Pediatrics Massage Evidence Map

Massage can be defined as any form of tactile stimulation by human hands. Typically in pediatrics, massage is a gentle, slow stroke of each part of the body in turn. The purpose of this pediatrics evidence map was to describe different massage interventions and report on related health outcomes.

Methods: Search of PubMed, Virtual Health Library, PEdro, and EMBASE resulted in:

  • 38 reviews published between 1995-2019 with most published in the last 10 years.
    • 18 systematic reviews
    • 5 meta-analyses
    • 15 narrative reviews
  • Pediatric massage was evaluated as either: positive, negative, or neutral/mixed results.

Results: Positive effects of massage were found related to: pain, physical and metabolic effects, chronic disease, effects of chemotherapy, growth, development, stress, social function, movement, sleep, bonding, mental health, patient safety, quality of care, hospital costs, palliative care and antibiotic consumption.

  • A few articles showed no effect or mixed effects in: lung function, stress, sleep and behavior
    • However, these categories showed more positive effects than neutral or negative, and more research may be needed.
  • No articles showed negative results.

Conclusions: The evidence map identified positive effects of massage in 28 areas, and zero negative effects.

  • Pediatric massage can be utilized for a wide range of issues, in the hospital and in outpatient settings
    • In the NICU specifically, infant massage is an inexpensive tool that should be utilized as part of developmental care
de Britto Pereira, P. A. D., Abdala, C. V. M., Portella, C. F., Ghelman, R., & Schveitzer, M. C. (2021). Pediatrics massage evidence map. Complementary Therapies in Medicine61, 102774.

Massage and Congenital Muscular Torticollis

If Congenital Muscular Torticollis is left untreated, head tilt, facial asymmetry and spine changes can occur.

Study: Retrospective Comparative Study at the Hunan University of Chinese Medicine

Subjects: 56 term infants with unilateral congenital muscular torticollis

  • Control group: pain free stretching to avoid micro injuries, 3 times a week, which included:
    • 10 stretches for 5-10 seconds each with rest intervals of 10 seconds for 5 sessions per day
    • All sessions included 2-person stretching to stabilize the shoulders during the stretches and maintain good blood flow
  • Massage group: massage prior to receiving the same SCM stretching as controls:
    • 3 finger massage for 3 minutes, gently stroked the SCM muscle
    • An additional 2-3 minutes, the SCM was stroked longitudinally from one end of the muscle to the other with the thumb

Outcomes: Cervical ROM and Muscle Function Scale

Results: The experimental group showed greater improvement in rotation (p=0.046) and lateral flexion (p=0.04).

  • No statistical significance was noted between the 2 groups in muscle function scale after treatment (p=0.126)

 Discussion: Massage therapy along with traditional treatment and SCM treatment is safe and effective.

  • The earlier treatment is started, the shorter the duration of treatment is needed
    • In some cases, only 3 months of treatment was required
  • No statistical difference was found between groups regarding need for surgery
    • Additional studies are needed to further evaluate treatments to reduce need for surgical interventions
Tang, W., Zhoujin, L, Xu, W., Ye, W., Wang, H., Wang, Y., Shao, X., Wang, M., Xu, J. (2023) Effect of Massage Therapy on Infants with Congenital Muscular Torticollis: A Retrospective Study. Frontiers in Pediatrics. doi: 10.3389/fped.2022.984675

Massage Reduces Pain after UVC Insertion

Researchers estimate that infants receive pain medicine less than 5% of the time for painful procedures, and likely less than that for umbilical venous catheter (UVC) placement.

Study: Randomized Control Trial at the Qaem hospital in Mashhad, Pakistan

Subjects:  64 infants ages 30-37 weeks gestation were divided into 2 groups

  • Experimental group: received massage before the UVC placement
    • 15 minute massage, in 3 phases, using olive oil
    • Positioned prone, the massage included the head, neck, neck to shoulders, upper back to waist and hips to ankles
  • Control group: standard care (no massage)

Outcomes: The Premature Infant Pain Profile (PIPP) and vital signs were measured: during UVC placement, 2 minutes and 5 minutes post placement. Additionally, a video recording of the infant’s behavior and facial movements were analyzed in both groups.

Results: Infants in the experimental group had significantly lower mean HR increase and more stable arterial oxygenation levels (p<0.0001) compared to the control group.

  • Changes in control group mean PIPP scores (pre-post) were 3.5x higher than the experimental group.
  • Infants in the massage group took <30 seconds to return to baseline HR and oxygen saturation levels while infants in the control group took >120 seconds to recover (p<0.0001).

Discussion: Applying massage before UVC placement is associated with significant pain reduction in preterm infants.

Bagheri, F., Benham Vashani, H., Baskabadi, H., Ramezanade, T., E. (2020). An Investigation of the Effects of Massage Therapy on Pain Caused by Umbilical Vein Catheter Insertion in Premature Neonates: A Clinical Trial. Pakistan Journal of Medical and Health Sciences. 14 (4), Oct-Dec 2020

Bringing it to the Bedside

The evidence is clear that touch and massage are powerful caregiving activities which should be incorporated into daily care by all caregivers to optimize infant  growth and development.  Neonatal Touch & Massage Certification  (NTMC) has both On-Line Education and Hands-On Training focused on specific ways  to bring these evidence-based practices to your everyday caregiving.  Together, we can impact the next generation of infants who begin their lives in the NICU.