Critical Review

Infant massage benefits for infants and parents/caregivers: A critical review

FLORIDA STATE UNIVERSITYCOLLEGE OF HUMAN SCIENCES

M. Kay Keller, M.P.A., S.S.W., C.I.M.I.

January 2010

Objective

Report whether or not results were dependable and if implications could be legitimately derived from results to determine if there are specific benefits of providing infant massage as an intervention to infants receiving massage and to the persons providing the massage.

Statement of the Problem

• A wide range of social and health problems are attributed to adverse childhood experiences (Centers for Disease Control and Prevention, 1998).

• Research indicates a lack of nurturing emotional and physical experiences resulting in an inter-generational cycle of child abuse and neglect, substance abuse, domestic violence, and health related disorders (Center for Disease Control and Prevention, 1998).

• The longer an infant is deprived of nurturance the more severe the attachment disorder (O’Conner & Rutter, 2000).

• In so far as, parental competence contributes to increased outcomes of child well-being (Coren, 2005) and can increase the well-being of both parents or caregivers and children (Coren, 2005), this review focused on one type of parenting intervention, infant massage.

Historically

Previous Research indicated benefits for infants including:• infants exposed to substances in utero• infants at risk of child abuse and neglect• infants experiencing developmental delays• infants of teen parents• infants born prematurely• and infants of fathers

Field, 1995; Field & Diego, 2008; Field & Hernandez-Reif, 2001; Field et al., 1996; Mendes & Procianoy, 2008; O’Higgins et al., 2008; Pelaez-Nogueras et al., 1996; Scafidi et al., 1996

Research Question

This critical review aimed to evaluate experimental and quasi-experimental research previously published which focused on answering the question:

“Does providing infant massage benefit the infant

and the parents or caregivers?”

Critical Review Process

This critical review process was achieved by a determined plan to complete a rigorous review.

Methods

Sample

The articles selected for this critical review were published research studies targeting parents or caregivers who massaged infants.

Samples in these research studies were further reviewed to determine if there was a description of any confounding variables such as whether or not an infant developmental and/or physical disability was diagnosed.

Methods

Inclusion/Exclusion Criteria

Only peer reviewed journal articles on Infant Massage, printed in English on Infant Massage were included in this review from the earliest date to 2009.

All located studies were reviewed for adherence to rigorous standards as accepted by the social sciences professional community and general accepted practices in the field of social science..

Selection criteria to determine which articles had independent findings were articles whose objective was to research infant massage as an intervention provided by caregivers or parents with measured outcomes for the infant and/or parent/caregiver.

Methods

The articles identified by the inclusion and exclusion criteria were critically reviewed to determine the rigor, relevance and robustness of reliability coefficients and validation studies based upon the appropriateness of the statistical measurements selected for the methodological design of each article.

In addition, criteria as described by Gibbs (2003) and Isaac & Michael (1995) was applied to experimental and quasi-experimental designs.

Potentially relevant studies identified and screened for retrieval(n=201)

Ineligible studies excluded not an infant massage intervention, participants not parents or caregivers or duplicate articles(n= 157)

Abstracts of studies retrieved(n=44)

Studies excluded if not an intervention study or not measuring health outcome(n=6)

Potentially appropriate studies for review. Studies evaluated in detail to determine relevance to inclusion criteria (n=38)

Studies excluded from review if results presented did not relate outcomes to the benefit of parents/caregivers & infant (n=7)

Studies with usable information by outcome (n=31)

Quorum Flowchart

Methods

Qualitative research was not reviewed as experimental and quasi-experimental designed studies provide the appropriate methodology to address the outcomes and results of this research question.

Qualitative methodological designs address formative evaluation, the processes by which the intervention is applied, and are not appropriate for determining the outcome or results of this research question (Issac & Micheal, 1995).

Part I

The first part of the review provides a description of the systematically identified research literature from diverse fields of study.

