This critical review was the result of reviewing 300+ articles and selecting the most rigorous studies to conduct review of Infant Massage for the Preliminary requirements into Doctoral Candidacy. This results in 33 articles, representing 13 countries, in a variety of settings.

1. Infant massage benefits for infants and parents/caregivers:
A critical review
FLORIDA STATE UNIVERSITY
COLLEGE OF HUMAN SCIENCES
Mary Kay Keller, M.P.A., S.S.W., C.I.M.I.
January 2010

2. Objective
Report whether or not
results were dependable
and if implications could
be legitimately derived
from results to determine
if there are specific
benefits of providing
infant massage as an
intervention to infants
receiving massage and to
the persons providing the
massage.

3. Statement of the Problem
• A wide range of social and health problems are attributed to adverse
childhood experiences (Centers for Disease Control and Prevention, 1998).
• Research indicates a lack of nurturing emotional and physical
experiences resulting in an inter-generational cycle of child abuse
and neglect, substance abuse, domestic violence, and health related
disorders (Center for Disease Control and Prevention, 1998).
• The longer an infant is deprived of nurturance the more severe the
attachment disorder (O’Conner & Rutter, 2000).
• In so far as, parental competence contributes to increased outcomes
of child well-being (Coren, 2005) and can increase the well-being of
both parents or caregivers and children (Coren, 2005), this review
focused on one type of parenting intervention, infant massage.

4. Historically
Previous Research indicated benefits for infants including:
• infants exposed to substances in utero
• infants at risk of child abuse and neglect
• infants experiencing developmental delays
• infants of teen parents
• infants born prematurely
• and infants of fathers
Field, 1995; Field & Diego, 2008; Field & Hernandez-Reif, 2001;
Field et al., 1996; Mendes & Procianoy, 2008; O’Higgins et al., 2008;
Pelaez-Nogueras et al., 1996; Scafidi et al., 1996

5. Research Question
This critical review aimed to evaluate experimental and quasi-
experimental research previously published which focused on
answering the question:
“Does providing infant massage benefit the infant
and the parents or caregivers?”

6. Critical Review Process
This critical review process
was achieved by a
determined plan to
complete a rigorous
review.

7. Methods
Sample
The articles selected for this critical review were published research
studies targeting parents or caregivers who massaged infants.
Samples in these research studies were further reviewed to determine
if there was a description of any confounding variables such as
whether or not an infant developmental and/or physical disability
was diagnosed.

8. Methods
Inclusion/Exclusion Criteria
Only peer reviewed journal articles on Infant Massage, printed in
English on Infant Massage were included in this review from the
earliest date to 2009.
All located studies were reviewed for adherence to rigorous standards
as accepted by the social sciences professional community and
general accepted practices in the field of social science..
Selection criteria to determine which articles had independent findings
were articles whose objective was to research infant massage as an
intervention provided by caregivers or parents with measured
outcomes for the infant and/or parent/caregiver.

9. Methods
The articles identified by the inclusion and exclusion criteria were
critically reviewed to determine the rigor, relevance and robustness
of reliability coefficients and validation studies based upon the
appropriateness of the statistical measurements selected for the
methodological design of each article.
In addition, criteria as described by Gibbs (2003) and Isaac & Michael
(1995) was applied to experimental and quasi-experimental designs.

10. Potentially relevant
studies identified and
screened for retrieval
(n=201)
Ineligible studies
excluded not an infant
massage intervention,
participants not parents
or caregivers or
duplicate articles(n= 157)
Abstracts of studies
retrieved
(n=44)
Studies excluded if not
an intervention study or
not measuring health
outcome
(n=6)
Potentially appropriate
studies for review.
Studies evaluated in
detail to determine
relevance to inclusion
criteria (n=38)
Studies excluded from
review if results
presented did not relate
outcomes to the benefit
of parents/caregivers &
infant (n=7)
Studies with usable
information by outcome
(n=31)
Quorum
Flowchart

11. Methods
Qualitative research was not reviewed as experimental and quasi-
experimental designed studies provide the appropriate methodology
to address the outcomes and results of this research question.
Qualitative methodological designs address formative evaluation, the
processes by which the intervention is applied, and are not
appropriate for determining the outcome or results of this research
question (Issac & Micheal, 1995).

