How to calm children through massage.

This article was written by an early childhood professor in Chile. It describes how she, as director of the early childhood center associated with the University of Playa Ancha at Valparaiso, Chile, conducted an informal study to determine if massage would benefit infants from at-risk homes who display negative emotional behaviors, and help them adjust to a group care setting.

Many of us, concerned about the possibility of physical abuse and molestation, may find it strange or inappropriate to consider using massage in a group care setting. Caregivers and teachers of you n g children in the United States, as well as other countries, are very cautious about touching and hugging young children. Some cultures, however (Japan, Brazil and India are examples), use massage with infants.

The Japanese culture discriminates among layers of attachment of infants. Attachment moves from the parent-baby dyad to the extended family and then to the culture. Touch and massage are part of the attachment process in all layers (Brazelton & Field, 1990). In South India, daily massage is part of an infant's bath routine. This practice of daily massage continues through the first year and is considered to help bring about deep sleep (Landers, 1990). Vemala Schneider McClure observed this practice in an orphanage in India in 1973. Subsequently, she founded the International Association of Infant Massage Instruction in the United States to instruct parents in infant massage (Evans, 1990). Evans recommends massage for traumatized infants, orphans, adopted babies, battered infants placed with foster families, and hospitalized and premature infants.

Chile's culture is very warm and demonstrative. Hugging and kissing when greeting a friend is the norm for both sexes. Friendly touching occurs as a natural part of interactions between adults and children. The idea of caressing a child is normal within that cultural context. Given this environment, caregivers do not have to concern themselves much about litigation stemming from inappropriate physical touching.

On the other hand, there is much concern in Chile about young children suffering from the effects of poor parenting. Many of the infants and toddlers served in early childhood centers suffer from the consequences of single-parent families, teenage parents, poverty, and parents who abuse alcohol and drugs. A combination of these risk factors is common. Rios Bernal studied young children who demonstrate the effects of early mistreatment as part of her research on massage.

Therapeutic massage for infants and children is not unknown in the United States. Tiffany M. Field, Professor of Psychiatry and Pediatrics at the University of Miami School of Medicine, is among those who have studied the effects of massage therapy on infants and children, including premature infants, cocaine-exposed infants, HIV-exposed infants and infants of clinically depressed mothers (Field, 1995; McIntosh, 1994; Scafidi, Field & Schanber, 1993). Field's (1995) study, which also included full-term infants without medical problems, found that massage therapy helped to lessen infants' anxiety. In addition, she reported that the cost of treatment could be kept low by having volunteers and parents give the therapy. Other studies have examined the use of therapeutic touch for healing (Heidt, 1990), the effect of touch on hospitalized patients (Fisher & Gallant, 1990) and the use of massage with child and adolescent psychiatric patients (Larson & Field, 1990).

Bernal's work with massage in a child care setting is similar to the massage done in a clinical setting with infants and toddlers in Field' s studies. The procedures Bernal describes are parallel to the strategies presented in the Evans article cited above. Research on the effectiveness of using massage with normal infants is still very limited. Additional data from more formal studies might indicate that massage can be beneficial outside clinical settings.

- Sue Wortham, Professor, University of Texas at San Antonio 

In recent years, profound social, cultural and economic changes have altered familial relationships, in both developed and developing countries. In many cases, children in these circumstances are deprived of affection and the basic necessities. Often, it is the youngest children who are most deeply affected, and they may respond by behaving aggressively and forming poor relationships with their parents, teachers and playmates. In particular, infants and preschoolers from at-risk homes will manifest unusual levels of aggressive behavior, crying, indifference, tantrums and other negative behaviors.

We know that children in this age group have a great need to be loved, touched, caressed and stimulated. Such caresses are as vital as food, and as indispensable to normal development as vitamins, proteins and minerals. By understanding this, we can learn to use massage to help children's circulation, relax their muscles and calm their nerves. Soothing children will help them sleep better and they will be less likely to have colic and gas.

The Importance of Touching

To smell is to perceive the world that is beyond what the hand can reach. To listen is to explore even further. And to see! Oh, to see is to caress the universe thousands of kilometers away with the eyes. Each sense takes one a little further into the vast, turning frontiers of a more varied and rich universe.

Close physical contact and caresses are very potent media of communication, since the skin is the largest sense organ on the entire body. Through direct, physical contact the young child can enjoy a sense of warmth and well-being. Stimulation of the skin, from caresses or massage, can trigger the release of nerve signals that promote a sense of well-being, as well as freeing growth hormones that will increase the child's size and weight.

Case Studies in Infant and Toddler Massage

For three years, I have been developing a program for using massage to calm children at my university's preschool center, which is also known as "The Beehive." I have observed and recorded the effects of massage and its importance to children's development.

We can document that a fetus is in perpetual contact with its mother during the prenatal period. After birth, the contact continues through nursing. Children need to receive continual loving gestures to feel secure and well-accepted in a group setting. The following are examples of how we used massage to nurture infants at "The Beehive" and, consequently, helped them adapt to the center.

Alejandro, 6 months old, was the only child of a mother who seemed apprehensive and insecure about her ability to care for her son. She was interviewed by a psychologist, who traced some of the infant's behavior - terrified, continuous crying, restless sleep and fear of adults - to problems within the woman's marriage.

Alejandro was given daily massage by the professional in charge of that age level. In the beginning, the child would cry for about five minutes. After he calmed down, his muscles would extend and the massage helped him relax. After 20 minutes, Alejandro was noticeably more tranquil. He was given a bath in tepid water, after which he slept deeply for approximately 15 minutes.

