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Massage Therapy: Establishing a Bond

Alexandra C. Zitsch

School of Nursing, James Madison University

NSG 464: Introduction to Nursing Research

Dr. Donna Schminkey

April 7, 2021
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Abstract

When a newborn requires hospitalization immediately following birth, a disruption in emotional

attachment between the mother and her infant can occur. Infant massage has proven to be

effective in maintaining and strengthening the bond between the mother and neonate. This paper

reviews eight articles consisting of qualitative and quantitative studies which identifies important

concepts including the benefits of infant massage, the physiological changes that occur in

bonding and the ways to properly execute an infant massage. The purpose of this paper is to

determine the effects infant massage has on bonding and how those bonds leave everlasting

impressions on the infants. In order to fully understand bonding and infant massage, further

research is required. Additional limitations to these studies were outlined and addressed.

Keywords: Infant massage, newborn massage, neonatal intensive care unit, NICU,

bonding, attachment
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Massage Therapy: Establishing a Bond

Upon birth, infants that require hospitalization are immediately removed from their

mother and the bonding process is interrupted. Although skin-to-skin contact is most commonly

used to enhance the bonding process, it is not always a viable solution for infants in the Neonatal

Intensive Care Unit (NICU). As an alternative, infant massage is an effective solution for these

newborns as it has been shown to accelerate attachment between the mother and infant (Shoghi

et al., 2018). A stronger emotional connection between the mother and newborn has many

benefits, but these benefits can only be achieved through proper execution of the massage and an

understanding of the physiological process required in order to enhance that bond.

Discussion

Benefits of Infant Massage

From the moment a NICU baby is born, they are subjected to negative stimuli from

countless heel sticks and invasive, painful procedures. Infant massage is the first positive

interaction these newborns experience and it is essential in establishing trust between the mother

and infant. The ability or inability of an individual to build trust affects language development,

emotion and cognition (Hartani et al., 2019). In order for infants to form a bond, the interaction

that takes place between the mother and infant needs to be reciprocated. According to Hartani et

al. (2019), quality interactions, which includes a high level of responsiveness from both parties,

promotes a baby’s behavioral, social-emotional, and cognitive development while also

facilitating physical health. Mothers who performed infant massage reported a greater level of

confidence in their ability to care for their babies, a faster decline in postpartum depression and

lower levels of stress (Medina et al., 2018).

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Physiological Components of a Stronger Bond

Studies have shown that infant massage is successful in facilitating a bond between the

mother and infant, but what physiological and psychological processes take place in order to

allow this to happen? The simple act of touch, transpired by infant massage, becomes the first

sensorial system activated within a newborn and it satisfies the newborn’s innate need for

communication (Porreca et al., 2018). Communication is first established through tactile

stimulation in which the newborn is able to convey somatosensory information such as emotions,

temperature, softness, pain, and pressure (Porreca et al., 2018). When touch is brought about

through massage, the hypothalamic-pituitary-adrenocortical (HPA) system interprets the stimuli

and in turn, accelerates the emotional response of the infant subsequently initiating a bond

(Porreca et al., 2018). A high-contact interaction early on in the infant’s life has long-lasting

effects on his/her ability to regulate their emotions as an adult (Porecca et al., 2018).

Proper Implementation of Infant Massage

Effectiveness of infant massage relies heavily on the caregiver’s technique, pressure, area

of massage, position, frequency, and newborn status (Widyaningrum, 2018). The most important

factor to take into consideration is the status of the newborn. Frequent assessment should take

place regarding color changes, tremors, alertness, responsiveness and motor state (Allen, 2017).

During the massage, areas in which the newborn will experience discomfort, such as the heel due

to a recent heel stick, should be avoided (Allen, 2017). Maintaining eye contact throughout the

duration of the massage is necessary because it can enhance bonding and it can also provide

insight to physiological changes in the baby. Knowing how to identify changes in the baby’s

status is only one contributing factor to a successful massage which is why education is such an

important intervention (Allen, 2017).

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Implications

Preterm births and births requiring care from the NICU are increasing around the world and in

the United States (Shoghi et al., 2018). Interventions used to enhance attachment between the

mother and baby are limited and massage is a proven intervention that dates back thousands of

years. In the NICU, negative touch is the primary form of contact while positive touch takes up

less than 5% of that tactile stimulation (Seattle Children’s, 2019). In addition to enhancing the

bonding process, massage improves feeding, mental development, motor development, decreases

pain, anxiety, depression, and increases weight gain (Seattle Children’s, 2019). The

implementation of infant massage first requires the nurse to be trained by a qualified massage

instructor. Once the nurse is trained, he or she will be able to teach the parents how to perform it

through demonstration. Massage is a noninvasive, cost-effective, simple intervention, with an

incredible amount of psychological and physiological benefits. Using massage as the standard

practice could improve the overall health of babies and mothers around the world.

Conclusion

Separation of a mother and her neonate can disrupt the bonding process as well as alter

the mother’s acceptance of her baby (Shoghi et al., 2018). In cases where skin-to-skin contact is

not appropriate due to the status of the infant, massage is a cost effective and successful way to

increase emotional attachment between the mother and baby (Shoghi et al., 2018). Although

research regarding infant massage has been completed, more research is needed in order to

determine which aspects of the massage contribute the greatest to the strength of the bond.

Additionally, if implementation is to be successful, specifications on how to educate the parents

on infant massage need to be addressed. Nurses in the NICU are in a unique position to provide
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caregivers with the resources needed to strengthen the bond they have with their baby through

the simple act of touch.

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References

Allen, T. (2017). Infant massage: Considerations for the medical environment. Massage

Magazine, 255, 50-54.

Hartanti, A., Slimo, H., & Widyaningsih, V. (2019). Effectiveness of infant massage on

strengthening bonding and improving sleep quality. Indonesian Journal of Medicine,

4(2), 165-175. https://doi/org/10.26911/theijmed.2019.04.02.10

Medina, I., Granero-Molina, J., Fernandez-Sola, C., Hernandez-Padilla, J., Avila, M., &

Rodriguez, M. (2018). Bonding in neonatal intensive care units: Experiences of

extremely preterm infants’ mothers. Women and Birth, 31(4), 325-330.

https://doi.org/10.1016/j.wombi.2017.11.008

Pados, B. & McGlothen-Bell, K. (2019). Benefits of infant massage for infants and parents in the

NICU. Nursing for Women’s Health, 23(3), 265-271.

https://doi.org/10.1016/j.nwh.2019.03.004

Porreca, A., Parolin, M., Bozza, G., Freato., & Simonelli, A. (2016). Infant massage and quality

of early mother-infant interactions: Are there associations with maternal psychological

wellbeing, marital quality, and social support. Frontiers in Psychology, 7, 2049.

https://doi.org/10.3389/fpsyg.2016.02049

Widyaningrum, R. (2018). The effectiveness of baby massages using audiovisual approach for

improving interactions between mother and infant in kradenan, srimulyo, piyungan,

bantul. Journal of Nursing Practice, 1(2), 53-59. https://doi.org/10.30994/jnp.v1i2.34

Seattle Children’s. (2019). Neonatal nursing education brief: Infant massage in the nicu. Seattle

Children’s Hospital Research Foundation.

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https://www.seattlechildrens.org/globalassets/documents/healthcare-professionals/

neonatal-briefs/infant-massage-in-the-nicu.pdf

Shoghi, M., Sohrabi, S., & Rasouli, M. (2018). The effects of massage by mothers on mother-

infant attachment. Alternative Therapies in Health & Medicine, 24(3), 34-39.