Features Patient Care Practice
Pediatric Massage, Part 1

In North America, we generally have a sense that most of our children are well nurtured and loved. But, did you know that recent studies have found that we are one of the most under-touched societies? A well-known researcher, Harry Harlow, used the research that he did with rhesus monkeys to prove that, as mammals, we need nurturing touch and comfort over food for survival. Like other mammals, including humans, monkeys nurture their young through touch stimulation. However, are we doing enough to nurture our children through touch in their early years?

Nicole Nifo is a registered massage therapist who specializes in working with infants and children.

Why are we a society lacking physical nurturing?
The advancements in technology and the Internet have changed the way we communicate with each other and, unfortunately, we are starting to lack face-to-face communication. Where physical stimulus such as a handshake or a hug could occur, we send a text message or an e-mail. Unfortunately, because we communicate with adults in this manner, we forget how much children need to communicate through physical touch. More children today than in years past are suffering from low self-esteem and are unable to communicate their emotions properly.

I feel this is connected to the fact that they do not receive enough physical nurturing at home from their family.

MTs Can Make a Difference
As massage therapists, we can make a difference in a child’s life. We can encourage parents to physically nurture their babies and use massage as a way to connect with their adolescent or young adult children.
Massage can help to:

• improve low confidence in children;
• improve their emotional trust in relationships with others;
• promote a positive body image and help children develop a deep personal connection to their bodies and themselves; and
• enhance close family relationships and support respectful, and nonviolent, communication in the family.

Many massage therapists who work with perinatal women have become more interested in learning about infant and pediatric massage. It is a skill set that complements any family-focused practice. The essence of pediatric massage is that we must provide safe and loving touch that encourages a positive body experience and that will help to stimulate the formation of healthy relationships in the child’s life.

Baby’s First Experience With Touch
A baby’s first experience of massage starts well before he or she is actually born into this world. A mother naturally massages her belly in a circular movement that is very instinctual when she is pregnant. Researchers at the Touch Research Institute of Miami School of Medicine have proven that a fetus actually responds to a vibration stimulus and its mother’s touch as early as three months.

When an RMT massages a patient’s abdomen during a prenatal massage, the fetus, which is  surrounded by amniotic fluid, is gently caressed by the therapist’s warm hand. This is actually  considered the baby’s first massage. Belly massage feels relaxing for your patient and will help her bond more to her baby.

As the fetus responds to the mother’s touch, (s)he will also respond to massage by following the therapist’s hand or by pushing back. The core techniques for abdominal prenatal massage must always be gentle, using techniques that are flat-handed, and with the intention of sending relaxing love energy to the fetus while soothing the stretchable abdominal tissue of the mother.

Personally, as a massage therapist, my experience with abdominal massage has been amazing! It is my favourite part of massaging a pregnant woman. My clients are always so relaxed after abdominal massage and always comment whether their baby was calm and relaxed, or following my hands and kicking back.

Infant Massage
Touch is the the most prevalent sense in the human body and the first and most developed sense that a baby is born with. Many cultures around the world incorporate baby massage into their daily lives and into after-birth practices. It is part of the postpartum ritual for some cultures to massage both mom and baby every day for weeks after birth. Over the past 20 years, research at the Touch Research Institute at the University of Miami has proven that touch and massage are crucial for the development – and, sometimes, survival! – of babies.

Benefits of Massage for Infants
Massage can promote relaxation, encourage sleep, growth and brainwave activity. Massage can also be used to reduce the discomforts of teething, colic and gas; regulate breathing and heart rate; and help develop the digestive and immune systems.

Massage also serves to comfort and give physical reassurance and self-esteem. A child’s first emotional bonds are built from physical comfort, which will lay the foundation for further emotional growth and intellectual development.

Teaching Infant Massage
The massage therapist can work on a doll to easily demonstrate basic and simple massage techniques while the parents practise on their baby.

Asking permission is one of the most important parts of infant massage. Parents are also instructed to verbally ask permission and watch out for willingness and unwillingness cues. Babies will literally kick away their parent’s hand if they do not enjoy the technique being used. RMTs will employ techniques to use in a full-body massage that are both safe and effective for newborns.

Some babies get gassy or constipated and parents are shown how to ease these discomforts through specific massage techniques. Massage can also be indicated to ease discomforts of teething; it can be applied by using a frozen baby wash cloth along the gum line and outside of the mandible.

Although it would be great to be able to massage babies all day long, it is more important to teach massage techniques to the parents who will be working directly on their child. During the late hours of the night when a baby wakes up with gas pain, it is the parents who must be the most effective in providing infant massage for their child.
My teachers have always taught me that parents are the “experts” of their baby and babies are the “boss” during an infant massage session.

Providing Therapeutic Infant Massage
There are times when having the massage therapist provide massage directly to the baby is indicated. These include:

• when parents are not confident with handling their baby and need to see how the baby responds and enjoys the massage;
• when the massage therapist needs to demonstrate the “gentle but firm” pressure;
• when parents want their child to receive massage from a skilled and qualified massage therapist because they understand the positive effects of massage therapy themselves;
• when birth trauma, or a congenital disorder, occurs, parents will hire an infant massage therapist to work directly with their child to heal the injury;
• when a parent attends an infant massage class with multiple babies. Sometimes the parent needs an extra hand to massage one of the babies if they are both wanting massage;
• when health or medical issues exist, and the parents hire a trained infant massage therapist to work with their child.

