weight gain in either full- or pre-term infants is still rather unclear, especially as most studies found no major differences in kilocalorie intake between infants receiving massage and those not receiving massage. However, one recent study suggests it may be a 'chain reaction' triggered by the gentle contact infants feel.4

Researchers from the Touch Research Institute at the University of Miami found massage increases the activity of the vagus nerve, which connects the brain to vital parts of the body such as the stomach, heart, ears and mouth.4 This, in turn, improves gastric motility, which leads to greater weight gain.

Sleep and bonding

According to the International Association of Infant Massage (IAIM), regular contact improves infants' sleep and can even bolster their immune system. It reports that other benefits include aiding digestion, improving circulation and easing teething pain.5

It adds that massage stimulates production of oxytocin, a hormone which can be produced by both males and females during massage. It is useful as a pain reliever and has a calming effect on the person.

The practice is crucial for the bonding process between parent and child. Touch is a very powerful element in human bonding and infant attachment, as are communication, both verbal and non-verbal, and prolonged eye contact. Infant massage encompasses and supports all these vital aspects of bonding.

Delayed bonding may occur due to situations such as premature birth, recovery from caesarean section, medical complications, adoption, lack of physical and emotional support and post natal depression. In these cases infant massage can begin to recreate the elements of bonding.5

Research also shows specific medical benefits. A 2008 study at Ataturk University in Turkey showed that daily massage can reduce the number of hours a day infants cry due to colic.6

Massage is even reported to accelerate brain development and the rate at which a newborn's visual function develops, according to Italian researchers.7 They studied ten preterm newborn infants admitted to intensive care and gave them three daily massage sessions for five days at a time. Using a portable EEG system, they measured brain activity in the massage group and compared the results with a control group of neonates not given massage.

'We found massage accelerates the maturation of electroencephalographic activity and of visual function,' the researchers said.

Another reported benefit is for infants affected by jaundice. In 2011, Japanese scientists found that bilirubin levels were significantly reduced in the days following birth if the infant had frequent massage sessions compared to infants that did not, and called for massage to be used to help protect against neonatal jaundice, even in full-term infants.8

It is reported that mothers, too, can benefit from performing massage on their infants, especially teenage mums who face the combined stress of adolescence, parenthood and trying to maintain peer relationships. Community practitioners should bear this in mind when advising young mothers.

University of Alabama researchers looked at how carrying out infant massage affected African-American adolescent mothers with an average age of 16.2 The mothers were instructed to perform massage every day for two months. The results showed they were less likely to suffer depression and more likely to be able to cope with their infants' temperament than those who did not perform it.

Researchers said the key appears to be the close physical contact involved. They concluded: 'Infant massage training may lead to improvements beyond those achieved with a typical parent education curriculum. It shows potential as a low-cost supplement to current teen mother education in high schools.'

 

INFANT MASSAGE - POTENTIAL BENEFITS

  • Aids parent/child bonding
  • Improves weight gain
  • Bolsters the infant's immune system
  • Eases teething pain
  • Leads to better sleep
  • Comforts infants with colic
  • Accelerates infants' brain development
  • Prevents jaundice
  • Aids digestion
  • Improves circulation

 

Infant massage: the case for using oils

Although skin-to-skin contact is the cornerstone of good infant massage, research shows the benefits are significantly enhanced by the use of oil. A study carried out at the University of Miami shows oil results in fewer stress behaviours and lower saliva levels of the stress hormone cortisol than massage alone.9

Sixty healthy infants (one month old) were split into two groups. Half received 15 minutes of massage with oil and the rest without oil. Each infant was filmed to monitor signs of distress - such as grimacing, mouthing and clenched fists - as well as averting behaviours, such as head turning and gaze aversion. Researchers also monitored infants' heart rates and took saliva samples to check for cortisol levels.

The results showed the infants rubbed with oil showed fewer limb movements, spent less time grimacing or clenching their fists and were less likely to turn their head away than infants massaged without oil. Cortisol levels also declined more sharply and there was a larger increase in vagal tone.

'The greater effectiveness of massage with oil versus no oil is not surprising given that the lubricity of oil means less friction for the therapist and the infant,' the Miami researchers said.

'With oil the stroking movements can be smoother and more rhythmic. These findings tentatively suggest that massage, especially with oil, can reduce the stress levels of normal infants.'

