It is not uncommon, for infant care-givers to report sleep difficulties to early parenting allied health practitioners regardless of the reason for presenting for care. As sleep cycle lengths and total sleep time are linked to an infant's developmental stage impacts to sleep are likely to impact the majority if not all parents with infants.
This article aims to discuss the nature of infant sleep patterns and their impacts on their carer's and discuss what the research says about the potential positive links between infant massage and improved sleep quality for both infants and their care-givers.
Finally, suggestions are made as to the benefits of recommending infant massage sessions or classes to parents and caregivers and infants who are at risk of the longer-term impacts of sleep deprivation.
Sleep Difficulties
> Infant sleep and settling difficulties are a common and often stressful experience for infant care givers
> A study by Goodlin-Jones et al (2001) found that two thirds of infants needed resettling by an adult to return to sleep upon waking at night
> There are many factors that can contribute to how well an infants sleep e.g. the environment or underlying medical conditions
> Often overnight sleep disturbances are as a result of infant feeding patterns in infancy
> A newborn will sleep in blocks of a few hours and wake up due to hunger
> Infants develop a diurnal sleep pattern over their first 12 months post birth; however, infants will wake frequently overnight, usually driven by hunger and require assistance to settle
> An infant care giver on average will wake on average 3 times overnight to tend to an infant's needs.
> The issue of sleep deprivation becomes even more problematic when sleep difficulties stretch past infancy and into toddlerhood (Mindell et al., 2016).
How a Caregiver's Sleep Affects a Baby
The Parent's Experience
When infant caregivers don't get enough sleep, it changes how they feel and act every day. Studies show that sleep deprivation drains a parent's energy, makes their moods less stable, and makes it harder for them to think clearly or solve problems (Underdown et al., 2009; Razaei et al., 2022).
Because the parent is so exhausted, they may find it much harder to stay calm when trying to soothe a crying baby. Over time, this constant fatigue can cause the bond between the parent and the baby to weaken (Mrljak, 2022).
The "Chain Reaction" for the Baby
Because babies rely on adults for everything, a parent's exhaustion eventually gets "under the skin" of the baby.
Emotional Growth: To a baby, a parent is like a battery. When that battery is full, the parent reacts quickly to the baby's cries. Sleep loss drains that battery, making it harder for parents to be "sensitive" to what the baby needs (Bai et al., 2020). Without this steady connection, babies struggle to learn how to handle their own big feelings.
Brain Power: Babies build their brains by playing and talking with adults. This is called "serve-and-return." Exhausted parents often don't have the energy for these interactions (Hoyniak et al., 2018). Without this "brain food," a baby's learning and memory skills can start to slow down.
The Immune System: The most surprising link is to the baby's health. When a caregiver is too tired to provide a calm and responsive environment, the baby's body can experience what experts call 'toxic stress.' This stress causes the baby to release a chemical called cortisol (Philbrook et al. 2014). This is important because researchers have found that high cortisol levels can prevent the immune system from working properly. This makes it harder for a baby's body to fight off infections and stay healthy (Morey et al. 2015).
What research has been done using infant massage to improve infant's sleep?
> Several studies in the last 20 years have focused on improving the quality and duration infant sleep.
> In multiple studies where 15 minutes of massage was given to an infant by their parent before bed reduced the time it took for their infant to transition from an awake to a sleep state (Field & Diego 2001, 2008); improvements in both mother and baby's overall amount of sleep at night (Field and Diego, 2008), a reduction in the frequency of overnight waking (Rezaei et al., 2022; Field et al. 2016). Kusumastuti Tamtomo, Salimo & Desta, (2016) suggested that massage induced sleep chemicals which may have helped 3-6month olds feel more settled, comfortable ultimately enabling them to sleep for longer periods with the interruption of feelings of discomfort. As well as reduced night wakings, Mindell et al.(2017) found mothers of 3-18month olds who performed infant massage at night perceived improved mood in themselves and their infant's the following morning; Sulasdi, & Ismarwati, (2023); most studies, at least in part relied on self-reported questionnaires provided by parents to determine improved sleep quality and several didn't specify how they defined ‘improved sleep quality' in the improvements they reported (Saputro and Bahiya 2021; Sulfianti, Amir and Yakub 2023).
The past 20 years of literature reviews looking into the relationships between infant massage and sleep quality appear to support infant massage for improved depth of sleep, sleep cycle length sleep and increased total of hours of sleep per day for infants (Sulasadi & Ismarwati, 2023).
In addition to this mothers who performed infant massage on their infants experience reduced stress levels, increased confidence with identifying their infant's cues and increased general knowledge of their infant's care needs (Sulasadi & Ismarwati, 2023).
How transferable is the available research?
> According to a 2013 Cochrane review assessing ‘whether infant massage is effective in promoting infant physical and mental health in low-risk, population samples' there is inconclusive research on the direct effects that infant massage has on infant sleep.
