Massage for Babies - Literature review Example

?Baby Massage Introduction Massaging newborn babies has been a tradition in several countries in the world since time immemorial (Leonard, 2008). Literature says that massaging was used first by Chinese during the 2nd century BC (Kulkarni et al, 2010). Massaging is a technique in which touch is applied to the baby in a systematic manner (Kulkarni et al, 2010). Massaging can be done with or without application of a lubricant like oil (Storm, 2010). The purpose of oil application is to reduce the friction during massaging. The type of lubricant applied depends on the location. Massaging can be started any time after birth and literature has shown enormous benefits associated with massage therapy for the babies. The benefits are found in term babies, preterm infants and also sick babies. In this essay, benefits of massage therapy will be evaluated through review of appropriate literature for the purpose of evidence based practice. Benefits of baby massage in preterm babies One of the consistent benefits noted with massage therapy in newborn babies is weight gain (Fucile and Gisel, 2010). Scafidi et al conducted a randomised controlled trial in which the benefits of massage therapy in preterm infants were evaluated. Those in the study group received massage therapy for 45 minutes each day in 3 divided session for ten days. Results of the study showed that those subjected to massage therapy had 21 percent more weight gain when compared to those in the control group. In yet another study by Mathai et al (2001), similar results were demonstrated. However, in both the studies, trials were performed on those with average gestation of 30 weeks and hence, the role of massage therapy in those less than 30 weeks of gestation cannot be ascertained. There is also not much literature to support the benefits of massage therapy in very preterm babies in terms of weight gain. Massage therapy on preterm infants also makes the baby less fussy, less irritable and less stress-related behaviour (Field et al, 2006). Study by Mathai et al (2001) also demonstrated that massage therapy improved behaviour of the preterm infants in terms of orientation and stability. Oil massage also has some nutritional benefits, especially in preterm babies, in whom weight gain is very important. This is because, the oil, which is vascular and thin gets easily absorbed topically and contributes to calorie intake of the baby. Some studies have reported that oil massage with plant oils like coconut oil elevated serum triglyceride levels in preterm infants and small for gestational age infants. Even rise of linoleic acid levels, essential for growth and development has been reported (Arora et al, 2005). Lahat et al (2006) reported that preterm babies receiving massage therapy have lower levels of expenditure of energy, thus contributing to better somatic growth. Massage therapy has also shown to decrease the incidence of late-onset sepsis in preterm babies and this is very important for those who are extremely small and premature, thus decreasing the duration of stay in the hospital, thereby reducing hospital costs (Mendes and Procianoy, 2008). One interesting benefit of massage therapy is the decrease in mortality rate when performed on preterm babies who are at risk for mortality (Diego et al, 2007). It has been proposed that decreased risk of nosocomial infections is the cause for decrease in mortality. Benefits in preterm, sick and term babies: communication benefits and others One of the greatest effects of massage therapy is the enhanced mother-infant interaction and boding and this has been demonstrated in many studies (Ancora, 2010). Even in preterm infants, there is evidence that massaging the baby by the mother increases bonding and interaction between the mother and the baby (Lee, 2006). Indicators of stress behaviour in infants are grimacing and clenched fisting and these are shown to be reduced in infants who receive oil massage. According to Epple (2011), "baby massage is also a fantastic way for parents to learn how their baby communicates with them, enabling parents to understand what their baby wants and comfort them with loving touch." Massage therapy also affects the sleep-wake pattern of babies. Studies have shown