The document summarizes touch and massage therapy for newborns. It discusses the history of infant massage, types of touch including active, passive and positive touch. It outlines the process of neonatal massage including environment, duration and techniques. Effects of massage discussed are improved weight gain, sleep patterns, behavior and bonding. Massage may decrease late onset sepsis, energy expenditure and pain perception. Recent advances explore effects on brain development and bilirubin levels. Benefits of massage therapy for newborns are stimulation of systems, weight gain and stress reduction while being safe with no harmful effects.

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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