> There are some significant limitations to how widely the available research can be applied.
> Across the studies looking at improvements in infant sleep quality there are variations in duration of massage, infant age range, health status of the newborns in the studies e.g. premature vs at term infants, cultural influences, the oils and lotions used in conjunction with the massage and types of massage used (if stated at all).
> The lack of control of variables, inability to isolate the physiological causes and effects of massage at a chemical level, relatively small sample sizes, high number of subjective reporting methods or opaque data collection strategies makes extrapolation to a broader population difficult (Mrljak et. al, 2022)
> Many of the studies in question do not appear to take into consideration that performing massage on an infant engages multiple body systems which could all potentially influence arousal.
Polyvagal Theory and Sleep
So, what does massaging my baby actually do?
> Infant massage involves both sensory and kinesthetic stimulation of skin and muscles.
> The skin is the largest organ of the human body by surface are the primary interface for infant massage.
> During infant massage both autonomic and peripheral nervous are stimulated.
> Studies on sleep quality and infant massage seem to consistently highlight the positive effect of touch and tactile stimulation for the infant.
> Massage appears to promotes feelings of safety, a fundamental biological need and drive to survive infancy (Porges, 2022).
> When massage is given by a primary or sufficiently safe and familiar care-giver, this signals ‘safety' to an infant's nervous system causing the hypothalamus to secrete oxytocin and serotonin
> Stimulation of an infant's skin during massage is also thought to increase melatonin secretion and reduce secretion of cortisol, which can help to reduce stress levels, pain and discomfort, which would otherwise pose as a barrier to entering into and maintaining sleep in infants (Sulasdi & Ismarwati, 2023; Kusumastuti Tamtomo, Salimo & Desta 2016).
Why is infant-care-giver bonding and attachment an important outcome?
> Infants are not born with the ability to independently regulate their circadian rhythm.
> Kusumastuti Tamtomo, Salimo & Desta (2016) theorized that 3-6-month-old babies that were massaged prior to sleep may have slept longer because the longer they slept the more opportunity their nervous system was able to spend developing its circadian rhythm
> As infants depend on their care-givers to help them enter into stages of sleep, the quality of interactions between infants and their care-givers are a key factor in development
> The way caregivers, particularly primary care-givers respond to an infant's needs shapes the development of their circadian rhythm as well as their socio-emotional development (Esposito et al 2017).
> As a result, supporting parents in the development of healthy or secure attachment is an important consideration for practitioners working in the early parenting space especially those facing prolonged sleep difficulties
> Current research backs well-established research by Ainsworth et al.(1990) investigating the use of baby carriers on infant attachment and parental bonding
> Due to their proximity, parents who wore their infant in soft carrier, especially front facing, had more opportunities to observe and act on cues provided by the infant (Ainsworth et al., 1990)
> The principle behind the findings may also apply to performing infant massage in a front facing position.
Implications for Practice
> Responsive care giving is an intervention central to infant mental and physical wellbeing that can reach far beyond the stage of infancy.
> Early parenting allied health practitioners can support improvements in infant sleep quality by educating parents and caregivers on the importance of healthy attachment and bonding in infancy and providing them with tools to do the same.
> It is important that primary care-care givers understand that infants have the capacity to recognise and understand motor actions well before their cognitive or semantic knowledge develops (Bertenthal and Boyer 2025) and ahead of their care-givers actions (Monroy et al., 2020).
> Infant massage from a trained provider teaches parents and care givers how to provide consent and identify when an infant is or is not showing interest in an offer of massage by their care giver.
> Participation in infant massage programs has been associated with increased parental confidence and more positive attitudes toward parenting (Vicente, Veríssimo and Diniz, 2017).
Summary
The nature of infant sleep architecture and the dependency of infants means that sleep is an inevitable part of carer experience. As infants need sleep to help their brains mature good sleep promotes a cycle of growth and maturation of the circadian rhythm. Early parenting practitioners are often at the cold face of hearing about the impacts of sleep deprivation on individuals and families. The research doesn't draw straight correlation lines between massage and improved sleep quality but does seem to suggest that the massage can have a significant and positive impact on the endocrine and nervous system pathways that promote physiological processes in the infant (and parent too) important in falling asleep and staying asleep.
In suggesting or recommending infant massage to parents and care-givers with infants, Early Parenting Practitioners can:
> Indirectly promote parasympathetic nervous system activity which may aid infants in settling to sleep
> Provide an adjunctive intervention to help minimize the duration of inevitable sleep disturbances in infancy
> Offer a tool that may indirectly help parents as they combat the ill effects of sleep deprivation caused by inevitable disturbances in infancy
> Nurture the development of healthy infant-parent attachment for lifelong health benefits
> Build care-giver confidence and skill recognizing and responding to their infant's cues
References:
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