Touch & Massage therapy in Newborns

Dr Padmesh

• 1. History • 2. Types of massage• 3. Procedure• 4. Effects of massage• 5. Drawbacks• 6. Recent advances & research

Touch & Massage therapy in Newborns

• History:• Tradition in India since time immemorial• Ayurveda in ancient India taught infant massage• In China during the Qing dynasty• Recent surge in this ancient art as therapy• Touch Research Institute in Miami estd 1990

Johari H. (1996). Ayurvedic Massage: Traditional Indian Techniques for Balancing Body & Mind.

• Types of Touch:

• 1. ACTIVE: with voluntary movement on part of subject.

• 2.PASSIVE: without voluntary movement on part of subject– Care touch: associated with feeding /changing diapers/

handling /holding/ KMC– Massage: methodological touch intended to stimulate.

Can J Physiol Pharmacol. 1994 May;72(5):558-70.

• POSITIVE TOUCH:

• Term coined by Cherry Bond

• Technique originated from Dr Frederick Leboyer's book ‘Loving Hands’ - Shantala a young Indian mother, massaging her baby in the streets of Calcutta.

Semin Neonatol 2002; 7: 477-486

• Role of Infant skin:

• (1) Sensory surface • (2) Protective mantle• (3) Psychological/perceptual interface with

caregivers and parents• (4) Information rich surface for non-invasive

monitoring

• The baby's experience:

• Skin is the largest sensory organ of the body (2500 sq cm in newborn)

• Tactile system is the earliest sensory system to become functional

• THE PROCESS OF NEONATAL MASSAGE:

• Conducive environment. • Room with – soft light, – warm temperature, – low noise levels.

• Massage between feeds• Ideally 1 hour after a feed to avoid regurgitation or

vomiting. • Involve entire body starting from head, neck, trunk and

extremities.

• THE PROCESS OF NEONATAL MASSAGE:

• Field’s massage therapy:– Both tactile and kinesthetic stimulation. – 15 minute sessions– 5 minutes of tactile stimulation followed by 5 minutes

of kinesthetic stimulation and ending again with 5 min of tactile stimulation.

– 3 massage sessions per day. – Duration of 2-4 weeks.

Field T. Massage therapy. Complementary Alternat Med 2002; 86:168-171.

• THE PROCESS OF NEONATAL MASSAGE:

• Mathai’s massage therapy: Tactile + Kinesthetic– 1st phase: Baby placed prone & 12 strokes of 5 sec

each starting from head, neck, shoulder to buttocks

– 2nd phase: Baby placed supine & 12 strokes of 5 sec each starting from face, cheeks, chest, abdomen, upper limb, lower limb, palms and soles.

– 3rd phase: Kinesthetic stimulation- alternate flexion & extension movements at major joints: ankle, knee, elbow and shoulder.

• THE PROCESS OF NEONATAL MASSAGE:

• Firm stroke with flat of fingers.

• Moderate pressure better than light pressure.

• By trained medical professional or by mother.

• Mothers as effective as trained professional

• Effects of massage in Newborn:

• Weight gain• Sleep-wake pattern• Infant behaviour• Decrease in Late onset sepsis• Decreased energy expenditure• Decreased OOP• Decreased perception of pain• Decreased mortality

• Effects of massage in Newborn:

• Weight gain• Most consistent parameter.• Vagal stimulation• Less energy expenditure

Infant Beh Dev 1990; 13: 167-188.

• Effects of massage in Newborn:

Massage

Increase in vagal activity

Improved gastric motility

Better absorption of nutrients

Better weight gain

Acta Paediatr 2007; 96: 1588-1591.

• Effects of massage in Newborn:

• Weight gain• Increase in serum insulin and serum IGF-1 levels.

• Decreases levels of stress by:– decreasing the serum cortisol and norepinephrine– increasing urinary excretion of epinephrine and

norepinephrine.

J Pediatr 1991; 119: 434-440.

• Effects of massage in Newborn:

• Weight gain

• Scafidi et al: • 40 preterms (Mean GA 30 weeks.Mean birthweight 1.17

kg) 45 minutes/day (3 sessions of 15 mins each) for 10 days.

• Massage group : 21% greater weight gain (34 vs 28 g).

• Mathai et al: • Similar results -weight gain of 21.9%; 4.24g/day)

Infant Beh Dev 1990; 13: 167-188.

• Effects of massage in Newborn:

• Weight gain

Early Hum Dev. 2014 March ; 90(3): 137–140.

• Effects of massage in Newborn:

• Weight gain

Early Hum Dev. 2014 March ; 90(3): 137–140.

• Effects of massage in Newborn:

• Sleep wake pattern:• Kelmanson, et al: • Less than 36 weeks gestation (birth weight <2.5 kg)• Massage till 8 months of age– improved quality of sleep– less awakening during sleep. – more active during day.

Complement Ther Clin Pract 2006; 12: 200-205.

• Effects of massage in Newborn:

• Infant behaviour:• Scored better on Brazelton behaviour assessment scale in

terms of – ‘orientation’, – ‘range of state’ – ‘regulation of state’ – ‘autonomic stability’

Brazelton TB. Neonatal Behavioral Assessment Scale, 2nd edn.

