What is Infant Massage?
Infant Massage is a vital, dynamic interaction that forms the foundation of relationship building that will last a lifetime. Nurturing touch between a parent/caregiver and an infant enriches physiological, social-emotional, and mind/body/spirit connections for the infant being massaged, as well as for the parent. (Shneider,2003)
Infant Massage Methodology
According to IMIS, (2009) the methodology of strokes for infant massage consists of a well balanced combination of Indian and Swedish massage in addition to reflexology. Indian massage is characterized by strokes being directed away from the body in the direction of hair growth.
What is pre-term?
Prematurity according to (Crisp, Taylor, Douglas & Rebeiro, 2013) is defined as any infant born before 37 weeks. It is poorly understood as to the causes of prematurity, however maternal, foetal or placental problems may be contributing factors. Prematurity can impact on babies’ development and growth, also their responses to pain and touch, due to immature /underdeveloped body systems, they can display distress cues which can sometime be difficult to detect. Massage can assist in maturation in these body systems, enhance development/weight gain and improved long term health outcomes and wellbeing, for example sleep patterns /feeding and general growth.
- Massage releases both oxytocin and endorphins and can assist in relieving discomfort from pain, teething, chest or sinus congestion, colic, wind, or constipation.
- Relaxation and release of emotional stress.
- Enhances neurological development.
- Teaches infants that touch is a form of expression and increases infant’s body awareness and improves sensory awareness.
- May help some infants sleep longer.
- Helps tone muscles and aids growth.
- Enhances the bonding process.
- Strengthens the immune system.
- Increases circulation and oxygen and nutrient flow to the cells.
- Helps encourage midline orientation, which assists with co-ordination and balance.
- Teaches children from birth that they are in charge of their own body and that it is OK for them to say no to people touching them.
- Is relaxing and fun for parents. Massage provides quality time with a working parent and is a great way for fathers to be involved also.
- Increases the parent’s ability to help relax their child in times of stress/illness.
- Infant massage is fun!
- Weight gain in pre-term infants.
- Assists in creating messages that touch can be relaxing/comforting.
- Infant massage can also benefit children with special needs, babies born prematurely, hypo or hyper-tonic infants, Asthma, Autistic Spectrum Disorders, ADD, ADHD, Depression, Dermatitis, Juvenile Rheumatoid Arthritis and Diabetes.
- Infant massage may also be of great benefit for those mothers suffering from
Learning to massage a baby can occur at any age in their development. It can be done when a baby is 2 – 6 weeks old, 2 – 6 months old or when a baby is much older. By learning to massage a baby, parents can discover the joys and benefits. A baby’s physical and emotional development can be enhanced by the enormous range of benefits listed.
Just as important is that massage is fun for parents and their baby, it provides a wonderful closeness and teaches baby about loving, nurturing, and appropriate touch. Caring touch through massage not only communicates love but can also help create a serene and nurturing climate that both enjoy. Baby massage classes provide an opportunity to discuss issues related to babies and parenthood, and are a wonderful way to meet other parents and to discuss and share experiences. Massage classes are conducted in a relaxed atmosphere, at a pace that allows for nappy changing, feeding, and settling.
What is the most appropriate oil recommended to use on babies and infants?
Are they safe/recommended for premature babies?
It is recommended that the oils used should be cold pressed/organic-pesticide and essential oil free, derived from nuts/seeds/fruits. Pure cold pressed oil is noticeably absorbed by the skin, as opposed to mineral oil which tends to leave a greasy residue. Mineral oils are not recommended to use on infants and pre-term babies as they are petrochemical derived, and as such can be harmful. They have not been proved to be safe for use with infants. Some physicians believe mineral oils can block pores and cause rashes.
As cold pressed oils are so well absorbed, it is important to ensure that they are pesticide free. Whatever medium a parent uses for massage, they must be happy to ingest. This recommendation does not apply to the reverse. E.g., just because an oil is edible, does not necessarily make it suitable for massage e.g., sesame cooking oil is not recommended as it has been heat treated, altering composition, and making it not suitable for massage.
Essential oils are not recommended to be used under the age of 12 months due to potency and strong odour.
The same oil recommendations apply to premature babies, particularly as this will reduce any friction on the skin which can be stimulating.
When is the best time to massage a baby/infant and how long should the massage last?
How does this apply to premature babies?
If a baby is happy and healthy, we need to look at the regular daily cycle of an infant. This is important in determining when parents should offer and conduct a massage. We are also looking at body language and cues. In their daily cycle a baby will cry, go into a deep sleep, light sleep, drowsy period and then a quiet alert state. The most appropriate time to massage an infant is in the quiet alert time, this is when the baby will lie happily and quietly, simply looking around the room - often occurring after a nap or following a feed after a nap. The length/duration of a massage should always be determined by the baby/infant, and not the clock. As soon as a no cue is shown for whatever reason the massage should cease.