12. Part I
The first part of the review
provides a description of
the systematically
identified research
literature from diverse
fields of study.

13. Methods
Research Description - Location
Country Author Country Author
Australia Scholz & Samuels, 1992 Japan Fujita et al., 2006; Ohgi, 2004
Brazil Mendes & Procianoy, 2008 Mexico Gonzales et al., 2009
Canada Elliot et al., 2002 Russia Kelmanson & Adulas, 2005
Ecuador Jump et al., 2006 S. Korea Kim et al., 2003
Finland Huhtula et al., 2000 Turkey Arikan et al., 2007
India Arora et al., 2005; Mathai et al.,
2003; Sankaranarayanan et al, 2005
United Kingdom Gitu et al., 2002; Glover et al.,
2002; O’Higgins, 2008;
Onozawa, 2001
Israel Ferber et al., 2005; Ferber et al.,
2002; Ferber et al., 2002
USA Cullen et al., 2000; Diego et al.,
2007; Feij’o et al., 2006; Field et
al., 1996; Field et al., 1996; Field
et al., 1998; Massaro et al., 2009;
Pelaez-Nogueras 1996; Scafidi &
Field, 1995; Teti et al., 2009

14. Methods
Research Description - Setting
Setting Author
Childcare Center Field et al., 1998; Field et al., 1996
Home Arikan et al., 2007; Cullen et al., 2000; Elliot et al., 2002; Huhtula et al.,
2000; Ferber et al., 2002; Fujita et al., 2006; O’Higgins, 2008; Onozawa,
2001
Hospital Feij’o et al., 2006; Ferber et al., 2002; Field et al., 1996; Gitu et al., 2002;
Glover et al., 2002; Kelmanson & Adulas, 2005; Mendes & Procianoy,
2008; Ohgi, 2004; Scafidi & Field, 1995; Scholz & Samuels, 1992
NICU Arora et al., 2005; Diego et al., 2007; Ferber et al., 2005; Gonzales et al.,
2009; Massaro et al., 2009; Mathai et al., 2003; Sankaranarayanan et al,
2005; Teti et al., 2009
Observation room Pelaez-Nogueras, 1996
Orphanage Jump et al., 2006; Kim et al., 2003

15. Methods
Infant Participants Descriptions
Experience Author
Born Premature Arora et al, 2005; Diego et al., 2007; Feij’o et al., 2006; Ferber et al.,
2005; Ferber et al., 2002; Gitu et al., 2002; Gonzales et al., 2009;
Kelmanson & Adulas, 2005; Massaro et al., 2009; Mathai et al.,
2003; Mendes & Procianoy, 2008; Sankaranarayanan et al, 2005; Teti
et al., 2009
Cerebral Insults Ohgi, 2004
Colic Arikan et al., 2007; Huhtala et al., 2000; Elliot et al., 2002
Healthy Arikan et al., 2007; Cullen et al., 2000; Elliot et al., 2002; Ferber et
al., 2002; Field et al., 1996; Field et al., 1996; Field et al., 1998;
Fujita. et al., 2006; Glover et al., 2002; Huhtala et al., 2000;
Onozawa, 2001; Pelaez-Nogueras, 1996; Scholz & Samuels, 1992
Infant Diarrhea Jump et al., 2006; Kim et al., 2003
Maternal HIV Scafidi & Field, 1995
Maternal Depression Feij’o et al., 2006; Field et al., 1996; Fujita. et al., 2006 ; O’Higgins,
2008; Onozawa, 2001; Pelaez-Nogueras, 1996

