The art of infant massage can positively impact neonates with jaundice, help increase weight in low birth weight neonates and assist mothers to bond with their baby after a traumatic or difficult birthing experience. These are just some of the many benefits that infant massage may bring to infants and their parents.
The practice of massaging infants dates back to ancient times and it is for good reasons that we continue to practise it today.
Infant massage and jaundice
Hyperbilirubinemia is prevalent in the first week of life. It is found in 80% of premature neonates and 60% of term neonates (Santoso, Karuniawati & Fauziandari 2022).
Hyperbilirubinemia in excess can potentially be toxic and cause death. However, the most severe complication of neonatal jaundice is kernicterus. In addition to kernicterus other risks include athetoid cerebral palsy, paralysis, hearing loss and dental dysplasia. (Santoso, Karuniawati & Fauziandari 2022)
Phototherapy is often used as a standard method in treating hyperbilirubinemia. However, there are side effects, including hyperthermia, dehydration, retinal disorders, skin rash, diarrhoea and bronze baby syndrome. Phototherapy can also increase the psychological stress of the mother and baby as well as increase the risk of melanoma development in the future. (Santoso, Karuniawati & Fauziandari 2022).
Phototherapy reduces bilirubin levels, however, a number of studies have been undertaken to find adjuvant therapies to further reduce bilirubin levels (Santoso, Karuniawati & Fauziandari 2022).
Vagus Nerve Stimulation
One alternative therapy that has been studied was providing field massage to neonates. This is a method of massage that has a focus on providing stimulation to the neonates chest, face and abdomen area. Subsequently stimulating the vagus nerve, in turn stimulates peristalsis (Marieb & Hoehn 2022). The metabolism is then increased and the functioning of the digestive organs improve, assisting the excretion of bilirubin through urine and faeces that has subsequently been broken down through phototherapy (Santoso, Karuniawati & Fauziandari 2022).
Mrljak et al (2022) found that field massage was effective in increasing the excretion of bilirubin in neonates during the course of phototherapy. To reduce bilirubin levels field massage is to be given two times per day for four consecutive days for 15 minutes as per the result findings. (Santoso, Karuniawati & Fauziandari 2022).
Abdellatif et al (2020) indicated that high levels of bilirubin were found in meconium and this could be absorbed into the blood. Infant massage resulted in an increase of bowel movements, and thus, a decrease of bilirubin levels. As meconium, and later faeces eliminates bilirubin from the body, clearance of meconium as soon as possible aids in the prevention of physiological jaundice (Santoso, Karuniawati & Fauziandari 2022).
Prevention is better than cure
Providing field massage to healthy premature neonates has also been effective in reducing bilirubin levels to prevent hyperbilirubinemia. Field massage provided from the first postnatal day, for four consecutive days at two to three times a day for 15-20 minutes resulted with an increase in the frequency of defecation and a significant difference in bilirubin levels (Santoso, Karuniawati & Fauziandari 2022).
The review on six studies show an increase in the frequency of defecation and a decrease in bilirubin levels following massage regardless of the measuring instrument, the type of massage and the infants age (Mrljak et al 2022).
Santoso, Karuniawati & Fauziandari (2022) indicate that more often massage stimulation is performed, more effects will be gained in relation to the digestive and metabolic process, thus increasing defecation. This increase reduces the reabsorption of conjugated bilirubin secreted in the intestine and therefore prevents an increase in bilirubin.
Based on the results of the research carried out in a number of studies that field massage performed two times a day for 15 minutes over four days can assist in the frequency of defecation as much as 2-8 times a day in neonates with hyperbilirubinemia, reducing bilirubin levels from 18.44 mg/dl to 6.94 mg/dl (Santoso, Karuniawati & Fauziandari 2022).
It can be concluded that field massage combined with conventional phototherapy showed improved bilirubin levels as a result. Nevertheless, field massage also acted prophylactically against jaundice in healthy newborns. The increase in the frequency of defecation was considered to be an underlying cause of the decrease in bilirubin levels.
