Henrik Norholt on August 01, 2011

Infant Massage Effects on Infant Weight Gain, Infant Sleep Patterns and Mother-Infant Relationship

For most parents, infant massage is a rewarding activity in its own right. Just consider the sheer enjoyment of touching and gently rubbing and stroking this little marvel of nature, with its lush, soft and delicately fragrant skin and all its subtle, yet clear signs of appreciation of being massaged.

Over and above being a mutually pleasurable activity, research into infant massage over the past decades has established a range of beneficial effects on the infant, and equally important, on the relationship between the mother and her baby. In this article, we will look at some of the effects of infant massage on premature and full-term babies, respectively. These effects include weight gain, sleep organization and mother-baby relationship.

Infant massage for premature infants

Extensive research has been conducted on the effects of infant massage on stable pre-term infants. Certainly, premature birth is no trivial matter. At present approximately 14% of infants in the United States are born prematurely, according to The National Center for Health Statistics. Prematurity, in turn, is one of the leading causes of infant morbidity and mortality, and it results in approximately 15.5 billion dollars in hospital costs per year.

Following intensive care treatment, weight gain becomes the main criterion for hospital discharge. Thus, several interventions have been designed to promote preterm infant weight gain, including massage therapy.

Several independent, randomized, controlled studies confirm the efficacy of infant massage in promoting weight gain in premature babies, leading to earlier discharge from the hospital.

The infant massage protocol, in studies on the effects of massage therapy on neonatal intensive care unit preterm infants, involves moderate pressure stroking (tactile stimulation) and flexion and extension of arms and legs (kinesthetic stimulation). These sessions have varied between 10 and 15 minutes and have been held two to three times a day for 5 to 10 days.

Mothers as massage therapists

The question occasionally arises whether infant massage can be done by mothers or if professional physiotherapy is required to achieve these desired increases in weight gain.

An elegant study investigated this issue by assigning preterm infants to three groups. These three groups included one treatment group in which the mothers performed the massage, and another, in which professionals unrelated to the infant administered the treatment. These two groups were then compared to a control group. Over the 10-day study period, the two treatment groups gained significantly more weight compared to the control group suggesting that mothers were able to achieve the same effect as that of trained professionals.

Maternal depression

Benefits on the infant massage were not just observed for the babies involved. Interestingly, the mothers who massaged their infants in one study experienced a decrease in depression symptoms, which are often seen in mothers of preterm infants. In another study using mothers as the massage therapists, even one session was effective in lowering both the mothers’ depression and anxiety symptoms.

Moderate pressure is critical

The question of whether light or moderate pressure in the massage therapy is most effective in promoting weight gain has also been addressed in several studies. The evidence to hand suggests that moderate pressure is most optimum. Moderate pressure massage has also been shown to reduce stress behaviors in the massaged infants, compared to the control group.

Infant massage for full-term babies

Weight gain

The effects of infant massage on the baby’s weight gain are not just seen in premature babies.

In one study, parents delivered the massage to their full-term newborns from day one to the end of the first month. Those infants gained more weight and gained more length, as well as performed better on the thoroughly validated “Brazelton Neonatal Behavior Assessment Scale,” by the end of the month that the parents provided the massage.

The parents involved were taught by massage therapists in infant massage classes whereupon the parents could continue the massages at home.

Sleep organization

Other studies have looked at another crucial element of a baby’s sound development – the baby’s sleep organization, or sleep patterns. Certainly, any parent of a baby suffering from sleep disturbances will appreciate practices which will help reduce this phenomenon.

One study sought to examine the effects of infant massage therapy on the baby’s ability to gradually adjust its phases of rest and activity in such a way that these phases align better with day and night – and thus the timing of the parents’ phases of rest and activity. The study also investigated the adjustment of the rhythm of the excretion of sleep hormone melatonin.

Starting at the age of approximately ten days old, the babies were given 14 days of infant massage therapy. The babies’ cycles of rest-activity were measured both before and after the 14-day massage therapy, and, subsequently, at six and eight weeks.

At eight weeks, the non-massaged control group babies revealed one peak of activity at approximately 12 midnight and another one at approximately 12 noon. Hardly the ideal timing of activity for parents who are trying to get a good night’s sleep to cope with the challenges of life with a newborn….

For the massaged group of babies, at eight weeks, a major peak of activity was early in the morning and a secondary peak in the late afternoon. This is certainly a more accommodating rhythm of baby activity levels for most parents, especially when one or both parents are working.