Methods

Research Description - Location

Country Author Country Author

Australia Scholz & Samuels, 1992 Japan Fujita et al., 2006; Ohgi, 2004

Brazil Mendes & Procianoy, 2008 Mexico Gonzales et al., 2009

Canada Elliot et al., 2002 Russia Kelmanson & Adulas, 2005

Ecuador Jump et al., 2006 S. Korea Kim et al., 2003

Finland Huhtula et al., 2000 Turkey Arikan et al., 2007

India Arora et al., 2005; Mathai et al., 2003; Sankaranarayanan et al, 2005

United Kingdom Gitu et al., 2002; Glover et al., 2002; O’Higgins, 2008; Onozawa, 2001

Israel Ferber et al., 2005; Ferber et al., 2002; Ferber et al., 2002

USA Cullen et al., 2000; Diego et al., 2007; Feij’o et al., 2006; Field et al., 1996; Field et al., 1996; Field et al., 1998; Massaro et al., 2009; Pelaez-Nogueras 1996; Scafidi & Field, 1995; Teti et al., 2009

Methods

Research Description - Setting

Setting AuthorChildcare Center Field et al., 1998; Field et al., 1996

Home Arikan et al., 2007; Cullen et al., 2000; Elliot et al., 2002; Huhtula et al., 2000; Ferber et al., 2002; Fujita et al., 2006; O’Higgins, 2008; Onozawa, 2001

Hospital Feij’o et al., 2006; Ferber et al., 2002; Field et al., 1996; Gitu et al., 2002; Glover et al., 2002; Kelmanson & Adulas, 2005; Mendes & Procianoy, 2008; Ohgi, 2004; Scafidi & Field, 1995; Scholz & Samuels, 1992

NICU Arora et al., 2005; Diego et al., 2007; Ferber et al., 2005; Gonzales et al., 2009; Massaro et al., 2009; Mathai et al., 2003; Sankaranarayanan et al, 2005; Teti et al., 2009

Observation room Pelaez-Nogueras, 1996

Orphanage Jump et al., 2006; Kim et al., 2003

Methods

Infant Participants Descriptions

Experience Author

Born Premature Arora et al, 2005; Diego et al., 2007; Feij’o et al., 2006; Ferber et al., 2005; Ferber et al., 2002; Gitu et al., 2002; Gonzales et al., 2009; Kelmanson & Adulas, 2005; Massaro et al., 2009; Mathai et al., 2003; Mendes & Procianoy, 2008; Sankaranarayanan et al, 2005; Teti et al., 2009

Cerebral Insults Ohgi, 2004

Colic Arikan et al., 2007; Huhtala et al., 2000; Elliot et al., 2002

Healthy Arikan et al., 2007; Cullen et al., 2000; Elliot et al., 2002; Ferber et al., 2002; Field et al., 1996; Field et al., 1996; Field et al., 1998; Fujita. et al., 2006; Glover et al., 2002; Huhtala et al., 2000; Onozawa, 2001; Pelaez-Nogueras, 1996; Scholz & Samuels, 1992

Infant Diarrhea Jump et al., 2006; Kim et al., 2003

Maternal HIV Scafidi & Field, 1995

Maternal Depression Feij’o et al., 2006; Field et al., 1996; Fujita. et al., 2006 ; O’Higgins, 2008; Onozawa, 2001; Pelaez-Nogueras, 1996

Methods

Participants Descriptions

Massager Author

Elder Field et al., 1996

Father Cullen et al., 2000; Scholz & Samuels, 1992

Mother Arikan et al., 2007; Arora et al, 2005; Feij’o et al., 2006; Ferber et al., 2002; Ferber et al., 2002; Fujita. et al., 2006; Glover et al., 2002; Mendes & Procianoy, 2008; Ohgi, 2004; O’Higgins, 2008; Onozawa, 2001; Pelaez-Nogueras, 1996; Teti et al., 2009

Mothers watchedWhile staff provided

Field et al., 1996

Parents Elliot et al., 2002; Gonzales et al., 2009; Huhtala et al., 2000

Professional Staff Diego et al., 2007; Ferber et al., 2005; Field et al., 1996; Field et al., 1996; Gitu et al., 2002; Jump et al., 2006; Kelmanson & Adulas, 2005; Kim et al., 2003; Massaro et al., 2009; ; Mathai et al., 2003; Sankaranarayanan et al, 2005; Scafidi & Field, 1995

Part II

The second part of the review provides an integration of the identified research literature and critically reviews the theoretical framework and the rigor of the identified research design.

