Massage for the Pediatric and Infant Population

Recent research continues to build on what we know about how massage can benefit both infants and pediatric clients.

 by David Malone, May 1, 2024

You know from your own practice that one of the greatest assets of massage therapy is its versatility. Massage research continues to advance the profession by highlighting how massage impacts both the physical and mental well-being of your clients, with several studies suggesting massage can help relieve symptoms of acute and chronic health conditions and alleviate stress and anxiety, for example.

So often, people assume the primary benefits of massage belong to adults. But that isn’t really true.

In recent years, more research is showing massage therapy may provide a host of benefits for infant and pediatric clients, too.

“Massage therapy for pediatric and infant clients offers significant benefits for various conditions, including sleep issues, autism, eczema, weight gain, anxiety and pain management,” says Tina Allen, LMT, CPMMT, CPMT, CIMT, founder and director, Liddle Kidz Foundation.

According to Allen, some of the overarching benefits of pediatric massage include:

  • Relaxation
  • Growth and development support
  • Alleviation of gastrointestinal issues and aids in digestion
  • Emotional well-being support
  • Reduced pain and discomfort
  • Enhanced sleep quality
  • Improved circulation
  • Strengthens bond between parent and child (parent-led massage)

Similar to your adult clients, working with infant and pediatric clients requires you to tailor every session to meet the unique needs of the child, both in the goals of the work you do together and in how you interact with the child. For example, massage therapists should be prepared to accommodate child-specific needs and differences, such as a decreased attention span, and more delicate skin and musculature.

“In pediatric massage, the pressure applied is much lighter compared to adults,” Allen explains. “The techniques are gentler and more suited to a child’s delicate skin and developing musculature.”

Related: Research on Massage for Adolescents with Cancer

Additionally, the duration of a massage session for a child will typically be shorter. Infants can quickly become bored and overstimulated during a massage, and overstimulation can end up negating many of the benefits a massage may offer younger children, like improved relaxation and sleep.

Intake for pediatric clients will also look a little different. Your pediatric clients may have health concerns that are unique to them, so consider adding questions around social and emotional health (being sure to respect scope of practice), as well as ADHD, autism and other sensory processing disorders.

Remember, too, that parents should be present throughout the intake and massage session. Not only can the parent provide helpful feedback, but they can also put the child at ease and provide a real sense of security.

Pediatric and Infant Massage for Sleep

One of the most studied potential benefits of pediatric and infant massage is the potential for improved sleep. “Massage therapy can enhance sleep quality in children by promoting relaxation, improving the production of melatonin and reducing the levels of stress hormones,” Allen says. “This effect facilitates deeper and more restful sleep, which is crucial for overall health and development.”

One study1 explored the effects of massage therapy and white noise application on the sleep quality and duration of premature infants. The study was conducted in a randomized controlled experimental design with three groups of premature infants ranging in gestational age from 28 to 37 weeks. The study included 120 premature infants evenly divided among a massage therapy group, a white noise group and a control group.

Researchers noted an increase in sleep duration and sleep efficiency for premature infants in the massage group, as well as a decrease in both the number of awakenings and wakefulness after sleep onset scores. Sleep duration also increased for infants in the white noise group, though only by roughly two hours compared to the more than five-hour increase for infants in the massage group. 

An early systematic review2 evaluated non-pharmacological interventions for sleep promotion in hospitalized children and adolescents of all ages. The analysis investigated 10 trials comprising a total of 528 participants ages three to 22, eight of which investigated behavioral interventions such as massage therapy, touch therapy and bedtime stories.

Results from one of the studies included for analysis found 87 percent of participants felt they slept better following massage, with 92 percent of parents reporting they wanted their child to receive a massage again. Additionally, researchers noted that evidence from some single studies indicated that sleep efficiency may increase and the percentage of nighttime wakefulness may decrease more over a five‚Äźday period following a massage than usual care. 

“Improved relaxation often leads to better sleep patterns,” Allen confirms. “This is especially important for infants and children, as quality sleep is crucial for healthy development.”

Infant Massage for Eczema

According to nationaleczema.org, eczema is an inflammatory skin condition that causes dry, itchy skin, rashes, scaly patches, blisters and skin infections.

Infants are particularly prone to eczema because their skin barrier is more fragile than adults. According to the Cleveland Clinic, eczema affects an estimated 15 to 20 percent of infants under the age of two. Skin irritants and allergens, an immune system reaction and genetics can all trigger infant eczema.

A 2023 study3 explored the influence of mother-performed infant massage (MPIM) on infantile eczema, quality of life, growth and maternal mental state. This randomized controlled trial included 66 full-term infants with eczema who were randomly divided into an eczema control group (EC) and an eczema with MPIM group (EM). Healthy full-term infants were also included in a control group.

The mothers in the EC group received routine care instructions, while the mothers in the EM group received routine care instruction and guidance for providing massage. The control group received no specific instruction. Data were collected at baseline and at the end of 2- and 5-months of intervention. Mothers were assessed for anxiety and depression at the same time intervals.

The study found the scores of eczema area severity index and infantile dermatitis quality of life index were significantly lower in the EM group than the EC group. The EM group also had a lower relapse rate in infants with eczema, along with significantly lower scores on the self-rating anxiety scale and self-rating depression scale in the mothers.

Additionally, no adverse reactions were reported following MPIM. “MPIM could effectively promote the remission of infantile eczema and reduce its relapse, along with relieving maternal anxiety and depression mood,” researchers noted.