If the baby is premature or unwell, then precautions should be taken and advice must be sought from the child’s doctor, nurse, or health practitioner, to assess for readiness/physiological stability, and any signs of stress, before offering a massage or any form of touch therapy.
What are the most suitable/safe positions for massage (in particular for premature infants)?
There are certainly many different positions to massage infants, cuddling, side lying supported, supine, prone and sitting. With newborn infants for example, parents can lean against a wall, or a sofa whilst sitting on the floor, with their knees bent together. Newborn babies can comfortably lie on their parent’s thighs, with the head resting on the knees. This is a wonderful position for full term babies and premature babies if ready and physiologically stable, as it provides an excellent distance between eyes of the parents and baby for eye contact. This can enhance the bonding process.
When considering premature babies, they can be touched/massaged inside or outside the crib - as ready and able to tolerate, if they are physiologically stable and showing no signs of distress. If they are stable enough to come out of the humidicrib, premature babies can be cuddled for touch therapy (containment) and possible massage. Containment is a wonderful technique for premature babies to begin with, as it allows bonding/attachment to develop; also enabling the baby to get used to touch, and subsequent massage techniques.
Once baby has grown too big for newborn massage, parents are advised to lay their baby on the floor on a change mat covered by a blanket or towel. IMIS (2009) strongly advises against performing massage on a change table or raised surface. Whilst this stance is taken by IMIS(2009), in a hospital environment for example- teaching massage on the floor can be impractical. Each hospital is advised to form and follow its own policies and procedures on safe placement and location of performing massage. One suggestion IMIS (2009) has put forward is to clearly display a poster with clear wording/instruction advising parents to dry the oil from their hands and dress their baby prior to picking them up during or following massage.
What are the basic/standard massage strokes that can be performed on a premature infant and when/where should they be performed?
Prior to and before performing any massage it is important to assess for readiness. Is it the right time? If in doubt at any point, it is advisable not to continue or perform the massage. (IMIS 2009) Also, it is important that parents consider the following:
- Hand hygiene
- Jewellery must be removed
- Parents perform a permission sequence
- Timing - is it appropriate for baby and parents?
- Encourage and implement a relaxed warm environment, low lighting /soft music.
- Nail length must be checked.
There are a few things that need to be checked in terms of assessing for readiness before beginning a massage:
- Physiological stability of infant
- Be aware of body language and cues, it needs to be ensured that baby has demonstrated they are coping well with forms of touch therapy and containment prior to massage.
- Is the baby able to sustain massage therapy for that period, and remain physiologically stable; whilst fitting into the routine of the hospital environment?
Signs of acceptance & stress signals - Infants response
When considering massage, it is vital to be aware of any signs of readiness, acceptance and stress. Observe and note any signs that the baby is ready for massage and how they respond subsequently with any later massage.
Alter the environment e.g., low/dim lighting, reduced noise, appropriate temperature.
A baby can show acceptance and positive responses to massage IMIS(2009). The following can be taken as signs of acceptance:
- Fingers are flexed/open
- Knees relaxed
- Arms relaxed
- Relaxed feet
- Body language overall is relaxed, indicating baby is happy to be massaged
Signs of Stress ('Stress Signals') can vary from mild to strong, indicating to stop soon, or cease immediately:
- Looking away/ Turning of head away
- Digestive disturbances
- General uneasiness/irritability
- Alterations to vital signs, (not within expected normal ranges)
If there any indications that parts of massage have led to any stress indicators, these should me omitted from massage IMIS(2009).
Preparation Via Touch Therapy
IMIS (2009) suggests a positive approach starting with containment, followed by skin to skin (via kangaroo care) and slowly progressing to massage whilst the infants body language is carefully monitored. Containment is a technique where the baby is held in the foetal position by the parents, where parents positing their forearm to cup the baby’s head. The baby’s arms would be held together at their chest. With the opposite arm the parents can also support the legs and feet.
It is also possible to practice containment techniques with the infant lying in the prone/supine position (inside the crib, or outside in the cot as tolerated) with one hand cupping the head, or resting firmly on the back, while the other
provides a firm boundary for the feet. Preterm infants can be bought into the containment position safely within the cot in the NICU. Often this is the first positive touch experience, and bringing them outside of the cot may first begin with kangaroo care depending on the current health status of the infant.