Methods

Author Measurement Design Analysis strategy

Reliability & Validity Citations

Multiple Post-tests

Detailed description of Infant Massage

Description of Instructor’s credentials

Arikan et al., 2007

Physical (crying) Experimental Intention to Treat

Reliability Coefficient Citations

Arora et al, 2005 Physical Experimental Attrition Rates X X

Cullen et al., 2000

Interaction Experimental Validity Citation References

X X

Diego et al., 2007

Physical Experimental X X

Elliot et al., 2002 Physical & Interaction

Experimental Reliability Coefficient Citations/ Validity Citation References

X

Feij’o et al., 2006

Interaction Experimental

Methods



Multiple Post-tests



Field et al., 1998 Interaction Quasi Intention to Treat

X X

Field et al., 1996 Physical Experimental

Field et al., 1996 Interaction Experimental Reliability Coefficient Citations

X

Ferber et al., 2005

Interaction Experimental Attrition Rates

Ferber et al. 2002

Physical Experimental Intention to Treat

X

Ferber et al., 2002

Physical Experimental X

Fujita et al., 2006

Interaction Experimental Intention to Treat

X

Methods



Multiple Post-tests



Gitu et al., 2002 Physical Quasi

Glover et al., 2002

Both Quasi X

Gonzales et al., 2009

Physical Experimental Attrition Rates Reliability Coefficient Citations

X

Huhtula et al., 2000

Physical (crying) Experimental X

Jump et al., 2006 Physical Experimental Intention to Treat/ Attrition Rates

X X

Kelmanson & Adulas, 2005

Physical Quasi

Methods



Multiple Post-tests



Kim et al., 2003 PhysicalExperimental

Reliability Coefficient Citations/ Validity Citation References

X X

Massaro et al., 2009

Physical Experimental Attrition Rates X X

Mathai et al., (2003)

Physical Experimental X

Mendes & Procianoy, 2008 Physical

Experimental Attrition Rates X

O’Higgins, 2008

Interaction Experimental X X

Ohgi, 2004 Physical Experimental

Methods



Multiple Post-tests



Onozawa, 2001 Interaction Experimental Intention to Treat

Reliability Coefficient Citations

X X

Pelaez-Nogueras 1996

Interaction Experimental Reliability Coefficient Citations/ Validity Citation References

X X

Sankaranarayanan et al, 2005

Physical Experimental Attrition Rates Validity Citation References

X X

Scafidi & Field, 1996

Physical Experimental Validity Citation References

X

Scholz & Samuels, 1992

Interaction Experimental Reliability Coefficient Citations

X X

Teti et al., 2009 Interaction Experimental Intention to Treat

X

Methods

Limitations

No theoretical premise

Threats to Validity• Homogeneity of participants characteristics• However, no study described generational or immigrant status, disability status, sexual orientation, gender

identity, or language preferences.• Limited sample sizes (No power analysis to determine, 21 studies) • Furthermore, studies not conducted over a longer period, such as 12 weeks, are not considered longitudinal

studies and limit generalizability. • Sixteen studies did not address intention to treat and/or attrition rates.• Healthy infants generalizable to health infants• 4 did not randomly assigned and 24 did not blindly assign participants• Did not address limitations of designs or ecological validity• No hypothesis, did not explicitly identify the Dependent or Independent Variable• No operational definitions of the terms• No reliability coefficients or validity citations for the measurement tools • No justification of appropriateness of statistical analysis• Infant Massage protocol not described• Pre-, Post, Multiple Measurements testing interaction

Part III

Finally, a summary of the conclusions is reported (Rothman, Damron-Rodiques, Shenassa, 1994).

Methods

Participants Outcomes

Infant Outcome Parent/Caregiver Outcome

Decrease in crying/colic Decreased symptoms of stress, anxiety & depression

Decrease in length of hospital stayIncreased caregiving activities

Decrease in DiarrheaIncreased interaction

Increased Interaction (Engagement & Entrainment Behavior)

Improvements in Lifestyles

Increase in Physical GrowthIncreased Self Efficacy

Increased Sleep Time Parent/Caregiver Outcome

Implications for Future Research

• Infants initiating engagement behaviors

• Fathers increasing quality of interaction with infants

• Mothers reporting less symptoms of depression after massaging or watching infants be massaged

• Volunteers reported increased social satisfaction after massaging infants.

