Review
Preterm infant massage therapy research: A review

https://doi.org/10.1016/j.infbeh.2009.12.004Get rights and content

Abstract

In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in at least one study. The use of oils including coconut oil and safflower oil enhanced the average weight gain, and the transcutaneous absorption of oil also increased triglycerides. In addition, the use of synthetic oil increased vagal activity, which may indirectly contribute to weight gain. The weight gain was associated with shorter hospital stays and, thereby, significant hospital cost savings. Despite these benefits, preterm infant massage is only practiced in 38% of neonatal intensive care units. This may relate to the underlying mechanisms not being well understood. The increases noted in vagal activity, gastric motility, insulin and IGF-1 levels following moderate pressure massage are potential underlying mechanisms. However, those variables combined do not explain all of the variance in weight gain, highlighting the need for additional mechanism studies.

Section snippets

Massage therapy studies

Randomized, controlled studies have documented greater weight gain in preterm newborns receiving moderate pressure massage therapy (see Field et al., 2004, Vickers et al., 2004 for reviews). These include our studies on preterm newborns who received 5–10 days of massage therapy and showed a 21–48% greater increase in weight gain and hospital stays of 3–6 days less than control infants (Diego et al., 2005, Dieter et al., 2003, Field et al., 1986, Scafidi et al., 1990, Wheeden et al., 1993) (see

Exercise studies

Greater weight gain has also been observed in preterm infants receiving passive limb movements. This exercise, which is a form of stimulation similar to the kinesthetic component of our massage protocol, involves flexing and extending the limbs (Eliakim et al., 2002, Moyer-Mileur et al., 2000, Nemet et al., 2002). The weight gain in these studies was less than in the massage therapy studies (0–38%). However, the exercise sessions in these studies were shorter than the typical 15 min massage

Research on ways of delivering massage therapy/exercise

Other research in the area of preterm infant massage therapy has focused on the delivery of massage therapy protocols. This research includes studies on mothers or parents as the therapists, on the use of oils to enhance the therapy effects and on hospital cost savings.

Potential underlying mechanisms for the effects of massage therapy

Some potential underlying mechanisms have been examined for the effects of massage therapy on preterm infant weight gain. Increased calorie consumption and/or greater calorie conservation was first explored as a potential mediator of the effects of massage therapy on weight gain. However, findings across our studies consistently showed that preterm infants receiving massage therapy did not consume more calories (Diego et al., 2005, Dieter et al., 2003, Field et al., 1986, Scafidi et al., 1990,

Moderate pressure is critical

Moderate pressure may be an essential component of the infant massage, as a recent study by our group revealed that preterm infants who received moderate pressure stroking gained significantly more weight (26% more) than infants who received light pressure stroking (Diego et al., 2005) (see Table 1). Similarly, static, light pressure touch does not result in greater weight gain as reported by others including the Cochrane Review based on the compilation of several data bases (Harrison et al.,

Summary

In this paper, preterm infant massage therapy studies are reviewed. Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. Research on ways of delivering the massage is also explored including using mothers versus therapists and the added effects of using oils. The use of mothers as therapists was effective in

Acknowledgements

We would like to thank the mothers and infants who participated in our studies which were supported by NIH Senior Research Scientist Awards (# MH 00331 and # AT 01585) and an NIMH Merit Award (MH # 46586) to Tiffany Field and funding from Johnson and Johnson Pediatric Institute.

References (52)

  • F. Scafidi et al.

    Effects of tactile/kinesthetic stimulation on the clinical course and sleep/wake behavior of preterm neonates

    Infant Behavior and Development

    (1986)
  • M. Backstrom et al.

    Metabolic bone disease of prematurity

    Annuals of Medicine

    (1996)
  • H.Y. Chang et al.

    Musings on the wanderer: What's new in our understanding of vago-vagal reflex? IV. Current concepts of vagal efferent projections to the gut

    American Journal of Physiology. Gastrointestinal and Liver Physiology

    (2003)
  • H.L. Cifra et al.

    Massage therapy with preterm infants and children with chronic illnesses

  • F. Colonna et al.

    Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) in growing preterm infants on enteral nutrition

    Journal of Pediatric Endocrinology and Metabolism

    (1996)
  • A. De-Roiste et al.

    Tactile stimulation: Short and long-term benefits for preterm infants

    British Journal of Developmental Psychology

    (1996)
  • M.A. Diego et al.

    Preterm infant massage elicits consistent increases in vagal activity and gastric motility that are associated with greater weight gain

    Acta Pediatrica

    (2006)
  • J.N. Dieter et al.

    Stable preterm infants gain more weight and sleep less after five days of massage therapy

    Journal of Pediatric Psychology

    (2003)
  • L. Duan et al.

    Studying impact of touching on growth and development of infants

    Chinese Nursing Research

    (2002)
  • A. Eliakim et al.

    Spontaneous activity in premature infants affects bone strength

    Journal of Perinatology

    (2002)
  • Field, T., Diego, M., Hernandez-Reif, M., Dieter, J., Kumar, A., Schanberg, S., et al. (2008). Insulin and insulin-like...
  • T. Field et al.

    Stimulation programs for preterm infants

    Social Policy Report

    (2004)
  • T. Field et al.

    Massage with oil has more positive effects on newborn infants

    Pre and Perinatal Psychology Journal

    (1996)
  • T. Field et al.

    Tactile/kinesthetic stimulation effects on preterm neonates

    Pediatrics

    (1986)
  • S. Goldstein-Ferber et al.

    Massage therapy by mothers and trained professionals enhances weight gain in preterm infants

    Early Human Development

    (2002)
  • L.L. Harrison et al.

    Physiologic and behavioral effects of gentle human touch on preterm infants

    Research in Nursing & Health

    (2000)
  • Cited by (187)

    View all citing articles on Scopus
    View full text