Supporting a Family with a Preterm Infant
Preterm babies are touch-deprived because they are placed in incubators for the first several days or weeks of their life. Traditionally, a neonatal intensive care unit is a no-touch centre of the hospital. Preterm infants can be highly sensitive to touch, and the concern is that any overstimulation could cause physiological disorganization in sick preterm infants. Unfortunately, this thought stems from invasive touch at the hospital such as drawing blood and inserting feeding tubes causing apnea and bradycardia.

As massage therapists, we can encourage our clients to use kangaroo care (skin-to-skin contact) with their baby, as initial contact, and empower them to use gentle massage strokes for when light touch is safe for their child in the NICU. Teaching baby massage to a couple will help them feel confident as parents; communicate love and bond with their child; and promote a routine. Research has also proven that massaging a preterm infant will help regulate body temperature and breathing, promote brain activity, increase body weight, and can even help the infant leave the hospital sooner!

Working With Pediatric Patients
Massage with children can be a lot of fun, and a break from massaging all those deep-tissue, stressed out parents!

A pediatric massage is usually given to a child from the toddler stage (i.e., one year old) to adolescence or young adulthood (between 12 and 18 years of age). Pediatric patients are a special clientele to work with. Unlike giving an adult massage treatment, these age groups require a lot more attention and stimulation to keep them interested during their massage. Again, for all young children receiving massage, we need to create a comforting environment that is soothing, and establish, for them, an opportunity to form a trusting relationship. For very young children, I always encourage parents to bring their child’s favourite toy or object with them to their massage treatment because it is familiar and will help them to relax and enjoy the experience.

As a massage therapist, you must explain massage in an age-appropriate way. Not all children understand the word “massage,” so you can substitute a different word for it. Ask permission and understand both verbal and non-verbal cues. It is also important to communicate that massage should always feel good and that they can stop the massage at any time.

I go about massage with kids by playing touch games (like making a pizza), incorporating toys like finger or hand puppets and rolling objects that have different surfaces. It is important to remember that children have more touch receptors per square centimetre than adults because of their small size. I love using puppets or a ball to massage children with especially if they find skin-to-skin massage overstimulating or if it’s their first visit. Telling a massage story is also a great way to keep a pediatric patient involved and empowered – you can integrate playful massage strokes that allow them to participate in the telling of the story.

Working with Special-Needs Children
Gross motor development in infants is acquired from the head downwards and muscle tone starts from the feet upwards. Infants develop one set of skills in back-lying, another in stomach-lying, and a third when being held in sitting, standing, or being-carried positions. As a massage therapist, we can work alongside an occupational therapist (OT) and physiotherapist (PT) to aid in the treatment and development of these gross motor skills and improve muscle tone in children.

Performing Swedish massage strokes on a developmentally delayed child can help promote circulation, decrease tone in spastic muscles and increase tone in flaccid muscles. Some special-needs children have delayed motor co-ordination and that is why it is very important that the child and family work closely with an RMT, OT or PT to improve muscle function. This can also make it easier to perform different tasks.

Positioning a child into different positions, such as assisted standing while supporting their hips and pelvis, can help develop physical confidence and strength in their core muscles. I work with some infants at their daycare centre and treat them in an area where there is a two-foot mirror and balance bar. After I have applied Swedish massage techniques, I can assist my patient in standing by supporting their hips while they look in the mirror and hold on to the bar with their non-spastic side.

Take a Course in Infant/Pediatric Massage Therapy
Teaching infant massage, and specializing in pediatric massage therapy practice, has recently become popular throughout Canada, the United States, Australia and the United Kingdom. There are currently many education sources and associations that certify therapists to teach infant massage or to be certified in pediatric massage. It is important that you hire a mentor who is well experienced, well respected and has an understanding of the massage therapy profession in your province.

Currently, there are two ways that a massage therapist can implement infant massage into their practice. First, the massage therapist can teach the parents how to massage their baby. Second, the therapist can provide therapeutic massage for the baby directly.

We owe it to our profession to promote the loving care of these special patients, or to refer to a pediatric massage therapist who is passionate and comfortable working with them. Directly treating babies and children can be one of the most rewarding aspects of being a massage therapist. They are truly growing every day and, when we work with them on a regular basis, we can see the dramatic change and difference that massage therapy can have on the development of their tiny bodies, minds and spirits.

In part 2 of this article, I will present a case study where I have utilized massage therapy on a child with a congenital developmental disorder.  It will appear in the summer issue of Massage Therapy Canada. 

Resources

1. McNeely, Cindy. The Future is Now: expanding our practices by providing massage therapy for babies and children. Massage Therapy Today. pg. 4-8. March 2009.
2. Field, Tiffany. Touch. The MIT Press. Cambridge, MA  © 2007.
3. Field, Tiffany. The Amazing Infant. Blackwell Publishing. Malden, MA 02148-5020 © 2007.
4. Bradford, Nikki. Your Premature Baby. Firefly Books Ltd. Toronto, ON M2H 3K1 © 2003.
5. Martin, Sieglinde. Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders. Woodbine House, Inc. Bethesda, MD 20817 © 2006.
6. Allen, Tina. Pediatric Massage Therapist Certification Manual. The Liddle Kidz ™ Foundation. USA © 2005-2010.
7. Beider, Shay. Touching The Future. Massage Magazine. pp. 60-69. November 2006. www.massagemag.com.

Nicole Nifo has been practising as a Registered Massage Therapist since 2005. She has extensive massage therapy training in obstetric and pediatric patients. For six years, Nicole has been managing a family-focused practice through her clinic, Fully Alive Wellness Centre in Oakville, Ontario. She has also written many MT-related articles for women and children and continues to strive to find new ways of communicating the importance of nurturing touch for children. Nicole can be reached at www.fullyalivecentre.com or on twitter @FullyAliveWC.