Research

Additionally, numerous research studies showed positive outcomes for infants of mothers experiencing depression. These Outcomes included: – engagement– interaction– relaxation – relief from stress – and stimulation of the physiological systems – and increased sleep by infants who were massaged

Field, 1995; Field & Diego, 2008; Field & Hernandez-Reif, 2001;

Field et al., 1996; Mendes & Procianoy, 2008; O’Higgins et al., 2008;

Pelaez-Nogueras et al., 1996; Scafidi et al., 1996

Research

Infant massage was indicated to increase the frequency and quality of engagement of fathers and mothers with their infants

Cullen et al., 2000; Ferber et al., 2005;

Field et al., 1996; Onozawa et al., 2001;

Pardew, 1996; Scholz & Samuels, 1992

Research

Furthermore, mothers experiencing depression showed less depression after massaging their infants or watching their infants massaged by another caregiver

Feijo, Hernandez-Reif, Field,

Burns, Valley-Gray & Simco, 2006

Even volunteers who massaged infants showed an increase in their quality of lifestyle

Feijo et al., 2006

Parentbenefits

Baby receivesmassage

Baby benefits

Parent massages

infant

Research

In summary, research on infant massage has previously reported primary parents/caregiver outcomes as increased sense of parental competency and positive infant care behaviors.

• For the infant, primary outcomes reported include increased sleep time, relaxation, and relief from stress.

• Secondary outcomes reported include increased engagement cues and increased interaction between the parent/caregiver and the infant who received the massage for both the infant and the parent/caregiver.

• Secondary outcomes also included increased engagement and interaction behaviors with the adult

Field, 1995; Field & Diego, 2008; Field & Hernandez-Reif, 2001; Field et al., 1996; Mendes & Procianoy, 2008; O’Higgins et., 2008; Pelaez-Nogueras et al., 1996; Scafidi et al., 1996

ReferencesArikan, D., Alph, H., Gozum, S., Orbak, Z. & Cifci, E. (2008) Effectiveness of massage., sucrose solution, herbal tea or

hydrolysed formula in the treatment of infantile colic. Journal of Clinical Nursing, 17. 1754-1761.

Arora, J., Kumar, A. & Ramji, S. (2005) Effect of oil massage on growth and neurobehavior in very low birth weight preterm neonates. Indian Pediatrics, 42, 1092-1100.

Cullen, C., Field, T., Escalona, A., & Hartshorn, K. (2000). Father-infant interactions are

enhanced by massage therapy. Early Child Development and Care, 164, 41- 47.

Diego, M., Field, T., Hernandez-Reif, M., Deeds, O., Ascencio, A., & Begert, G. (2007) Preterm infant massage elicits consistent increases in vagal activity and gastric motility that are associated with greater weight gain. Acta Pædiatrica, 96, 1588-1596.

Elliot, M., Reilly, S., Drummond, J., & Letourneau, N. (2002). The effect of different soothing interventions on infant crying and on parent-infant interaction. Infant Mental Health Journal, 23, 310-328.

Feij’o, L., Hernandez-Reif, M., Field, T., Burns, W., Valley-Gray, S., & Simco, E. (2006). Brief report: Mother’s depressed mood and anxiety levels are reduced after massaging their preterm infants. Infant Behavior & Development, 29, 476-480.

Ferber, S., Feldman, R., Kohelet, D., Kuint, J., Dollberg, S., Arbel, E., & Weller, A. (2005).

Massage therapy facilitates mother-infant interaction in premature infants. Infant Behavior & Development, 28, 74-81.

Ferber, S., Kuint, J., Weller, A., Feldman, R., Dollberg, S., Arbel, E., & Kohlet, D. (2002) Massage therapy by mothers and trained professionals enhances weight gain in preterm infants. Early Human Development, 67, 37- 45.

Ferber, S., Laudon, M., Kuint, J. Weller, A. & Zisapel, N. (2002). Massage therapy by mothers enhances the adjustment of circadian rhythms to the nocturnal period in full-term infants. Developmental and Behavioral Pediatrics, 23,( 6), 410-416.

Field, T., Grizzle, N., Scafidi, F., Abrams, S., & Richardson, S., Kuhn, C. & Shanberg, S. (1996). Massage therapy for infants of depressed mothers. Infant Behavior and Development, 19, 109-114.

Field, T., Schanberg, S., Davalos, M. & Malphurs, J. (1996). Massage with oil has more positive effects on normal infants. Pre- and Perinatal Psychology Journal, 11 (2). 75-80.

