Infant Massage Presentation

Beth CarrollAnna Lake

Shannon McQuown

History of Massage Rubbing or laying in of the hands has

been around for thousands of years› Hippocrates and Julius Caesar

Decline in the Middle Ages due to the contempt for the pleasures of the flesh

Per Henrik Ling (19th century) developed Swedish massage› Combination of Chinese, Eqyptian, Greek,

Roman› 1st college to offer massage started in 1913

in Stockholm

East vs. West

Scientific Revolution (250 yrs ago) developed in the West› Body seen as a machine, connection

between mind and spirit seen as unscientific

Eastern cultures maintained traditional beliefs› “Rub it better” attitude

Reflexology, Shiatsu developed at this time

Global Parenting Practices Skin and touch seen in societies ranging

from India, Uganda, Bali, Figi, New Guinea….

Bogota, Columbia: Kangaroo Care is common practice for premature infants

India: Mothers massage everyone regularly for it’s soothing effects and affection non-verbal cues

Eskimos: Swaddling to promote heat and calming

Development & Touch Communication

› Eye contact, listening, verbal & non-verbal Motor

› Muscle tone, coordination, body awareness Socialization

› Engaged with caregiver, quiet alert state Self-Help

› Oral motor, lip closure Cognition

› Cause & effect, attention span, awareness of self/body

Benefits of Infant Massage Stimulation

› Growth hormone production, increased oxygenation

Relaxation› Muscles, stress, pain management, CRR

Relief› Constipation/gas, sleep, teething

Bonding/Interaction› Eye contact, skin, secure attachment

More Benefits Neurological Stimulation

› Reflexes disappear, more complex pathways, increase hormones

Emotional Development› Caregiver attachment, trust, sense of control,

Physical Development› Increase weight gain, body length, muscle tone

Mental Development› Attention span, curiosity, intelligence, verbal

skills

Bonding: Mother to Baby

Touch Eye-to-Eye High Pitched Voice Entrainment Biorhythmicity

Breast Milk Bacterial Nasal

Flora Odor Heat

Bonding: Baby to Mother

Eye-to-Eye Cry Ocytocin

Prolactin Odor Entrainment

Hospitalization: Disruption of Bonding

Bonding Barriers:› Infant’s Medical Condition

Baby viewed by parent as too fragile to hold or touch

Several pumps, I.V.s, and NG Tubes attached to baby Lack of Knowledge Fear of pulling or compromising I.V.s/ Hurting Infant

› Loss of Caregiver Role Nursing Staff takes charge of basic parental roles:

Changing diapers, feedings, bathing, etc. Parent no longer able to “protect baby from harm”

(i.e.- painful medical procedures)› Feelings of Self-Blame/Helplessness

Breaking Barriers through Infant Massage

Empowering Parent› Provides caregiver a positive/active role in

their baby’s healing and well-being› Alleviates potential guilt› Builds confidence

Providing the Infant Opportunities for Positive Touch› Baby can feel safe, and not connect all touch

in the hospital as painful

Implementing infant massage into the hospital setting

Protocol vs. no protocol Potential barriers that may arise Interventions that may be helpful

Ways to implement infant massage without a protocol

Receive referrals or electronic consults from physicians, nurse practitioners, PT/OT, etc.

Parent driven consults Consent forms

Ways to utilize a protocol when providing infant massage

Important topics to cover:› Benefits for both caregiver and patient

Encourages bonding, improved communication and understanding of infant cues for caregiver, etc.

› Format of class and/or 1:1 session› Safety guidelines for infants receiving massage

Receive medical approval for massage 32 weeks gestational age or greater Intact skin in the area to be massaged Non-vented or on stable long-term ventilation Non-septic Greater than 1 week post-op Weaning or not requiring sedation medication

Ways to utilize a protocol when providing infant massage

Important topics to cover cont..› Logistics

Where/when class will be offered Any cost for parent Supplies provided (baby lotion, play mats, etc.) Documentation of infant massage instruction and

session outcomes

Barriers to providing infant massage in the hospital setting

Lack of consistency of caregiver at bedside Patient’s temperament or state of alertness at

time of session Time constraints (conflicting schedules between

infant massage instructor and caregiver, ability for instructor to balance infant massage work vs. other duties such as other child life specialist work)

Lack of openness from parent or other staff members

Caregiver has other children to attend to Infant not medically stable (e.g. patient with skin

conditions, open wounds, infection, etc.)

How creating a protocol could help

Provides guidelines for medical staff regarding infants that are appropriate for massage

Creates a consistent approach to introducing infant massage services to families and staff

Allows for a streamline approach for all staff members providing infant massage education to caregivers regardless of organization they receive infant massage certification through.