Parent-Led Massage: Benefits for Both

The benefits of parent-led massage are wide ranging—not just for the child, but also for the parent provider.

“There are the usual reasons for parent-led massage, like relieving colic, improving sleep, relieving teething pain, helping the baby process their daily stress, to name a few,” says Barbara Jazzo, a licensed massage therapist who teaches parents how to provide infant massages to their children. “But I feel the most important reason is for parents to bond with their child. Having a parent’s hands on their baby is a very intimate action.” This intimacy allows parents to begin to relate to their baby’s cues so they learn what conveys discomfort, hunger or tiredness, for example.

The main goal of an infant massage is to relax the baby, so Jazzo suggests using long strokes. For some areas of the body, circular strokes may also work. “The difference between infant and older child massage is both the amount of pressure and the number of strokes,” Jazzo explains. “A person may use less pressure with an infant, and perhaps fewer strokes.”

Jazzo begins her introductory class on parent-led massage by asking participants why they are interested in massage for their child. Having an idea of parents’ goals helps her better understand what parents are hoping to learn.

For many parents, pressure is a primary concern. So, Jazzo typically starts by talking about appropriate amounts of pressure when working with children. Too much, as is the top concern for many parents, is not good, but neither is too little. “Too light is tickling and can overstimulate the baby,” Jazzo explains.

The first strokes Jazzo teaches focus on the legs and the arms. Massage techniques for the stomach, chest and face might also be covered during the introductory session, as well as what kind of oil to use, contraindications and exercises parents can do with their baby.

Allen has seen the benefits of parent-led massage first-hand while working with a family whose baby was born with a serious cardiac condition. “Rather than me working directly with the baby, I thought it would be more beneficial if I taught the mother how to perform the massage,” Allen says. “Initially, she was hesitant, worried about the delicate health of her child. I decided my role was to support and guide her.”

Allen visited the family’s home three times, helping the mother gain confidence, demonstrating how gentle touch can be safe and beneficial, and emphasizing the importance of a mother’s touch in healing and bonding. On the third visit, Allen noticed a significant change in the mother, who had become more confident and finally began massaging her baby and forming a stronger connection. The baby also seemed to relax and respond positively to the mother’s touch.

“Now, at 16, this child is a testament to the power of touch therapy and the bond between a mother and her child,” Allen says. “It seemed evident that the massage therapy, administered lovingly by his mother, had a significant role in his survival and ongoing well-being.”

Parent-led Massage: What Does the Science Say?

A feasibility study4 examined the effects of a physical and occupational therapy-led and parent-administered massage program aimed at improving parent mental health and infant development in extremely preterm infants. Parents in the study attended weekly hands-on education sessions with a primary therapist while in the hospital, and received bi-weekly support emails for 12 months post-discharge.

Researchers measured parent anxiety, depression and massage competence at baseline, upon discharge from the hospital, less than four months post-discharge, and then again at 12 months post-discharge. Results showed that the parents met or exceeded all feasibility targets at both baseline and discharge, with parent-rated feasibility and acceptability scores remaining high at all points in time.

Mother-led Infant Massage for Postpartum Depression

Postpartum depression, according to the Mayo Clinic, is a condition new moms experience that commonly includes severe mood swings, crying spells, severe anxiety, difficulty bonding with their baby, loss of appetite, anger, thoughts of suicide and difficulty sleeping. Untreated, postpartum depression can last from three to six months or longer.

According to postpartumdepression.org, about one in 10 women will experience the condition, with some studies reporting the incidence as frequent as one in 7. Of the women who experience postpartum depression, nearly 50 percent go undiagnosed by their health care provider. Additionally, younger mothers (aged 25 or younger) are 7 percent more likely to develop postpartum depression than all other age groups.

While there are numerous treatment options for postpartum depression, a recent systematic review5 explored the effectiveness of mother-led infant massage on symptoms of maternal postnatal depression.

The review comprised eight studies with a total of 521 women with maternal postnatal depression. Researchers noted that all eight studies reported a reduction in postnatal depression in women participating in infant massage.

In addition, women who used infant massage achieved improved mother-infant interactions and improved self-efficacy.

References

1. Düken ME, Yayan EH. “The effects of massage therapy and white noise application on premature infants’ sleep.” Explore (NY). 2023 Sep 12:S1550-8307

2. Kudchadkar SR, Berger J, Patel R, Barnes S, Twose C, Walker T, Mitchell R, Song J, Anton B, Punjabi NM. “Non-pharmacological interventions for sleep promotion in hospitalized children.” Cochrane Database Syst Rev. 2022 Jun 15;6.

3. Lin L, Yu L, Zhang S, Liu J, Xiong Y. “The positive effect of mother-performed infant massage on infantile eczema and maternal mental state: A randomized controlled trial.” Front Public Health. 2023 Jan 11:10.

4. McCarty DB, Dusing SC, Thorpe D, Weinberger M, Pusek S, Gilbert A, Liu T, Blazek K, Hammond S, O'Shea TM. “A Feasibility Study of a Physical and Occupational Therapy-Led and Parent-Administered Program to Improve Parent Mental Health and Infant Development.” Phys Occup Ther Pediatr. 2023 Oct 22:1-20

5. Geary O, Grealish A, Bright AM. “The effectiveness of mother-led infant massage on symptoms of maternal postnatal depression: A systematic review.” PLoS One. 2023 Dec 13:18.