Maria, 6 months old, was the only child of a working mother who was torn by leaving her daughter at the child care center. Maria cried continuously, screamed and refused to eat. Her mother nursed the baby freely upon demand; during the night she slept with Maria, nursing her all night.

We began a daily regimen of massage, but for only 10 minutes at a time because it appeared that was all Maria would tolerate. We continued the massages for several days; it was not until the end of the week, however, that Maria became tranquil during this process. The child then began to sleep more peacefully, became better adapted to her group and accepted solid food. To complement this effort, the center offered support to the mother.

Margarita, 7 months old, was the daughter of young parents. The child had repeated tantrums, during which she threw herself on the floor. She slept intermittently at night, lacked an appetite for milk and adapted poorly to the group. After receiving daily massages, we observed that she responded well to the caresses, slept better, accepted food more readily and was essentially more tranquil than before. The child also participated harmoniously in center activities.

Characteristics of Body Massage

Consider the following points before carrying out a massage: 1) the best time for a massage is before bath-time, in a calm environment, when the child's stomach is empty and when the child is free of fever-like symptoms; 2) it is suitable to use massage with children of various ages, from less than one month old until preschool age.

To take advantage of the complete benefits, the person who performs the massage should sit on the floor, resting against a wall. Alternatively, the person can be seated in a comfortable chair, leaning back so she can support the baby in her lap. The baby should be laid on his back with his feet turned toward the caregiver's abdomen. I recommend using coconut, almond or chamomile oil to lubricate your hands before the massage.

Throughout the massage, the caregiver should look at and speak softly to the child, alternating between verbal and nonverbal communication. The silence increases concentration, while the voice calms the baby. It is important to concentrate your attention on the child. It is also advisable to complement the massage with soft background music that promotes relaxation. The person who performs the massage should remove rings, watches or any objects that can injure the child. Fingernails should be trimmed and filed to avoid scratching the baby.

Procedure

Touching requires much patience, affection and technical knowledge. It is good to begin the massage by moving along the child's neck and making small circles along the spinal column.

Begin facial massage by concentrating a loving touch on the nose. Pass your thumbs down the sides of the nose and in the contours of the mouth. Next, follow the contours up from the nose and above the eyes, and then proceed to the contours of the ears. This can be done with the fingertips.

Now you are going to affectionately massage the baby's chest, sliding your fingers along the thorax and making continuous small circles.

At the buttocks, slide your fingers along the sides; when arriving at the extremities, conduct the massage one finger at a time. Adults should use their thumb when massaging the soles of the feet.

The final phase of the loving touch is knowing how to end the massage. For proper closure, hold your hands in the shape of a shell and caress from the head to the extremities of arms and legs.

Conclusion

My research shows that after about a month of thrice-weekly massages, infants' behavior will change in the following ways:

* less repetitive crying

* more tranquil sleep

* muscular relaxation

* better adaptation to the group

* improved feeding habits.

We have begun teaching parents about the importance of caressing and affectionate contact to their children's development. Using videos and personal experience, we show them how to calm or soothe their children through massage.

References and Resources

Gentile, P. (1993). The deprived child. Sunday Chronicle, "El Mercurio."

LeBoyer, F. (1989). Shantala, massages for babies: A traditional art. Sao Paulo, Brazil: Education Ground Limited.

Petrie, P. (1987). How to play with your baby. Barcelona, Spain: Normal Education.

References (Introduction)

Brazelton, T. B., & Field, T. F. (1990). Introduction. In N. Gunzenhauser (Ed.), Advances in touch: New implications in human development (pp. xiii-xvii). Skillman, NJ: Johnson & Johnson.

Evans, L. (1990). Impact of massage on the neonate and the parent-infant relationship. In N. Gunzenhauser (Ed.), Advances in touch: New implications in human development (pp. 71-79). Skillman, NJ: Johnson & Johnson.

Field, T. F. (1995). Massage therapy for infants and children. Journal of Development & Behavioral Pediatrics, 16(2), 105-111.

Fisher, J. D., & Gallant, S. J. (1990). Effect of touch on hospitalized patients. In N. Gunzenhauser (Ed.), Advances in touch: New implications in human development (pp. 141147). Skillman, NJ: Johnson & Johnson.

Heidt, P. (1990). Therapeutic touch: Research on the healing relationship. In N. Gunzenhauser (Ed.), Advances in touch: New implications in human development (pp. 132-140). Skillman, NJ: Johnson & Johnson.

Landers, C. (1990). Child-rearing practices and infant development in South India. In N. Gunzenhauser (Ed.), Advances in touch: New implications in human development (pp. 42-52). Skillman, NJ: Johnson & Johnson.

Larson, S. K., & Field, T. M. (1990). Massage with child and adolescent psychiatric patients. In N. Gunzenhauser (Ed.), Advances in touch: New implications in human development (pp. 125-131). Skillman, NJ: Johnson & Johnson.

McIntosh, N. (1994, January). Massage in preterm infants. Archives of Disease in Childhood Fetal & Neonatal Edition, 70(1), F80.

Scafidi, F. A., Field, T., & Schanber, S.M. (1993). Factors that predict which preterm infants benefit most from massage therapy. Journal of Developmental & Behavioral Pediatrics, 14(3), 176-180.

Gilda Rios Bernal is Professor, General Basic Education, Physical Education, and Early Childhood Education, The University of Playa Ancha of Sciences of Education, Valparaiso, Chile.