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Enhancing Early Parent-Infant Interaction. Part Four: Infant Massage

Posted on: Sunday, 24 April 2005, 03:00 CDT

PARENT-BABY RELATIONSHIP

In the fourth part of this series, CHRISTINE BIDMEAD focuses on the ideal conditions for carrying out infant massage, as well as discussing ways to involve both the baby's father and older siblings to help enhance the enjoyment of the relationship between them

Community practitioner 2005; 78, 3: 103-105

The second update in this series examined positive touch as a strategy that practitioners might use in partnership with parents to enhance the parent-infant relationship.1 Positive touch was used as a way of relating to the infant in the early weeks, fulfilling a basic human instinctual need for both mother and child.

As the baby grows and becomes more used to being held and stroked, both parent and baby will look forward to these quiet, soothing times together.

What is described here is a natural progression from the early days when babies have become more used to being naked.

Health visitors can enhance their skills in being able to help parents use baby massage as a way of relating to the baby by training with the International Association of Infant Massage (details at the end of this update) to become a certified infant massage instructor. The instructors demonstrate the massage strokes on a doll so only the parents are in contact with their infants.

Encouraging parents to find a local infant massage group can be a useful way of enhancing parent-infant interaction and for parents to socialise. Not all parents will want to attend a group, however, for any number of reasons and so it can be an advantage to have a member of the health visiting team who is trained to introduce this to parents in the home.

Parents (mother and/or father) can be encouraged to use baby massage as a way of relating to their baby and there are a number of self-help books which parents might find useful to help them do this listed at the end of the update.

Some fathers may need to have their confidence boosted in touching and handling their newborn so could be encouraged to relate to their baby through touch, thus enhancing their enjoyment of their relationship with their son or daughter.

Older siblings may enjoy being massaged too and this can be a special way for the parent to reaffirm their love for them even though there is a baby to be cared for.

Once the parent is confident in massaging their baby, and having been observed by the older sibling, then the next step might be to encourage the parents to allow the child to help to massage the baby. This might best be accomplished once the baby is over the initial early weeks and is more robust. This can be the beginning of establishing a good relationship between siblings. The older child will grow in confidence and take pride in their ability.

Getting ready

Choosing a time

Finding a good time to massage the baby will require understanding of the infant behavioural states.2 The baby is likely to be most responsive when in the quiet, alert state. Some parents find that morning is a good time when their baby is most receptive. It can help to set them up well for the day ahead. Others find that other times are more appropriate before an afternoon nap or perhaps in the evening, after a bath to help the baby relax well before going to sleep.

It is best carried out between feeds because if the baby is full the process might be uncomfortable and if hungry they may not tolerate the massage for any length of time.

Massage sessions should be special times of relaxation for both the parent and the baby so using the relaxation techniques described in the second update1 will be important for a busy parent.

If the parent is consistent with the times of giving a massage then this will help the baby to learn to anticipate the sessions and look forward to them.

Cautions

If the baby is unwell then s/he is unlikely to give a positive response to the parent's request to give a massage and a massage would not be given. However, if a baby has a skin disorder (for example any open sores or cuts, dermatitis) then a massage should not be given without first seeking medical advice.

Some authorities suggest waiting 48 hours after an immunisation to see what effect this may have had on the baby3 while others feel that it might be a good way to calm a stressed baby. However, the injection site should be avoided until it is no longer sensitive.

Environment

It is good to find a quiet, warm and draught-free place for the baby massage so that the parent can give his or her full concentration to the baby. Warmth will be very important for a small baby as they cry less when warm and can lose body temperature rapidly when covered in oil.

The parent also needs to feel warm enough in the room to wear light, non-restrictive clothing and be able to relax. Putting the baby on a soft, warm surface, (for example soft warm towel) will help the baby feel comfortable.

Position

Any one of a number of positions may be appropriate for a baby massage. The key factor in deciding will be the parent's comfort and the ability of the position to facilitate face-to-face interaction with the baby so that s/he feels a sense of connection with the parent.

For the parent there should be no undue strain on the back as they lean forward to massage the infant.

Sitting cross-legged on the floor with the feet tucked under the knees and a straight back, with the baby in front of the parent with the bottom resting against the parent's crossed legs, is the classical pose for a baby massage.

The parent may also sit on the floor with their back supported against a wall and legs outstretched, with knees slightly bent outwards and the soles of the feet touching and spread out with the baby placed between.

The area between the knees can be padded out with a thick blanket covered with a warm towel and the baby positioned here (cradle position).4 However, not all parents find sitting on the floor easy. A changing table may be used and if the parent can sit at this then it would add to the sense of relaxation.

Oils

Oils should be chosen that allow the hands to glide freely over the baby's skin. Natural fruit or vegetable oils are probably the best and most easily absorbed by the baby's skin.

The best massage oils that are most easily available are:

* Sunflower oil (organic only) which is a fine oil recommended for use with premature babies.3 However, all babies will benefit from this oil as it has properties which are similar to the sebum in the baby's skin so it has a nourishing effect.

* Grapeseed which is known for its purity and easy absorption.

* Some authorities recommend the use of sweet almond oil which is light but slightly denser but it may be problematic with nut allergies and so might best be avoided.

* Some authorities suggest the use of olive oil especially if the baby has dry skin.

Any edible oil has the potential to cause an allergic reaction - as will any food, so whichever oil is chosen should be patch tested on the baby's skin to ensure that there are no reactions most often indicated by a rash.

Mineral oil, or so called baby oil, is not an ideal medium for baby massage as it does not absorb into the skin easily, leaving a greasy film. This pore-sealing effect can hamper the natural functions of the skin. Mineral oil is a highly processed by-product of petroleum; it is not broken down by the body or used in our diet, so the safety of babies sucking their fingers after application is an unknown risk factor.

