This critical review evaluates the benefits of infant massage for both infants and their parents or caregivers, addressing its potential in alleviating issues stemming from adverse childhood experiences. The review analyzes peer-reviewed studies to ascertain whether infant massage serves as an effective intervention, with findings suggesting positive outcomes such as decreased crying and improved caregiver interactions. Limitations in the studies, including sample size and design, indicate the need for further research to substantiate these findings.

1. Infant massage benefits for infants and parents/caregivers: A critical review FLORIDA STATE UNIVERSITY COLLEGE OF HUMAN SCIENCES M. 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 Sankaranarayanan 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

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