Massage on premature and low birth weight infants
Low birth weight (LBW) is found in many countries with an increasing trend, this may be caused by nutritional status and a history of maternal health. Unfortunately, infants with LBW are inclined to experience a delay in their growth and development (Lestari et al 2021).
Data obtained from UNICEF (2023) states that in 2020, an estimated 14.7 percent of neonates born globally suffered from LBW, 5-10 percent in Australia respectively. Infants with LBW have a higher risk of mortality during their first month of life and the infants who did survive faced lifelong consequences including a higher risk of stunted growth and lower IQ. A mother needs good nutrition and rest to grow a healthy baby as well as adequate antenatal care and a clean environment. A healthy pregnancy can help to prevent, identify and treat any conditions that may cause LBW and thus aim to reduce LBW and achieve the nutrition target set by the World Health Assembly (WHA).
The neonates birth weight is used to diagnose normal or LBW neonates. If the baby is born under 2500 grams the baby is classified as LBW. Body weight in infancy and toddlerhood can be used to monitor physical growth and nutritional status (Fatmawati, Zulfiana & Pratiwi 2021).
Body weight is the most fundamental anthropometric measure and is commonly used in neonates. Increasing body weight is an indicator for infant health and used to monitor infant growth. Growth includes weight, height, head and arm size, teeth and several other body changes as well as motor, sensory, cognitive, and psychosocial developments (Fatmawati, Zulfiana & Pratiwi 2021).
How does massage improve a babies weight
Infant massage stimulates the vagus nerve, thus increasing intestinal peristalsis therefore regulating the function of the organs including the chest and abdomen. Stimulating the insulin and ghrelin hormones, thereby increasing the absorption of food. Subsequently increasing the infants metabolism and therefore causing the infant to feel hungry, thus eating more often and directly increasing weight gain. In addition to this massage also increases blood circulation which assists growth and development (Fatmawati, Zulfiana & Pratiwi 2021). This stimuli allows muscles, bones and organ systems to function optimally while increasing the ornithine decarboxylase enzyme, an enzyme that guides cells and tissue growth (Lestari et al 2021).
Mrljak et al (2022) indicated that a significant weight gain following full body massage had beneficial effects on premature neonates and can also benefit all children. In addition to this, studies have demonstrated beneficial effects on non-premature neonates weight gain.
Studies have shown premature neonates who were massaged three times a day for 15 minutes over 10 days gained between 20-47 percent more weight than infants who were not massaged (Fatmawati, Zulfiana & Pratiwi 2021). Lestari et al (2021) indicate that an infant's weight gain increased significantly by an average of 3175 grams after receiving massage. There was an increase in the average weight gain of 200 grams after massage twice a week for two weeks.
Regular massage from birth increases the infant's weight faster than others, this could potentially be due to the production of growth hormones that have been stimulated by massage (Fatmawati, Zulfiana & Pratiwi 2021).
One study showed that 15 infants that had not received massage increased their body weight by an average of 1.42 percent and the 15 infants who were provided regular massage an an average of 4.11 percent increase in their body weight (Lestari et al 2021)
Health care professionals must be able to ensure that the growth and development process is optimal as the future of the infant depends on the health status within the first 100 days of birth (Lestari et al 2021).
Based on research findings it can be concluded that massage can significantly improve the infant's weight. The stimuli to the vagus nerve increases peristalsis maximising food absorption in the body. In addition, improving blood circulation, lymph nodes and increasing cell metabolism, this in turn helps to smooth the digestive system and can assist in the absorption of nutrients by the tissue that subsequently increases the infant's weight.
Infant massage after a birth trauma
Birth trauma can be physical, emotional or psychological and can cause psychological distress, fear or helplessness and increase the risk of anxiety, depression & post traumatic stress disorder (PTSD). Approximately 45 percent of women experienced trauma during childbirth and up to four to six percent of women developed PTSD following the birth of their child. (Ertan et al 2021).