While the benefits of oil are proven, there is some difference of opinion surrounding which type to use. Within professional circles, there appears to be a strong preference for vegetable-based oils, rather than mineral oil (also known as baby oil) derived from petroleum. According to a study published in 2011 in the British Journal of Midwifery, only a tiny percentage (n=6 of 91, 12.2%) of staff in NHS maternity and neonatal units surveyed routinely recommend the use of baby oil to parents.10 In contrast, 81 % of those surveyed who recommended massage advised parents to opt for olive oil. Second choice was sunflower oil, often favoured because it is cheap, lighter than olive oil and relatively easily absorbed into the skin.

Olive oil is the traditional choice for massage use, and there is also a well-established practice of using olive oil in the treatment of seborrhoeic dermatitis. However, some research suggests that the high concentrations of oleic acid - a key component of olive oil - may have a negative impact on the skin barrier.11

The BJM survey found olive oil is recommended to new parents by health professionals for their infants despite a dearth of evidence to support this practice.10

Sunflower seed and grapeseed oil are used as they have some of the highest levels of linoleic acid - an essential fatty acid that helps to protect the barrier layer of an infant's skin. However, high­quality sunflower oil can be difficult to obtain. In the non-scientific literature, the assumption that paraffin oil clogs the pores and prevents the skin from breathing, while vegetable oils penetrate deeper, is commonly spread. However, research shows both paraffin oils and vegetable oils only penetrate as far as the first upper layers of the skin barrier, which protects against the ingress of external pathogens, allergens and irritants. After testing different oils on six volunteers, researchers measured moisture levels to test their effects. The results showed mineral oil performed as well as the vegetable oil options.12

The IAIM says: 'Olive oil is not recommended for use on infant skin. We recommend a scent-free vegetable oil, preferably cold-pressed and organic.'5

The use of oils is widely accepted as an advantage in assisting massage. Oils with low levels of oleic acid and high levels of linoleic acid are considered desirable. There is a growing body of evidence and research is under way into the benefits of all oils. However, while the empiric evidence base needs further strengthening, healthcare professionals can consider the existing evidence base when advising clients.

 

Advice to be given to parents

Getting started: Advising parents on benefits of infant massage

There are no hard and fast rules for infant massage and your clients may have a preferred method based on their own experience. But the keys to success entail gentle stroking and movement of the infant's arms, legs, feet, abdomen and back.

It is important to explain to parents that massage is not just about the physical act of manipulation. Its effects are enhanced by parental eye contact with the infant, the soothing sound of a mother or father's voice as they carry out the massage, and the infant's recognition of the adult's smell as something familiar. The frequency, location and timing are less important and can vary from family to family.

According to the IAIM, 'Infant massage has been a parenting tradition in many cultures all over the world for thousands of years. It offers a special time to communicate both verbally and non-verbally with infants so that they feel loved, valued and respected. This is so beneficial in promoting the emotional wellbeing during the early months of an infant's life'.

Parents from communities without a tradition of infant massage may require some basic advice to get started.
 

Finding the right setting

Explain to parents how the right setting is very important to maximise the effects of infant massage. Parents should be advised to try and find somewhere that is warm (around 24 degrees celsius) and draught­free, where it is easy to relax with no obvious distractions. Ideally, it should have some natural daylight, or subdued lighting. Relaxing background music can also help. For many parents it will be appropriate to perform massage before or after an infant's bath, when they are already in a fairly relaxed state. In addition, time permitting, you can suggest to parents that it may also be possible to combine a leg and abdomen massage with the various nappy changes throughout the day.

IAIM says the important thing is that the infant is quietly alert, interested in what is going on around them and ready to interact with a parent; but parents should be advised to avoid rubbing the abdomen straight after feeding as this could cause vomiting.

 

Getting the infant's permission

Verbal cues will help the child recognise what is being proposed, i.e. a massage; this starts the process and is part of gaining permission. Parents need to be advised that if their infant does not want to be massaged, or has had enough, then they should not persist at that time.

There are vital cues that parents can be advised to look out for. He or she may, for example, turn their head away, 'crunch up' the forehead or suck in the cheeks. Other signs to stop include grimacing, crying and making a fuss. If an infant seems uncomfortable or is clearly not enjoying the massage, the parent should stop and give him or her a cuddle instead.

 

Keeping eye contact

Maintaining eye contact as much as possible throughout the massaging process is widely regarded as central to the bonding it can bring and parents should be told to bear this in mind when performing massage on their infant.