that massaged infants have more alert times and sleep less when compared to those who are not massaged. Also, the sleep pattern in massaged babies is consistent and the babies tend to awaken less during sleep. Massage therapy also hastens the onset of sleep in newborns and infants (Kulkarni et al, 2010). Another major benefit of oil massage is thermoregulation at skin level. Oil over the skin prevents loss of heat through convection, the most common mode of heat loss. There is evidence that massaging soon after birth prevents early hypothermia. This is very important in preterm infants in whom hypothermia dust o thermal dysregulation is frequent and can contribute to weight loss. Infact, thermal conservation with oil massage therapy appears better than other thermal conservation interventions like plastic swaddling, kangaroo care and radiant heater (Diego et al, 2008). Oil massage helps in prevention of development of cracks due to moisturising effect, thus improving barrier function of the skin. Some studies have demonstrated improved collagen formation necessary for bone growth and development .26. Thus, massage therapy is good for bone health and improves mineralisation and physical activity. However, there is not much evidence to ascertain this fact and more research is warranted in this regard (Mendes et al, 2008). Benefits in term babies There is whopping evidence that baby massage with oil is beneficial for amelioration of neonatal jaundice that is physiological. This is evident from the study by Chen et al (2011) in which the researchers found decrease in serum bilirubin levels in babies who were massaged. Education: Process of massage in newborn There are no definite guidelines for massage therapy and the techniques of massage therapy vary from palce to place based on traditions. Most studies however have a common pattern of massage therapy and this is known as Field's massage therapy (Field, 2002). In this therapy the baby gets both tactile simulation and kinesthetic stimulation. Tactile stimulation is provided in the beginning 5 minutes and ending 5 minutes of therapy and the middle 5 minute period constitutes of kinesthetic stimulation. each day 3 massage session are performed and thus the baby gets 45 minutes of massage therapy each day. In most of the studies, massage therapy was provided for 2-4 weeks. Massage therapy can be done by mother or any trained professional. Massage therapy by mother increases interaction and bonding between the mother and the baby. Massage therapy must be done in a warm room with low lights and low noise levels and must be given in between feeds to avoid vomiting or regurgitation of milk. The entire body must be involved for massaging starting from head downwards. The flat of the fingers must be used and firm strokes must be provided (Kulkarni et al, 2010). Mechanism of benefits due to massage therapy The most significant benefit with massage therapy has been weight gain. Initially, it was postulated that massage therapy causes increase in the consumption of calories due to alteration of the pattern of sleep-wake cycle. However, research has shown that though massaged babies stayed awake for longer duration of time, their calorie consumption does not increase (Dieter et al, 32). Another theory that has been postulated is that massage therapy increases vagal activity which further increases gastric motility. This leads to increased absorption of nutrients contributing to weight gain (Diego et al, 2008). In preterm infants, there is evidence that massage therapy increases rise in serum insulin and IGF-1 levels. Both these hormones contribute to weight gain due to increased utilization of glucose in the blood for somatic growth 34. Massage therapy also decreases stress levels of the baby and this occurs due to decrease in serum stress hormones like norepinephrine and cortisol (Kuhn et al, 1991). Massage therapy probably hastens maturity of the lungs through improved sympathetic maturation (Kuhn et al, 1991). The choice of lubricant depends on the cost, availability and safety of the lubricant. There is some evidence that massaging with oil increases alertness in the bay and decreases stress behaviour when compared to dry massaging. When compared to mineral oil, coconut oil massage shows better outcomes