16. Methods
Participants Descriptions
Massager Author
Elder Field et al., 1996
Father Cullen et al., 2000; Scholz & Samuels, 1992
Mother Arikan et al., 2007; Arora et al, 2005; Feij’o et al., 2006; Ferber et
al., 2002; Ferber et al., 2002; Fujita. et al., 2006; Glover et al., 2002;
Mendes & Procianoy, 2008; Ohgi, 2004; O’Higgins, 2008;
Onozawa, 2001; Pelaez-Nogueras, 1996; Teti et al., 2009
Mothers watched
While staff provided
Field et al., 1996
Parents Elliot et al., 2002; Gonzales et al., 2009; Huhtala et al., 2000
Professional Staff Diego et al., 2007; Ferber et al., 2005; Field et al., 1996; Field et al.,
1996; Gitu et al., 2002; Jump et al., 2006; Kelmanson & Adulas,
2005; Kim et al., 2003; Massaro et al., 2009; ; Mathai et al., 2003;
Sankaranarayanan et al, 2005; Scafidi & Field, 1995

17. Part II
The second part of the
review provides an
integration of the
identified research
literature and critically
reviews the theoretical
framework and the rigor
of the identified research
design.

18. Methods
Author Measurement Design Analysis
strategy
Reliability &
Validity
Citations
Multiple
Post-tests
Detailed
description of
Infant Massage
Description of
Instructor’s
credentials
Arikan et al.,
2007
Physical (crying) Experimental Intention to
Treat
Reliability
Coefficient
Citations
Arora et al, 2005 Physical Experimental Attrition Rates X X
Cullen et al.,
2000
Interaction Experimental Validity Citation
References
X X
Diego et al.,
2007
Physical Experimental X X
Elliot et al., 2002 Physical &
Interaction
Experimental Reliability
Coefficient
Citations/
Validity Citation
References
X
Feij’o et al.,
2006
Interaction Experimental

19. Methods
Author Measurement Design Analysis
strategy
Reliability &
Validity
Citations
Multiple
Post-tests
Detailed
description of
Infant Massage
Description of
Instructor’s
credentials
Field et al., 1998 Interaction Quasi Intention to
Treat
X X
Field et al., 1996 Physical Experimental
Field et al., 1996 Interaction Experimental Reliability
Coefficient
Citations
X
Ferber et al.,
2005
Interaction Experimental Attrition Rates
Ferber et al.
2002
Physical Experimental Intention to
Treat
X
Ferber et al.,
2002
Physical Experimental X
Fujita et al.,
2006
Interaction Experimental Intention to
Treat
X

20. Methods
Author Measurement Design Analysis
strategy
Reliability &
Validity
Citations
Multiple
Post-tests
Detailed
description of
Infant Massage
Description of
Instructor’s
credentials
Gitu et al., 2002 Physical Quasi
Glover et al.,
2002
Both Quasi X
Gonzales et al.,
2009
Physical Experimental Attrition Rates Reliability
Coefficient
Citations
X
Huhtula et al.,
2000
Physical (crying) Experimental X
Jump et al., 2006 Physical Experimental Intention to
Treat/ Attrition
Rates
X X
Kelmanson &
Adulas, 2005
Physical Quasi

21. Methods
Author Measurement Design Analysis
strategy
Reliability &
Validity
Citations
Multiple
Post-tests
Detailed
description of
Infant Massage
Description of
Instructor’s
credentials
Kim et al., 2003 Physical
Experimental
Reliability
Coefficient
Citations/
Validity Citation
References
X X
Massaro et al.,
2009
Physical Experimental Attrition Rates X X
Mathai et al.,
(2003)
Physical Experimental X
Mendes &
Procianoy, 2008 Physical
Experimental Attrition Rates X
O’Higgins,
2008
Interaction Experimental X X
Ohgi, 2004 Physical Experimental