Verbal communication should be explicitly explained as good practice to reinforce the bond and relationship between parent and child. When a parent uses a soothing voice, it helps the infant to feel nurtured and relaxed. Research shows preterm infants exposed to a recording of their mother's voice on a regular basis are more likely to feed properly and gain weight than those who do not hear it frequently.13

Parents should be advised to introduce their infants to massage gradually. This could start with a daily five-minute session and build slowly up to 15 minutes at a time. Even a short session of positive touch and massage will be beneficial for all.

 

Using a lotion or oil

A lotion or oil will help to reduce friction and make the massage more soothing. Parents should be told to place a ten pence-sized amount in the palm of their hand, then rub their hands together to distribute. This will also help to warm the liquid before it is applied to the skin. It's a good idea to advise parents to do a patch test first of the lotion or oil they intend to use so they can be sure it's suitable for their baby's skin.

See 'Quick Guide to Infant Massage' below for advice on how parents should perform a massage.

 

QUICK GUIDE TO INFANT MASSAGE

Parents should be told to start with the infant lying on their back. This enables the parent to get initial eye contact with the baby while gently telling them what is going to happen. Parents should rub their hands to make sure they're warm Then, using gentle, upward and downward movements, they should stroke the baby back and forth six times in a continuous action with contact throughout in the areas described below.

You may wish to advise parents that they can practice on the hand of a friend, rubbing back and forth six times or stroking with each hand, one after the other in a lapping motion with the left hand not breaking contact until the right starts its contact, which, although sounding complicated, is very easily understood when seen and done. This should be done on each of the following areas:

  • From the forehead down sides of the face to the neck
  • From the neck across the shoulders
  • From the chest to the waist
  • From the thigh to the foot and back again, on each leg
  • From the shoulder to the hand and back again, on each arm.

Learn more about NMC revalidation here.

 

References

1. Dieter JN, Field T, Hernandez-Reif M, Emory EK, Redzepi M. Stable preterm infants gain more weight and sleep less after five days of massage therapy. J Pediatr Psychol 2003; 28: 403-11.

2. Oswait KL, Biasini FJ, Wilson LL, Mrug S. OutcoA1es of a massage intervention on teen mothers: a pilot study. Pediatr Nurs 2009; 35(5): 284-9

3. Serrano MS, Doren FM, 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. J Perinat Neonatal Nurs 2010; 24(2): 172-81.

4. Field T, Diego M, Hernandez-Reif M. Potential underlying mechanisms for greater weight gain in massaged preterm infants. Infant Behav Dev 2011; 34(3): 383-9.

5. International Association of Infant Massage (IAIM). www.iaim.org.uk

6. Mkan D, Alp H, Gozum S, Orbak Z, Cifci EK. Effectiveness of massage, sucrose solution, herbal tea or hydrolysed formula in the treatment of infantile colic.) Clin Nurs 2008; 17(13): 1754-61.

7. Guzetta A, Baldini S, Bancale A et al. Massage accelerates brain development and the maturation of visual function.) Neurosci 2009; 29(18): 6042-51.

8. Chen J, Sadakata M, Ishida M, Sekizuka N, Sayama M. Baby massage ameliorates neonatal jaundice in full-term new born infants. Tohoku J Exp Med 2011; 223(2): 97-102.

9. Field T, Schan berg S, Davalos M, Malphurs J. Massage with oil has more positive effects on normal infants. Preand Perinatal Psychology Journal 1996; 1 1 (2): 75-80.

10. Cooke A, Cork MJ, Danby S, LavenderT. Use of oil for baby skincare: a survey of UK maternity and neonatal units. British Journal of Midwifery 2011; 19(6): 354-62.

11. Jiang SJ, Hwang SM, Choi EH, Elias PM, Ahn SK, Lee SH. Structural and functional effects of oleic acid and iontophoresis on hairless mouse stratum corneum. J Invest Dermatol 2000; 114(1): 64-70.

12. Patzelt A, Lademann J, Darvin Met al. In vivo investigations on the penetration of various oil and their influence on the skin barrier. Skin Res Technol 2012; 18: 364-9.

13. Krueger C, Parker_L, Chiu SH, Theriaque D. Maternal voice and short-term outcomes in preterm infants. Dev Psychobiol 2010; 52(2): 205-12.

Image credit | iStock

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