• Effects of massage in Newborn:

• Infant behaviour:– Preterm infants (mean GA 30 weeks) with moderate

pressure therapy (5 days) – Less fussy, cried less and showed less stress behavior. – Improves mother infant interaction and thus enhances

their bonding.

• Less energy expenditure– Increased Somatic growth

Taehan Kanho Hakhoe Chi 2006; 36: 1331-1339

• Effects of massage in Newborn:

• Decreased LOS:– Incidence of late onset sepsis (positive blood cultures

and CSF cultures) significantly less among infants (750-1500 g)

– Enhancing natural killer cells (NK cells) Better immunity

J Perinatol 2008; 28: 815-820.

• Effects of massage in Newborn:

• Decreased perception of pain:– Short term benefits – Decreasing pain during procedures.

J Paediatr Child Health 2006; 42: 505-508.

• Effects of massage in Newborn:

• Decreased Osteopenia of Prematurity:

• Aly, et al :• Preterm infants (28-35 weeks)• Degree of bone formation measured in terms of serum

type I collagen C terminal propeptide (PICP). • Significant increase in PICP levels.

J Perinatol 2004; 24: 305-309.

• Effects of massage in Newborn:

• Decreased Osteopenia of Prematurity:

• DEXA (dual energy X ray absorptiometry) scan performed as marker of bone mineralization.

• Infants who received massage therapy had a greater score when compared to controls.

J Perinatol 2008; 28 : 432-437.

• Effects of massage in Newborn:

• Reduced hospital stay

Decreased hospital stay

Reduced expenditure

Pediatrics 2008; 121: 522- 529.

• Drawbacks of massage in Newborn:

• Most studies enrolled medically stable preterms.

• Efficacy, safety of massage in sick preterm not established.

• Some babies develop allergic rash with oil.

• Massage to be avoided in medically unstable newborns & with serious cardiac disease.

Effects of OIL Massage in Newborn:

• Effects of OIL massage in Newborn:

• Massage may be done using a lubricant (oil).

• Choice of oil depends upon availability, cost and safety.

• Sunflower oil, coconut oil, mustard oil, sesame oil.

• Effects of OIL massage in Newborn:

• Nutritional purpose: • Transcutaneous absorption of lipids

• Serum triglyceride levels increased in preterms who received oil massage with safflower oil and coconut oil 4 times a day for 5 days.

• Soybean oil massage Increased serum linoleic acid improved anthropometric parameters

J Pediatr Gastroenterol Nutr 2000; 31: 387-390.

• Effects of OIL massage in Newborn:

• Local effects on skin: • Improved thermoregulation• Decrease in the convection losses through skin.• Incidence of hypothermia decreased by 30-50%.• Remove dead cells of skin• Improve texture of skin.• Improve skin barrier function

Pediatr Clin North Am 2000; 47: 757-782.

• Effects of OIL massage in Newborn:

• Decreased Mortality:• By protecting from infections

• Topical emollient treatment with safflower oil or aquaphor (petrolatum, mineral oil, mineral wax, lanolin alcohol) : 41% less likely to develop nosocomial infections than control.

Pediatrics 2008; 121: 522-529.

• Effects of OIL massage in Newborn:

• Field, et al: (Compared with no oil)

• Massage with oil makes baby more alert.

• Shows fewer stress

• Effects of OIL massage in Newborn:

• STUDIES:

• 3 groups: coconut oil, mineral oil and placebo compared.

• Infants 1.5-2 kg

• Massage therapy 4 times a day for first month.

• Infants with coconut oil massage better weight gain velocity as compared to mineral oil.

• Effects of OIL massage in Newborn:

• STUDIES:

• Sesame oil: greater improvement in anthropometric parameters as compared to mustard and mineral oil.

• RECENT ADVANCES & RESEARCH:

• Conclusion: • These findings do not currently support the use of infant

massage with low-risk groups of parents and infants. • Available evidence is of poor quality, and many studies do not

address the biological plausibility of the outcomes being measured, or the mechanisms by which change might be achieved.

• RECENT ADVANCES & RESEARCH:

• Effect of abdomen massage for prevention of feeding intolerance in preterm infants:

(Kadir Şerafettin Tekgündüz, Ayşe Gürol, Serap Ejder Apay and İbrahim Caner)

• Conclusion: • Nurses should apply abdominal massage twice a day as

an intervention helping to prevent gastric residual volume excess and abdominal distension in enterally fed preterm infants.

Italian Journal of Pediatrics 2014, 40:89

• RECENT ADVANCES & RESEARCH:

• Conclusion: • Massage intervention affects the maturation of brain

electrical activity and favours a process more similar to that observed in utero in term infants.

• RECENT ADVANCES & RESEARCH:

• Conclusion: • Massage at an early stage after birth can reduce neonatal

bilirubin levels.

• Benefits of massage: – Stimulation of circulatory and gastrointestinal systems, – Better weight gain, – Lesser stress behaviour, – Positive effects on neurological and neuromotor development– Infant-parent bonding,– Improved sleep.

• Massage therapy is safe with no harmful effects, if performed appropriately.

• Long term benefits of massage are not well established.

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