Many baby massage oils/gels also have an added scent, which may not be appropriate for a sensitive newborn who relies on the normal smell of their parent for bonding, feeding and instinctive sense skills.

Massage

In the beginning

The parent needs to ensure that their hands are warm and clean and are free of jewellery that might scratch the baby. Massage oils, a clean nappy and baby clothes need to be placed nearby.

The parent aims to communicate relaxation to the infant. The parent relaxation methods explained in the second update in this series are useful for this. Then all their concentration and focus needs to be on the baby.

It is important for the parent to remember that s/he is going to do this with the baby, not to the baby, so they need to remain sensitive to the baby's movements and to move with him or her.

As baby massage is a shared communication all babies should be responded to with respect, genuineness and love. Asking the baby's permission at the beginning of the session shows respect for the baby and cues the baby into what is about to take place.

Parents can tell if a baby is saying 'no' by the baby's use of the hands in a guarding motion, turning the head away, yawning, hiccupping, positing, flailing the arms about, moving his or her eyes around frantically or by kicking, fussing or crying.

If a parent seems to be getting a 'no' from the baby then often some adjustments to the environment, making it more comfortable and increasing the warmth may help. Alternatively the parent may need to consider if the baby is in the appropriate state of consciousness for a massage.2

A programme of holding reassurance may be used with positive touch1 if a baby seems not to respond well to full massage.

All the movements should be long, slow, rhythmic and firm, yet gentle, carried out with the parent being able to have face-to-face interaction with the baby. Each stroke may be repeated three or four times if the baby continues to be enjoying it. Starting the massag\e with the feet and legs is generally best as this is less intrusive and more likely to induce the baby to relax and establish trust.

Once the baby begins to get stronger, the level of strength of the strokes can increase accordingly. There are a variety of different strokes, which can be learnt by the parent and introduced slowly over the early weeks with and without clothing until the baby gets used to these regular sessions.

Baby massage in special circumstances

Premature babies

Encouraging parents to touch and hold their premature baby in the neonatal intensive care unit is the first stage of using baby massage with small babies.

Just by resting relaxed and caring hands around the infant while s/he is in the incubator can be beneficial for both parent and baby.

Introducing a full massage routine will take time and patience and is more likely to happen when the baby comes home than on a busy neonatal unit.

Special needs

The normal cycle of parent-infant interaction2 may be impaired where babies have various degrees of sensory loss (for example visual impairment, hearing impairment) or where there is developmental delay.

In addition parents may be overwhelmed by the problems that they face in coming to terms with difficulties and various diagnoses.

Daily massage can be the vehicle by which communication with the baby is established as the parent becomes more finely attuned to their infant.

Initial difficulties may be present for the parent in reading correctly the baby's cues (for example if the baby is deaf, blind or has cerebral palsy) but over time they will become more aware of how their baby communicates and what are his or her likes and dislikes.

The baby will also benefit from the sensory messages s/he receives. It can help to build the relationship between the parent and infant. If the baby has a condition that requires intervention (for example a shunt in cerebral palsy) or a serious medical condition, then it is wise to seek advice from the doctor or physiotherapist.

Rhymes and games

In the third update5 in the series, the importance of early verbal communication with babies was stressed with some ideas for implementation.

Infant massage brings together aspects for enhancing parent- infant interaction, observation techniques, positive touch and early play.

Even before the infant can fully understand language, the parent is encouraged to talk to the baby, asking permission for the massage to begin and giving feedback on what is being experienced, smiling and responding to the baby's facial expressions and vocalisations.

Playing soothing music may help to relax both the mother and the baby prior to massage and act as a cue for the baby to anticipate what is going to take place. Babies will also love being sung to, while older babies will enjoy taking part in action nursery rhymes and finger games during the massage.

Conclusion

Infant massage is a highly effective way of enhancing parent- infant interaction which has been shown to be beneficial for both parents and babies. Health visitors have a unique opportunity to encourage parents to take part in local infant massage classes where these are offered.

As more health visitors take up the training offered, the benefits are being rolled out to many communities and Sure Start projects throughout the UK.

There may well be huge benefit if these sessions were provided in every locality, with the possibility of providing support to parents who are less able to attend groups on a one-to-one basis in their homes from members of the health visiting team.

I would like to extend my thanks to the International Association of Infant Massage and Peter Walker for their helpful comments in the writing of this update.

Infant massage is a highly effective way of enhancing parent- infant interaction which has been shown to be beneficial for both parents and babies

As baby massage is a shared communication all babies should be responded to with respect, genuineness and love

Infant massage brings together aspects for enhancing parent- infant interaction, observation techniques, positive touch and early play

References

1 Bidmead C, Fames J. Enhancing early parent-infant interaction. Part two: positive touch. Community Practitioner 2004; 77, 11: 434- 436.

2 Bidmead C, Andrews L. Enhancing early parent-infant interaction. Part one: observation strategies. Community Practitioner 2004; 77, 10: 387-389.

3 Walker P. Baby massage for beginners: a step-by-step guide to a variety of routines and flexibility exercises for babies up to 3. London: Carroll & Brown, 2000.

4 McClure V. Infant massage: a handbook for loving parents (third edition). New York: Bantam Books, 2000.

5 Bidmead C, Mackinder L. Enhancing early parent-infant interaction. Part three: early play. Community Practitioner 2004; 77, 12: 471-473.

Christine Bidmead

Training facilitator

Centre for Parent and Child Support, South London and Maudsley NHS Trust

Copyright TG Scott & Son Ltd. Mar 2005

Source: Community Practitioner

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