Women who experience PTSD may feel abandonment, helplessness and guilt. These feelings directly impact the mother-child interactions and thus may impact on social isolation (Ertan et al 2021).
A traumatic birth experience may also negatively affect a couple's relationship, after a complicated childbirth the risk of postpartum depression, postpartum psychosis and anxiety are increased. Which in turn increases the risk of suicide (Ertan et al 2021).
Following childbirth the state of well-being of the mother and their partner is critical in the development of the child. Therefore the importance of mental health following childbirth should never be neglected (Ertan et al 2021).
Positive effects on baby’s emotional and psychological well-being
Studies have been done to identify early mother-infant interactions in providing infant massage with associations to the psychological well-being of the mother. A study involving 20 mothers and their infants aged between two and seven months showed a significant improvement in the mother-infant interactions after participating in infant massage classes, displaying a general increase in the mothers and infants emotional availability (Porreca et al 2017).
It is important to have good parent-infant attachment, to ensure that the infant feels safe generating improved conditions for exploration and development (Mrljak et al 2022). The mothers well-being improved when infant massage was provided as well as a reduction in the mothers anxiety, stress and depressive symptoms (Mrljak et al 2022).
Providing massage early
Mothers who learned and provided their baby with massage during their hospital stay experienced reduced anxiety and a stronger attachment with their baby. Mrljak et al (2022) also state that the mothers who continued to provide massage to their infants post-discharge displayed sustained reductions in anxiety and stress. These effects also extended to fathers who reported decreased stress levels when attending infant massage courses. These effects could be associated with the oxytocin hormone, as it is released as a result of physical touch. Increased levels of oxycontin was found in both the mother and infant during massage (Mrljak et al 2022).
Studies have shown that sensitive caregiving will allow the infant not to feel overwhelmed, restraining or accelerating his/her emotions and providing early touch is a useful technique to support the parents in developing healthy bonds between adults and their infants (Porreca et al 2017).
The adult has a general sense of well-being while providing massage to their infants as it assists the parent to feel close to their baby and a decreased fear of touching and handling their baby. Mothers who provided massage to their infants reported less anxiety, less depressed mood and improved mother-child interactions (Porreca et al 2017).
When a mother has associated risks it is critical in teaching her to massage her baby, as it often will decrease anxiety levels related to the feeling of helplessness. Providing infant massage reduces and balances cortisol, epinephrine and norepinephrine hormones which control stress levels (Porreca et al 2017).
In the transition to motherhood, depression is one of the most frequent distress conditions and is linked to behavioural and emotional outcomes for the child in terms of psychopathology and negative effects (Porreca et al 2017).
Support for both low and high-risk groups
Pregnancy Birth & Baby (2023) estimates that one in three women experience birth trauma and therefore it is important to promote infant massage lessons to support parents and early emotional and social relationships between adults and their children, favoriable in both low and high-risk groups. In addition, participating in infant massage classes creates opportunities for parents to meet other parents and create new bonds (Porreca et al 2017).
Porreca et al (2017) show that mothers who have attended infant massage classes benefited by having decreased depressive symptoms whilst learning to better interact with their baby, therefore leading to an improved maternal attitude and behaviour towards their baby’s responses. It has also been indicated that social support has been extensively linked to the well-being of parents and contributes to positive mental health.
It can be concluded that focusing on early mother-infant interactions in providing infant massage effectively enhances and strengthens social and emotional relationships and therefore has the ability to increase a mother and her partner's mental well-being. In addition to developing healthy relationships, infant massage supports physical growth and neurological development.
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Elia, K 2023, Adult hands holding infants feet, two babies eye to eye, baby receiving massage [Photographs]
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Waltham, J 2020 & 2023, Infant with jaundice, Infant in phototherapy crib, bathing infant, infant on scales, breastfeeding infant [Photographs]