Supporting research One study from the Touch Research Institute at

the Miami school of medicine* found that infants gained more weight and slept less (spending more time in the active alert state) after just five days of massage therapy.

The study* also showed that massaged preterm infants were discharged from the hospital between 3-6 days sooner than their counterparts in the control group.

*Dieter, J.N., Field, T., Hernandez-Reif, M., et al. (2003). Stable preterm infants gain more weight and sleep less after five days of massage therapy. Journal of Pediatric Psychology, 28 (6), 403-411.

Supporting research Another research study* from the Touch Research

Institute showed that pre-term infants demonstrated fewer stress behaviors after just five days of massage therapy.

This study* also hypothesized that massage therapy for pre-term infants may assist with desensitization of the stressful environment of the NICU evidenced by less activity of the infants and the infants demonstrating fewer stress behaviors such as crying, grimacing, yawning, sneezing, etc.

*Hernandez-Reif, M., Diego, M., & Field, T. (2007). Preterm infants show reduced stress behaviors and activity after 5 days of massage therapy. Infant Behavior &

Development, 30, 557-561.

Supporting research One case study* provided supportive evidence of

the value of infant massage for creating a strong infant-caregiver bond.

Mother and baby were not able to bond. After attending an infant massage class and

utilizing the strokes on her child, both the mother and child demonstrated a change in behavior.

The mother was more attentive to her infants cues and the infant began to form a secure attachment.

*Lappin, G. (2006). Using infant massage following a mother’s unfavorable neonatal intensive care unit experiences: A case study. Rehabilitation and

education for Blindness and visual Impairment, 37 (2), 87-94.

The Touch Research Institute

University of Miami School of Medicine Established in 1992 by Tiffany Fields, PhD Start-Up grant provided by Johnson &

Johnson First center in the world dedicated solely to

studying the benefits of touch, in application to science and medicine

Has published many articles supporting infant massage, particularly in the hospital-setting

Getting Your “In” in Infant Massage

Practical places to start Infant Massage services in your hospital:› Labor & Delivery Services

Many hospitals provide classes for expecting moms/new moms

› NICU Graduates Classes offered for families whose infants are

graduating from the NICU and going home for the first time

Concrete for parents to utilize amongst the uncertainties and fears of coming home with baby

Infant Massage in the Community

Infant massage is beneficial to every baby and family!

Can be used with all ages: babies, toddlers, teens

Fathers can play a huge role in their infant’s life through massage› Grandparents will enjoy it too!› Grandparent volunteer program

Dads and Infant Massage Strong attachment to Dad is just as

important as attachment to Mom Babies use Dad as a secure base from

which to explore Seek out Dad when frightened or uncertain Father’s impulse is to excite (vs comfort)

and babies can tell the difference Dad can make a huge difference in how

well the mother can mother…

“He can help provide a space in which the mother has elbow room; properly protected by her man, the mother is safe from having to turn outwards, from having to deal with her surroundings at a time when she is wanting so much to turn inwards, when she is longing to be concerned with the inside circle which she can make with her arms in the center of which is the baby.” - D. W. Winnicott

Potential Clients Depressed Mothers* At-risk families* Teen parents NAS/drug babies ASD/Attention disorders Abused & Neglected children, PTSD Chronic pain/diseases (JRA, migraines,

fibromyalgia, GI issues, cancer, FTT) Down Syndrome, MS, CP, Asthma, Diabetes NICU grads

Depression in Mothers Difference between baby blues & PPD

› Usually starts during the “Mutual Adjustment Phase”

Massage reduced maternal anxiety and depression

Reduced infant’s distress behavior and disturbed sleep patterns

After 2 weeks: infants fell asleep faster, slept longer, less fussy, and Mom played more easily with them

At – Risk Families Child abuse occurs most often in societies

where mothers are seldom relieved of their child-care responsibilities

Japan: “Childrearing Neurosis” US: Mom’s working multiple jobs, leaving

children with unfamiliar caregivers, boyfriends

Massage can help Mom’s work through guilt, increase bonding/attachment

Teaching massage to boyfriend/caregiver can increase sense of responsibility and love towards infant

How to Become Certified

Several Institutions to Choose From:› Infant Massage USA› International Loving Touch Foundation, Inc.› International Foundation of Infant Massage

Find when an Infant Massage training class is coming to your area

Potential Tuition Reimbursement, if offered at your hospital

Final Points Infant Massage should be performed on the

Infant by parent/caregiver only!› Infant Massage Instructors merely

demonstrate the massages to the caregiver- usually through example on a doll- but never directly on baby

Be sure that the caregiver providing the massage is a long-term and constant presence in the infant’s life

Time for a Demonstration!