Touch and massage therapy in newborn.

1. Touch & Massage therapy in
Newborns
Dr Padmesh

2. • 1. History
• 2. Types of massage
• 3. Procedure
• 4. Effects of massage
• 5. Drawbacks
• 6. Recent advances & research
Touch & Massage therapy in
Newborns

3. • 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.

4. • 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.

5. • 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

6. • 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

7. • 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

8. • 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.

9. • 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.

10. • 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.

11. • 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

12. • 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

13. • Effects of massage in Newborn:
• Weight gain
• Most consistent parameter.
• Vagal stimulation
• Less energy expenditure
Infant Beh Dev 1990; 13: 167-188.

14. • 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.

15. • 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.

16. • 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.

17. • Effects of massage in Newborn:
• Weight gain
Early Hum Dev. 2014 March ; 90(3): 137–140.

18. • Effects of massage in Newborn:
• Weight gain
Early Hum Dev. 2014 March ; 90(3): 137–140.

19. • 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.

20. • 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.

21. • 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

22. • 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.

23. • Effects of massage in Newborn:
• Decreased perception of pain:
– Short term benefits
– Decreasing pain during procedures.
J Paediatr Child Health 2006; 42: 505-508.

24. • 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.

25. • 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.

26. • Effects of massage in Newborn:
• Reduced hospital stay
Decreased hospital stay
Reduced expenditure
Pediatrics 2008; 121: 522- 529.

27. • 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.

29. • 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.

30. • 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.

31. • 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.

32. • 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.

33. • Effects of OIL massage in Newborn:
• Field, et al: (Compared with no oil)
• Massage with oil makes baby more alert.
• Shows fewer stress

34. • 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.

35. • Effects of OIL massage in Newborn:
• STUDIES:
• Sesame oil: greater improvement in anthropometric
parameters as compared to mustard and mineral oil.

36. • 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.

37. • 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

38. • 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.

39. • RECENT ADVANCES & RESEARCH:
• Conclusion:
• Massage at an early stage after birth can reduce neonatal
bilirubin levels.

40. • 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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