Tactile stimulation can be preventive health care for babies.
Informational Handout: Infant Massage for Gastrointestinal Problems
Touch is the first sense to develop. Tactile stimulation is the main way in which infants learn about and experience their world. An infant experiences the comfort of touch long before birth, while gently caressed in the safe, secure world of her mother's womb.
Parents frequently worry that they are spoiling their newborns by holding them or picking them up too often, yet touch soothes. Each time a parent picks up a fussing infant, she communicates that she understands her infant's needs—that she cares—and promotes the sense of trust essential to healthy infant development. Practitioners and parents can take advantage of this by introducing massage as a preventive health measure.
Effects of Touch
The skin is the third largest organ system in the body (measured by surface area), and the cerebral tactile area occupies a disproportionately larger share of the cortex than any other organ system.1 Touch contributes to the infant's physical, social, emotional and intellectual development.
Tiffany Field, PhD, founder of the Touch Research Institute at the University of Miami School of Medicine, compared preemies in the neonatal intensive care unit and found that regularly massaged infants gained more weight and had higher scores on the Brazleton Neonatal Behavioral Assessment Scale than babies who were not massaged. Massaged infants were ready to go home with their parents an average of six days earlier. Differences were still evident after the massaged babies' first birthdays; they had gained more weight and performed better on the Bayley scale of infant development.2,3
Touch strengthens the immune system. Preliminary studies examining the effects of touch on HIV-positive adolescents show that 12 weeks of twice-weekly massage were linked to an increase in natural "killer cells" and CD 4 counts. Similar outcomes have been documented in HIV-positive adults.4
Touch enhances a baby's emotional development. One researcher instructed a group of mothers to carry their babies for at least 3 hours a day, longer than the average 1 to 2 hours that mothers in Western societies generally carry their infants. Then he compared the crying patterns of those infants with babies not carried. Babies who were held more cried 43 percent less, especially during the typical crying peak at six weeks of age, and their cries gradually diminished overall.5
Advantages of Infant Massage
Infant massage is one way to guarantee adequate tactile stimulation for an infant. For babies, massage helps them sleep more soundly, be less fussy, and experience less colic. It improves circulation, enhances immune functioning, deepens respiration and promotes neurologic development. A full-body massage stimulates all the senses and helps reduce problems such as gas and constipation.6 Infants learn how to handle minor stresses produced by the alternating tension and relaxation experienced during massage; this prepares them to cope with larger stressors.
Parents and caretakers benefit from massage by the reciprocal satisfaction it engenders. The interaction that takes place during massage facilitates parent-child bonding and the development of trust and self-esteem. Parent and baby experience relaxation together. The postpartum, breastfeeding mother benefits from the direct skin contact massage provides. This contact triggers the release of essential hormones (oxytocin and prolactin) that help the uterus contract and the mother's body relax, and stimulates the production and release of breast milk. For fathers, infant massage is a close physical activity that they can share with their babies in lieu of breastfeeding.
Principles of Infant Massage
Before starting, infants should be undressed in a warm environment. Cold-pressed vegetable or nut oils, such as olive or sweet almond, decrease friction during the massage. These natural, edible oils are absorbed well into the skin and, except for rare sensitivities, are not problematic. A minimal amount of oils should be used on the face and head area to prevent seborrhea. Parents should be relaxed and able to set aside other concerns before beginning the massage.
The parent should ask "permission" of the infant before beginning the massage, since massage is an optional experience. They can observe baby for signs such as direct eye contact, rhythmic moving of arms and legs, or smiling, which signal that it is OK to proceed. If baby is not ready, massage should be postponed.
Babies and children can be massaged at any age, but 3 weeks to 4 weeks postpartum is the ideal time to start teaching infant massage to parents. Before that, touching and holding provide the best stimulation for baby. A crawling or walking baby who is used to massage may lie still at certain times of the day for massage, but systematic massage may not be so easy to accomplish. Parents can be instructed to "massage the part that presents before you" as their energetic infant propels himself through intense motor activity. After the tumultuous motor stage of 10 months to 18 months, the toddler should settle down again and lie still for his usual massage. Massage can also be initiated with an older-age child and remains a nurturing experience.
Fitting It into Practice
So how can you encourage massage in your busy practice? Keep a life-size doll in your clinic for demonstrating massage strokes. You may ask parents' and patients' permission to demonstrate the strokes directly on an infant if this seems appropriate. If time is short, have a video available for parents to watch. If parents are interested, refer them to nearby infant massage classes. Have handouts available for parents to take home .
Infants and young children who are adopted may especially benefit from massage, because it provides an essential physical element to facilitate parent-infant attachment.6 Similarly, infants and children in foster care who have been abused or maltreated and infants with a history of intrauterine exposure to cocaine can also benefit from massage.
Parents who want to learn infant massage can enroll in total body massage classes. However, if you are interested in certification as an infant massage instructor (to teach individual parents or group classes), contact the International Association of Infant Massage at (805) 644-8524, or the International Loving Touch Foundation (503) 253-8482. CE hours are granted for some courses.
Ann Linguiti Pron, NP, is a pediatric nurse practitioner and a certified infant massage instructor at Temple Health Connection, a program of Temple University in Philadelphia.
1. Montagu A. Touching: The Human Significance of the Skin. 3rd ed. New York: Harper & Row; 1986.
2. Field T, Schanberg SM, Scafidi F, et al. Tactile/kinesthetic stimulation effects on pre-term neonates. Pediatrics. 1986;77:654.
3. Field T, Scafidi F, Schanberg S. Massage of pre-term newborns to improve growth and development. Pediatric Nursing. 1987;13:385.
4. Field T. Massage therapy: More than a laying on of hands. Contemporary Pediatrics. 1999;16(5):77.
5. Barr R. Reduction of infant crying by parent carrying. In Gunzenhauser N. Advances in Touch: New implications in Human Development. Johnson & Johnson Consumer Products Inc.; 1990: 105.
6. McClure V. Infant Massage: A Handbook for Loving Parents. 3rd ed. New York: Bantam Books; 2000.