22. Methods
Author Measurement Design Analysis
strategy
Reliability &
Validity
Citations
Multiple
Post-tests
Detailed
description of
Infant Massage
Description of
Instructor’s
credentials
Onozawa, 2001 Interaction Experimental Intention to
Treat
Reliability
Coefficient
Citations
X X
Pelaez-Nogueras
1996
Interaction Experimental Reliability
Coefficient
Citations/
Validity Citation
References
X X
Sankaranarayana
n et al, 2005
Physical Experimental Attrition Rates Validity Citation
References
X X
Scafidi & Field,
1996
Physical Experimental Validity Citation
References
X
Scholz &
Samuels, 1992
Interaction Experimental Reliability
Coefficient
Citations
X X
Teti et al., 2009 Interaction Experimental Intention to
Treat
X

23. Methods
Limitations
No theoretical premise
Threats to Validity
• Homogeneity of participants characteristics
• However, no study described generational or immigrant status, disability status, sexual orientation, gender identity,
or language preferences.
• Limited sample sizes (No power analysis to determine, 21 studies)
• Furthermore, studies not conducted over a longer period, such as 12 weeks, are not considered longitudinal
studies and limit generalizability.
• Sixteen studies did not address intention to treat and/or attrition rates.
• Healthy infants generalizable to health infants
• 4 did not randomly assigned and 24 did not blindly assign participants
• Did not address limitations of designs or ecological validity
• No hypothesis, did not explicitly identify the Dependent or Independent Variable
• No operational definitions of the terms
• No reliability coefficients or validity citations for the measurement tools
• No justification of appropriateness of statistical analysis
• Infant Massage protocol not described
• Pre-, Post, Multiple Measurements testing interaction

24. Part III
Finally, a summary of the
conclusions is reported
(Rothman, Damron-Rodiques, Shenassa, 1994).

25. Methods
Participants Outcomes
Infant Outcome Parent/Caregiver Outcome
Decrease in crying/colic Decreased symptoms of stress, anxiety & depression
Decrease in length of hospital stay
Increased caregiving activities
Decrease in Diarrhea
Increased interaction
Increased Interaction (Engagement &
Entrainment Behavior)
Improvements in Lifestyles
Increase in Physical Growth
Increased Self Efficacy
Increased Sleep Time Parent/Caregiver Outcome

26. Implications for Future Research
• Infants initiating engagement behaviors
• Fathers increasing quality of interaction with infants
• Mothers reporting less symptoms of depression after
massaging or watching infants be massaged
• Volunteers reported increased social satisfaction after
massaging infants.

27. Research
Additionally, numerous research studies showed positive
outcomes for infants of mothers experiencing
depression. These Outcomes included:
– engagement
– interaction
– relaxation
– relief from stress
– and stimulation of the physiological systems
– and increased sleep by infants who were massaged
Field, 1995; Field & Diego, 2008; Field & Hernandez-Reif, 2001;
Field et al., 1996; Mendes & Procianoy, 2008; O’Higgins et al., 2008;
Pelaez-Nogueras et al., 1996; Scafidi et al., 1996

28. Research
Infant massage was
indicated to increase
the frequency and
quality of engagement
of fathers and
mothers with their
infants
Cullen et al., 2000; Ferber et al., 2005;
Field et al., 1996; Onozawa et al., 2001;
Pardew, 1996; Scholz & Samuels, 1992

29. Research
Furthermore, mothers
experiencing depression
showed less depression
after massaging their infants
or watching their infants
massaged by another
caregiver
Feijo, Hernandez-Reif, Field,
Burns, Valley-Gray & Simco, 2006
Even volunteers who massaged
infants showed an increase
in their quality of lifestyle
Feijo et al., 2006
Parent
benefits
Baby
receives
massage
Baby
benefits
Parent
massages
infant