Field, T., Hernandez-Reif, M., Quintino, O., Schanberg, S., & Kuhn. C. (1998). Elder retired volunteers benefit from giving massage therapy to infants. Journal of Applied Gerontology, 172, 229-239.

Fujita, M., Endoh, Y., Saimon, N., & Yamaguchi, S. (2006). Effect of massaging babies on mothers: Pilot study on the changes in mood states and salivary cortisol level. Complemntary Therapies in Clinical Practic, 12, 181-185.

Gitu, R., Modi, N., Gianakoulopoulos, C., Bond, C. & Glover, V. (2002) Acute effects of maternal skin-to-skin contact and massage on saliva cortisol in preterm babies. Journal of Reporductive and Infant Psychology, 20. 83-88.

Glover, V., Onozawa, K. & Hodgkinson, A. (2002) Benefits of infant massage for mothers with postnatal depression. Semin Neonatology , 7. 495-500.

Gonzalez, A., Vasquez-Mendoza, G., Garcia-Vela, A., Guzman-Ramirez, A., Salazar-Torres, M., & Romero-Gutierrez, G. (2009) Weight gain in preterm infants following parent-administered Vimala massage: A randomized controlled trial. American journal of perinatology, 26 (4, 247-252.

Huhtala, V., Lehtonen, L., Heinonen, R. & Korvenranta, H. (2000). Infant massage compared with crib vibrator in the treatment of colicky infants. Pediatrics, 105.

Jump, V. (2006). Impact of massage therapy on health outcomes among orphaned infants in Ecuador results of a randomized clinical trial. Family Community Health. 29, (4), 314-319.

Kelmanson, I. & Adulas, E. (2005). Massage therapy and sleep behaviour in infants born with low birth weight. Complimentary Therapies in Clinical Practice, 12. 200-205.

Kim, T., Shin, Y. & White-Traut, R. (2003). Multisensory intervention improves physical growth and illness rates in Korean orphaned newborn infants. Research in Nursing & Health, 26. 424-433.

Massaro, A., Hammad, T., Jazzo, B. & Aly, H. (2009) Massage with kinesthetic stimulation improves weight gain in preterm infants. Journal of Perinatology, 29. 352-357.

Mathai, S., Fernandez, A., Mondkar, J. & Kanbur, W. (2001) Effects of tactile-kinesthetic stimulation in preterms: A controlled trial. Indian Pediatrics, 38. 1091-1098.

Mendes, E., & Procianoy, R. (2008). Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates. Journal of Perinatology, 28, 815-820.

O’Higgins, M., Roberts, S., & Gover, V. (2008). Postnatal depression and mother and infant

outcomes after infant massage. Journal of Affective Disorders, 109, 189-192.

Ohgi. S., Akiyama, T., Arisawa, K. & Shiegemori, K. (2004). Randomised controlled trial of swaddling versus massage in the management of excessive crying in infants with cerebral injuries. Archives of Disease in Childhood, 89. 212-216.

Onozawa, K., Glover, V., Adams, D., Modi, N., & Kumar, C. (2001). Research report: Infant

massage improves mother-infant interaction for mothers with postnatal depression. Journal of Affective Disorders, 63, 201-207.

Pelaez-Nogueras, M., Field, T., Hossain, Z., & Pickens, J. (1996). Depressed mothers' touching increases infants' positive affect and attention in still-face interactions. Child Development, 67, 1780-1792.

Sankaranarayanan, K., Mondkar, J. Chauhan, M., Mascarenhas, B., Mainkar, A. & Salvi, R. (2005) Oil massage in neonates: an open randomized controlled study of coconut versus mineral oil. Indian Pediatrics, 42. 877-884.

Scafidi, F. & Field, T. (1996). Massage therapy improves behavior in neonates born to HIV- positive mothers. Journal of Pediatric Psychology, 21 (6). 889-897.

Scholz, K., & Samuels, C. (1992). Neonatal bathing and massage intervention with fathers,

Behavioral effects 12 weeks after birth of the first baby: The Sunraysia Australia

Intervention Project. International Journal of Behavioral Development, 15, 67-81.

Teti, D., Black, M., Viscardi, P., O’Connell, M., Baker, L. & Heiss, C. (2009). Intervention with African American premature infants: four-month results of an early intervention program. Journal of Early Intervention, 31. 146.

Critical Review

Health & Medicine

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