When the researchers looked into the so-called circadian rhythm (which regulates sleep and wake phases), via measurements of the hormone correlated to the circadian rhythm, melatonin, they found the following:

At 12 weeks, the nightly urinary excretions of melatonin were significantly higher – about 64%  – in the massaged babies, compared to the non-massage control group of babies. This result suggests that the massaged babies had adjusted their circadian rhythm better to life outside the womb, with its alternations between day and night. The massage therapy by mothers in the perinatal period seems to serve as a strong time cue, enhancing coordination of the developing circadian system with environmental cues, such as light, noise and activities of the caregivers.

Effects of infant massage on babies’ sleep patterns have been found in several other studies.

Mother-baby relationship

Infant massage differs from some of the other activities that parents will engage in with their baby, such as feeding, changing diapers, transporting, etc., in that there is no direct instrumental purpose in the activity of infant massage, other than that of imparting pleasure and relaxation to the baby.

In a study conducted in the UK, parents emphasized the benefits of massage on relaxation and bonding, an activity essential to the early stages of the developing relationship between a baby and its parents. Infant massage was a way of creating a special and enjoyable time together with their baby. It was also a way of learning about their baby, appreciating how responsive the baby could be to them as a parent, and learning to recognize and understand their baby’s communication to them. The parents highlighted how the activity of infant massage improved their relationship with their baby and made their baby happy and content.

A randomized, controlled study investigated the effect of infant massage on the mothers’ perception of their babies’ temperament.

When the babies were 12 months old, the mothers were asked to evaluate their babies’ temperament. Interestingly, the mothers in the infant massage group rated their babies as having a less difficult temperament than mothers of the control group. The infant massage mothers were more confident of their skills. They were also able to relate better with the baby and qualified it more positively than mothers in the control group.

A baby’s temperament is considered to result from the interaction between the baby’s genetic heritage, its environment, and social interactions. Within the environmental factors, the sensitivity of parental involvement and adequate responses from parents is an important element. The study suggests that mothers who learn how to perform infant massage have more positive attitudes towards motherhood and stronger capability to cope with the baby’s temperament.

Apart from the sheer fun of giving infant massage, there are plenty of good scientifically supported reasons to engage in it. And to boot, mothers have intuitively been doing it for millennia across the globe, notably in the Far East and South East Asia, so you are taking part in a long continued tradition.

Enjoy!

Selected literature:

Field T., Diego, M. & Hernandez-Reif, M. Preterm Infant Massage Therapy Research: A Review. Infant Behav Dev. 2010 April ; 33(2): 115–124.

Ferber S.G., Laudon M., Kuint J., Weller A. & Zisapel N. Massage therapy by mothers enhances the adjustment of circadian rhythms to the nocturnal period in full-term infants. J Dev Behav Pediatr. 2002 Dec;23(6):410-5.

Clarke, C.L., Gibb, C., Hart, J. & Davidson, A. Infant massage: developing an evidence base for health-visiting practice. Clinical Effectiveness in Nursing 2002 6, 121–128

Bárcia, S.1 & Veríssimo, M.The relationship between infant temperament and infant massage. Affiliation: 1UIPCDE, ISPA & Universidade Atlântica, 2UIPCDE, ISPA, Portugal. Poster exhibit at World Association of Infant Mental Health biennial conference, Leipzig, 2010.

On-line resources:

Touch Research Institute
http://www6.miami.edu/touch-research/
http://www6.miami.edu/touch-research/Touchpoints%20Summer%202010.pdf

The International Association of Infant Massage
http://www.iaim.net/

Infant Massage USA
http://www.infantmassageusa.org/

The Guild of Infant and Child Massage (United Kingdom)
http://www.gicm.org.uk/

International Association of Infant UK Chapter
http://www.iaim.org.uk/

Henrik Norholt

Dr. Henrik Norholt is a member of The World Association of Infant Mental Health. He holds a Ph.D. from the LIFE faculty of Copenhagen University and is a resident of Copenhagen, Denmark. He has been studying the effects of baby carrying as it relates to child psychological and motor development through naturalistic studies since 2001.

He is actively engaged in the study of current and past research into baby carrying through his large international network of family practitioners, midwives, obstetricians, pediatricians and child psychologists and shared his insights with the subscribers to Ergobaby’s blog.