30. Research
In summary, research on infant massage has previously reported primary
parents/caregiver outcomes as increased sense of parental competency and positive
infant care behaviors.
• For the infant, primary outcomes reported include increased sleep time, relaxation,
and relief from stress.
• Secondary outcomes reported include increased engagement cues and increased
interaction between the parent/caregiver and the infant who received the massage
for both the infant and the parent/caregiver.
• Secondary outcomes also included increased engagement and interaction behaviors
with the adult
Field, 1995; Field & Diego, 2008; Field & Hernandez-Reif, 2001; Field et al., 1996;
Mendes & Procianoy, 2008; O’Higgins et., 2008; Pelaez-Nogueras et al., 1996; Scafidi et al., 1996

31. References
Arikan, D., Alph, H., Gozum, S., Orbak, Z. & Cifci, E. (2008) Effectiveness of massage., sucrose solution, herbal tea or
hydrolysed formula in the treatment of infantile colic. Journal of Clinical Nursing, 17. 1754-1761.
Arora, J., Kumar, A. & Ramji, S. (2005) Effect of oil massage on growth and neurobehavior in very low birth weight
preterm neonates. Indian Pediatrics, 42, 1092-1100.
Cullen, C., Field, T., Escalona, A., & Hartshorn, K. (2000). Father-infant interactions are
enhanced by massage therapy. Early Child Development and Care, 164, 41- 47.
Diego, M., Field, T., Hernandez-Reif, M., Deeds, O., Ascencio, A., & Begert, G. (2007) Preterm infant massage elicits
consistent increases in vagal activity and gastric motility that are associated with greater weight gain. Acta
Pædiatrica, 96, 1588-1596.
Elliot, M., Reilly, S., Drummond, J., & Letourneau, N. (2002). The effect of different soothing interventions on infant
crying and on parent-infant interaction. Infant Mental Health Journal, 23, 310-328.
Feij’o, L., Hernandez-Reif, M., Field, T., Burns, W., Valley-Gray, S., & Simco, E. (2006). Brief report: Mother’s
depressed mood and anxiety levels are reduced after massaging their preterm infants. Infant Behavior &
Development, 29, 476-480.
Ferber, S., Feldman, R., Kohelet, D., Kuint, J., Dollberg, S., Arbel, E., & Weller, A. (2005).
Massage therapy facilitates mother-infant interaction in premature infants. Infant Behavior & Development, 28, 74-
81.
Ferber, S., Kuint, J., Weller, A., Feldman, R., Dollberg, S., Arbel, E., & Kohlet, D. (2002) Massage therapy by mothers
and trained professionals enhances weight gain in preterm infants. Early Human Development, 67, 37- 45.
Ferber, S., Laudon, M., Kuint, J. Weller, A. & Zisapel, N. (2002). Massage therapy by mothers enhances the adjustment
of circadian rhythms to the nocturnal period in full-term infants. Developmental and Behavioral Pediatrics, 23,( 6),
410-416.