After the containment technique is tolerated (without any signs of stress), the parent can perform the permission sequence, then move onto leg massage Indian strokes, incorporation strokes and then repeat the containment technique. This slow and gradual process will assist with and easy, gentle progression to a full body massage routine. There is no time frame associated with these techniques, just as much as is tolerated by the infant, and parents should always note, any signs of stress to indicate massage should cease, and baby has had enough.
Once baby has shown signs that they are coping well with containment, it is then safe to progress to kangaroo care. If they can tolerate being moved in and out of the crib, the parent can prepare by wearing a loose shirt to wrap around the baby. Then the baby is placed directly onto the parents’ chest (skin to skin) allowing the baby’s body temperature to be regulated through direct contact. Additional blankets can be applied as needed.
- Kangaroo Care-Benefits
- Reduction is maternal stress
- Decrease in irritability
- Physiological stability
- Less stress at times of procedures
- Improved breastfeeding
- Behavioural improvements
- Developmental improvements IMIS(2009)
The sequence for massage progression would be as follows:
Containment – Permission - Indian stroking - Incorporation strokes - Containment
It is essential that massage take place in an appropriate environment. If the infant is unable to regulate their temperature sufficiently, they should remain in the humidicrib IMIS(2009). There are two standard baby massage strokes, Indian and Swedish however, before any massage takes place parents must perform the permission sequence. The permission sequence used for paediatric massage is a learnt response, taking an average 2-8 weeks to learn and become familiar with. It is vital that parents are encouraged to perform the permission sequence prior to any massage so that the baby can learn to recognise the cues associated with this.
To perform a permission sequence, parents can rubs their hands together in front of the baby, and then ask “Do you want a massage now?” (IMIS 2009) As the baby begins to recognise these cues they will show particular body language, vocalisations and general communication that can indicate a yes or no response to a massage. Empowering parents to recogise and respond to these cues is one of the key benefits of infant massage. The permission serves two purposes, the first is to enable the baby to become used to touch; the second is to learn yes and no cues so we know it is an appropriate time to perform a massage. The best place to begin is the legs as this is the part of the body that babies are used to being touched due to frequent nappy changes.
Before beginning massage, following the permission sequence and a yes response has been demonstrated, parents can warm their hands and spread the oil , keeping contact with their baby before proceeding with some Indian massage strokes.
The most relaxing stroke to use for infant massage is the Indian massage technique. With this massage stroke, parents use a C-cup hand hold with their fingers and thumb curved to make the letter C. Parents can then perform long, firm strokes from the hip to the ankle, going away from the body. Support for the leg is provided by holding the ankle firmly, allowing the leg muscles to relax. (IMIS 2009). There is no restriction on the number of Indian massage strokes that need to be performed, just as many as the baby will tolerate and support will suffice. With premature babies, it is important not to over stimulate and to keep the environment calm and relaxed at all times.
Is it ok to massage a crying baby?
As crying can be taken as a no cue, it advisable that parents attend to their babies needs i.e. feeding/changing etc first and return to offer a massage when baby is more relaxed and settled. It’s important that parents ensure any excess oil is removed before picking up their baby to prevent slipping.
Crying during a chest massage is not unusual due to massage in this area often evoke an emotional response. If a baby is crying during chest massage, parents can look to the baby’s arms to interpret body language cues and find how they should best respond. If the arms are open, exposing the body, it indicates the baby is ok for massage to continue. If the arms are flailing or moving in and away from the body subtly, it is advisable for parents to return to offer a massage when baby is more settled and their needs have been attended to.
Is it contraindicated to massage a premature baby post-surgery or if they have a fever?
Contraindications refer to any situation where massage should be avoided. It is important to be wary of how soon massage can be introduced post-surgery, and parents must seek advice from their child’s primary health care provider to ascertain when it is safe to begin massage.
A ‘total contraindication’ indicates that massage is not recommended at all. Situations that constitute a total contraindication include acute inflammation-open or weeping wounds/bleeding.
A ‘local contraindication’ indicates that massage is not recommended on a defined, local area of the body. Situations that constitute a local contraindication include infected skin irritations ,unhealed naval, burns or cuts.
A ‘medical contraindication’ indication that massage is not recommended until medical clearance is received. Situations that constitute a medical contraindication include cardiovascular conditions such as thrombosis and embolism. IMIS(2009)
Most adult massage colleges teach that massage is contraindicated by fever, illness, and contagious diseases. With infant massage however, IMIS (2009) suggests that some massage can take place in these instances. Parents display an instinct to stroke their child when they are sick, however observations of parents in these circumstances show that they always use downward, Indian style strokes when their child is unwell. IMIS (2009) suggests therefore Indian and incorporations strokes are the only techniques used in the case of fever and that massage should only take place if the parent and baby want to share massage time together. In this instance massage is intended to be soothing and calming.
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