in terms of weight gain (Kulkarni et al, 2010; Sankaranarayanan, 2005). Drawbacks of massage therapy Massage therapy has several drawbacks too. In neonatal intensive care units, the policy is to touch the babies minimally to avoid nosocomial infection and thus massage therapy is not suitable for NICU babies. Most of the studies conducted on preterm babies are on stable babies and hence implications of massage therapy on sick preterm babies in NICU is not known and theoretically it increases the risk of infection. In some babies, allergic manifestations can occur due to oil massage (Kulkarni et al, 2010). Conclusion Thus, massaging is a useful technique for the health of preterm, term and sick babies. It enhances weight gain, establishes sleep-wake rhythm, decreases energy expenditure, decreases the risk of nosocomial infection, decreases mortality, decreases stress, decreases jaundice and enhances mother-baby interaction and bonding. References Arora, J., Kumar, A., Ramji, S. (2005). Effect of oil massage on growth and neurobehaviour in very low birth weight preterm neonates. Indian Pediatr., 42, 1092-1100. Ancora G. (2010). The well-being of the newborn infant in neonatal intensive care. Minerva Pediatr., 62(3 Suppl 1), 55-8. Chen, J., Sadakata, M., Ishida, M., Sekizuka, N., Sayama, M. (2011). Baby massage ameliorates neonatal jaundice in full-term newborn infants. Tohoku J Exp Med., 223(2), 97-102. Diego, M.A., Field, T., Hernandez-Reif, M. (2007). Preterm infant massage elicits consistent increase in vagal activity and gastric motility that are associated with greater weight gain. Acta Paediatr., 96, 1588-1591. Darmstadt, G.L., Dinulos, J.G. (2000). Neonatal skin care. Pediatr Clin North Am., 47, 757-782. Diego, M.A., Field, T., Hernadaz-Reif, M. (2008). Temperature increase in preterm infants during massage therapy. Infant Behav Dev., 31, 149-152. Epple A. (2011). Infant massage for children with disabilities and special needs. Pract Midwife., 14(2), 30-32. Field, T., Grizzle, N., Scafidi, F., Abrams, S., Richardson, S. (1996). Massage therapy for infants of depressed mothers. Infant Behav Dev., 19, 109-114. Field T. (2002). Massage therapy. Complementary Alternat. Med., 86, 168-171. Fucile, S., Gisel, E.G. (2010). Sensorimotor interventions improve growth and motor function in preterm infants. Neonatal Netw., 29(6), 359-66. Field, T., Diego, M.A., Hernandez-Reif, M., Deeds, O., Figuereido, B. (2006). Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants. Infant Behav Dev., 29, 574-578. Kulkarni, A., Kaushik, J.S., Gupta, P., Sharma, H., and Agrawal, R.K. (2010). Massage and Touch Therapy in Neonates: The Current Evidence. Indian Pediatrics, 47(17), 771- 776. Kuhn, C.M., Schanberg, S.M., Field, T., Symanski, R., Zimmerman, E., Scafidi, F., et al. (1991). Tactile-kinaesthetic stimulation effects on sympathetic and adrenocortical function in preterm infants. J Pediatr., 119, 434-440. Lahat, S., Mimouni, F.B., Ashbel, G., Dollberg, S. (2007). Energy expenditure in growing preterm infants receiving massage therapy. J Am Coll Nutr., 26, 356-359. Lee, H.K. (2006). The effects of infant massage on weight, height, and mother-infant interaction. Taehan Kanho Hakhoe Chi, 36, 1331- 1339. Leonard, J. (2008). Exploring neonatal touch. Wesley J Psychol., 3, 39-47. Kelmanson, I.A., Adulas, E.I. (2006). Massage therapy and sleep behaviour in infants born with low birth weight. Complement Ther Clin Pract., 12, 200-205. Mathai, S., Fernandaz, A., Mondkar, J., Kanbur, W. (2001). Effects of tactile-kinesthetic stimuation in preterms: A controlled trial. Indian Pediatr., 38, 1091-1098. Mendes,, E.W., Procianoy R.S. (2008). Massage therapy reduces hospital stay and occurrence of late onset sepsis in very preterm neonates. J Perinatol., 28, 815-820. Scafidi, F., Field, T., Schanberg, S., Bauer, C., Tucci, K., Roberts, J., et al. (1990). Massage stimulates growth in preterm infants:A replication. Infant Beh Dev, 13, 167-188. Storm L. (2010). Infant massage in the NICU. Interview by Deb Discenza. Neonatal Net., 29(5), 334-5. Sankaranarayanan, K., Mondkar, J.A., Chauhan, M.M., Mascarenhas, B.M., Mainkar, A.R., Salvi, R.Y. Oil massage in neonates: an open randomized controlled study of coconut versus mineral oil. Indian Pediatr., 42, 877-884. Read More