32. Field, T., Grizzle, N., Scafidi, F., Abrams, S., & Richardson, S., Kuhn, C. & Shanberg, S. (1996). Massage therapy for
infants of depressed mothers. Infant Behavior and Development, 19, 109-114.
Field, T., Schanberg, S., Davalos, M. & Malphurs, J. (1996). Massage with oil has more positive effects on normal
infants. Pre- and Perinatal Psychology Journal, 11 (2). 75-80.
Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S., & Kuhn. C. (1998). Elder retired volunteers benefit from
giving massage therapy to infants. Journal of Applied Gerontology, 172, 229-239.
Fujita, M., Endoh, Y., Saimon, N., & Yamaguchi, S. (2006). Effect of massaging babies on mothers: Pilot study on the
changes in mood states and salivary cortisol level. Complemntary Therapies in Clinical Practic, 12, 181-185.
Gitu, R., Modi, N., Gianakoulopoulos, C., Bond, C. & Glover, V. (2002) Acute effects of maternal skin-to-skin contact
and massage on saliva cortisol in preterm babies. Journal of Reporductive and Infant Psychology, 20. 83-88.
Glover, V., Onozawa, K. & Hodgkinson, A. (2002) Benefits of infant massage for mothers with postnatal depression.
Semin Neonatology , 7. 495-500.
Gonzalez, A., Vasquez-Mendoza, G., Garcia-Vela, A., Guzman-Ramirez, A., Salazar-Torres, M., & Romero-Gutierrez,
G. (2009) Weight gain in preterm infants following parent-administered Vimala massage: A randomized controlled
trial. American journal of perinatology, 26 (4, 247-252.
Huhtala, V., Lehtonen, L., Heinonen, R. & Korvenranta, H. (2000). Infant massage compared with crib vibrator in the
treatment of colicky infants. Pediatrics, 105.
Jump, V. (2006). Impact of massage therapy on health outcomes among orphaned infants in Ecuador results of a
randomized clinical trial. Family Community Health. 29, (4), 314-319.
Kelmanson, I. & Adulas, E. (2005). Massage therapy and sleep behaviour in infants born with low birth weight.
Complimentary Therapies in Clinical Practice, 12. 200-205.
Kim, T., Shin, Y. & White-Traut, R. (2003). Multisensory intervention improves physical growth and illness rates in
Korean orphaned newborn infants. Research in Nursing & Health, 26. 424-433.
Massaro, A., Hammad, T., Jazzo, B. & Aly, H. (2009) Massage with kinesthetic stimulation improves weight gain in
preterm infants. Journal of Perinatology, 29. 352-357.
Mathai, S., Fernandez, A., Mondkar, J. & Kanbur, W. (2001) Effects of tactile-kinesthetic stimulation in preterms: A
controlled trial. Indian Pediatrics, 38. 1091-1098.

33. Mendes, E., & Procianoy, R. (2008). Massage therapy reduces hospital stay and occurrence of late-onset sepsis in
very preterm neonates. Journal of Perinatology, 28, 815-820.
O’Higgins, M., Roberts, S., & Gover, V. (2008). Postnatal depression and mother and infant
outcomes after infant massage. Journal of Affective Disorders, 109, 189-192.
Ohgi. S., Akiyama, T., Arisawa, K. & Shiegemori, K. (2004). Randomised controlled trial of swaddling versus massage
in the management of excessive crying in infants with cerebral injuries. Archives of Disease in Childhood, 89. 212-
216.
Onozawa, K., Glover, V., Adams, D., Modi, N., & Kumar, C. (2001). Research report: Infant
massage improves mother-infant interaction for mothers with postnatal depression. Journal of Affective Disorders,
63, 201-207.
Pelaez-Nogueras, M., Field, T., Hossain, Z., & Pickens, J. (1996). Depressed mothers' touching increases infants'
positive affect and attention in still-face interactions. Child Development, 67, 1780-1792.
Sankaranarayanan, K., Mondkar, J. Chauhan, M., Mascarenhas, B., Mainkar, A. & Salvi, R. (2005) Oil massage in
neonates: an open randomized controlled study of coconut versus mineral oil. Indian Pediatrics, 42. 877-884.
Scafidi, F. & Field, T. (1996). Massage therapy improves behavior in neonates born to HIV- positive mothers. Journal of
Pediatric Psychology, 21 (6). 889-897.
Scholz, K., & Samuels, C. (1992). Neonatal bathing and massage intervention with fathers,
Behavioral effects 12 weeks after birth of the first baby: The Sunraysia Australia
Intervention Project. International Journal of Behavioral Development, 15, 67-81.
Teti, D., Black, M., Viscardi, P., O’Connell, M., Baker, L. & Heiss, C. (2009). Intervention with African American
premature infants: four-month results of an early intervention program. Journal of Early Intervention, 31. 146.