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Massage and Pediatric Conditions

Toddlers and children are referred for therapeutic massage and cranial sacral therapy to treat a wide variety of medical and developmental conditions.
A competent massage therapist must keep several things in mind when working with this age group.  These clients deserve to be treated as “people” who contribute and have a solid place in society. 


September 16, 2009
By Patricia M. MacNeil BA RMT

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Toddlers and children are referred for therapeutic massage and cranial sacral therapy to treat a wide variety of medical and developmental conditions.

A competent massage therapist must keep several things in mind when working with this age group.  These clients deserve to be treated as “people” who contribute and have a solid place in society. 

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Avoid “talking down” to kids; meet them where they are at – find out their likes: books, games, toys, heroes and concerns; and involve them in their treatment.

Obtain as much information as possible from parents or guardians on the telephone and provide them with information about treatment, possible side effects and so forth. 

You want the treatment time with the child to run as smoothly as possible, so I limit discussions to subsequent telephone conversations and avoid unnecessary chatter – which can frustrate the child. He/she needs to come in and leave the treatment room as quickly as possible.

Consent to treatment must be signed by the parent/guardian of a child; however, these young clients are very quick to communicate their consent or lack of consent to treatment on a given day. 

Learn to read their body language and non-verbal cues. Let them know what a treatment entails and remember that if you succeed in touching a child for only five minutes, this may actually be a major accomplishment and the child will then trust you and allow you to work for a longer period during the next visit.

Have the parent/guardian read books, lie on the table beside the child or play games with the child.  These tricks are great for kids who have difficulty staying still. For these children, “stretch” breaks are a must: let them get off the table for a minute or so, then hop back on for further treatment. Stickers, rewards, counting and timing are other tricks of the trade with deep breathing out loud to help the young client relax.

For those children who are terrified of being touched, for example, on the head, or who suffer from birth trauma, the use of “anchoring” techniques is critical to avoid “re-traumatizing” the child. Anchoring is touch that is reassuring to the child. It involves using one hand to comfort and one hand to treat. The empathetic hand remains on the child in a compassionate way, while the therapist uses the other hand to determine the child’s reaction to treatment and boundary requirements.
 

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You will need to be very clear as to whether you want to treat the child alone in the room, or if you want the parent or guardian present. In certain cases it is obvious that their presence is required to assist you in your treatment protocol; however, there are other instances where the adults’ presence will actually cause the child to be more hyperactive and distracted, in which case you will need to have the parents leave. Try to reach a decision about this as soon as you can from the onset of treatment. Be very clear and consistent in this area!

Always remember in pediatric massage therapy or cranial sacral therapy that you are working with a child – not an adult. This means that you will approach your treatment plan much differently, making room for the child’s reactions to touch, and your pressure of course will be much lighter!

At the end of each session, briefly explain to the child what you have done and be sure to give him/her positive feedback, and inquire how he/she is feeling.

Finally, let yourself be touched by the beauty, spontaneity, innocence and wisdom of these young ones for they are our future generation!

Following is a list of common pediatric conditions and concerns that a massage therapist may encounter.  Keep it in a handy place!

Common Pediatric Conditions

AIDS – follow the same protocol as adults and be sure to treat the young client as a “normal” person, but with a light touch.

Asperger’s Syndrome
– behavioural syndrome often accompanied by repetitive fixations and “toe
walking” requiring soleus and achilles treatment.

ADD/ADHT
– Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder can have strong cranial implications. They require short treatments using toys, games, reading books, and stretch breaks; parasympathetics, autonomic and soothing massage. Give rewards for their co-operation.

Autism – psychological and strong environmental allergic factors.  Maintain good non-verbal contact, “anchoring” touch, parasympathetics and follow client’s lead and pace.  Use a slow approach.

Birth Trauma – forceps, cord, vacuum suction, caesarean section and prematurity. All require specific approaches to massage therapy to avoid re-traumatization. Anchoring is essential. Massage is highly beneficial for this trauma.

Cancer
– soothing massage.  Good encouragement, and treat client as “normal” – the disease is only part of the person.

Cerebral Palsy – varying degrees including palliative, scoliosis, muscle spasticity and possible lung involvement. Be thorough in case history and assessment. Maintain good communication with young client. Not too vigorous.

Cleft Pallet – pre- and post-surgical referrals. Treat facial, neck, shoulders and chest muscles and adhesions. Be prepared for physical appearance.

Disturbances in Musculoskeletal Balance – often caused by abnormal pressure on head or neck either before or during birth, or from injuries of infancy resulting in cranial asymmetry and inefficient muscle tone on opposing sides of joints.

Downe Syndrome – responds well to massage therapy and enjoys giving touch. Games, books and
talking are helpful.

Fetal Alcohol Syndrome – most difficult to treat. Short appointments, books, toys, distractions, rewards, stretch breaks and soothing para-
sympathetic and autonomic nervous system work is required. Short appointments.

Growing Pains – often in children 4 to 12 years of age. After a long day, the child has severe pain in the legs at bedtime for one to two hours. The exact cause is unknown but often musculoskeletal imbalance is found.

Hydrocephalus
– disturbance in drainage of fluid in head often requiring surgical placement of shunts in body. Avoid direct pressure on shunts.

Juvenile Diabetes – child may wear an insulin pump. Check insulin levels before and after treatment.  Have juice available.

Learning/Language Delayed –  often caused by cranial asymmetry.  May be accompanied by hyperactivity. Child may use sign language.  Toys, books, rewards, stretch breaks  and soothing massage are good.

Orthodontics – massage and cranial sacral therapy. Facial, neck, shoulders, trigger points, facial release, stretching. Proceed slowly using anchoring techniques and feedback from child.

Osgood-Schlatter Syndrome – knee pain in young adolescents, mainly boys. Tibial tubercle pain and swelling. Soothing massage, drainage and muscle release work inferior and superior to knees – good response.

Praeder-Willis Syndrome
– chromosonal affecting pituitary and appetite hormones. Child has no feeling of satiation. Hypotonic muscle tone. Responds well to massage.

Psycho-emotional – anxiety, bolemia, anorexic, suicidal, depressive, addictions. Involve client in treatment and use a team approach.  Advise of possible emotional reactions to touch. These conditions respond well to massage.

Recurring Ear Infections
– possible temperoral bone imbalance resulting in pressure on eustachian tube.

Spine and Brain Injuries
– same principles as adults, lighter touch.  Involve client in treatment and encourage independence.

Stabismus – crossed or lazy eye caused by an imbalance in the muscles controlling eyeball movement.  Different causes including possibly cranial asymmetry.

Tourette’s Syndrome
– behavioural syndrome. Short appointments, toys, games, books, stretch breaks and rewards.


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