Pediatric Massage Therapy Research: A Narrative Review.

This narrative review on pediatric massage literature from the last decade suggests that massage therapy has positive effects on several pediatric conditions. These include preterm infant growth, psychological problems including aggression, gastrointestinal problems including constipation and diarrhea, painful conditions including burns and sickle cell, muscle tone disorders including cerebral palsy and Down syndrome, and chronic illnesses including diabetes, asthma cancer, and HIV. Potential underlying mechanisms for the massage therapy effects include increased vagal activity and decreased stress hormones. Limitations of the literature include the need for more randomized controlled trials, longitudinal studies, and underlying mechanism studies.

Depressed and non-depressed mothers' touching during social interactions with their infants.

Touch is a critical channel of communication used by mothers to communicate and interact with their infants and to contribute to their infants' socio-emotional development. The present study examined maternal touching in 41 mothers with and without depressive symptomatology. Mothers and their 4-month-old infants participated in the Still-Face (maternal emotional unavailability) and Separation (maternal physical unavailability) procedures. Maternal touching behaviours were video-recorded and coded using the Caregiver Infant Touch Scale (CITS). Results indicated that mothers with higher levels of depressive symptoms engaged in less touching following the perturbation period in the Still-Face procedure, whereas mothers with lower levels of depressive symptoms maintained stable levels of touching across both interaction periods. Mothers with higher levels of depressive symptoms displayed less playful/stimulating types of touching. Taken together, these results underscore the importance of touch and suggest key differences in touching behaviour between dyads with maternal depressive symptomatology and those without.

Couples' relationship affects mothers' and fathers' anxiety and depression trajectories over the transition to parenthood.

BACKGROUND: The association between the couple relationship and the mothers' and fathers' psychological adjustment to the transition to parenthood has been examined in the literature. However, the direction of effects between these variables has not been extensively explored. This study aimed to assess the direction of effects between mothers' and fathers' positive and negative interactions and anxiety and depression symptoms trajectories over the transition to parenthood. METHODS: A sample of 129 couples (N = 258) completed self-report measures of positive and negative interactions, anxiety and depression symptoms at each trimester of pregnancy, at childbirth, and at 3- and 30-months postpartum. Dyadic growth curve models were performed using multilevel modeling. RESULTS: Whereas anxiety and depression showed no moderation effect on positive and negative interactions over time, negative interaction moderated depression from 3- to 30-months postpartum. Mothers and fathers with high negative interaction scores experienced a steeper increase in depression from 3- to 30-months postpartum. Additionally, gender moderated the effect of positive interaction on anxiety from 3- to 30-months postpartum. Fathers with low positive interaction scores experienced an increase in anxiety, whereas fathers with high positive interaction scores and mothers with high or low positive interaction scores did not experience changes in anxiety from 3- to 30-months postpartum. LIMITATIONS: Despite the longitudinal aspect of the models, a possible causal relationship need to be taken with caution. CONCLUSIONS: Our results suggest that mothers' and fathers' positive and negative interactions affect their anxiety and depression symptoms trajectories: negative interaction raises mothers' and fathers' depression symptoms and positive interaction prevents the increase of fathers' anxiety symptoms over the postpartum period.

Postnatal anxiety prevalence, predictors and effects on development: A narrative review.

The increasing prevalence of postnatal anxiety highlights the need for summarizing the recent research on this condition to inform screening and intervention efforts. This narrative review of the literature was derived from a search on PubMed and PsycINFO for papers published since 2010. The demographic risk factors for postnatal anxiety include being a young mother, having more education and being employed. Childbirth risk factors include being primiparous in one sample and multiparous in another, caesarean delivery, fear of the birth and of death during delivery, lack of control during labor, low self-confidence for the delivery and the delivery staff, and premature delivery. Social support problems include the lack of family support, marital/family conflict, and social health issues. Psychiatric history risk factors include prenatal depression and anxiety. Postnatal anxiety has negative effects on breast-feeding, bonding, mother-infant interactions, infant temperament, sleep, mental development, health and internalizing behavior and on conduct disorder in adolescents. Unfortunately, only six postnatal anxiety intervention studies could be found including paternal education, music therapy during labor, mothers massaging their infants, cognitive behavior therapy and administering oxytocin. The negative effects of postnatal anxiety and the limitations of the research in this review highlight the need for further research.

Reference values and changes in infant sleep-wake behaviour during the first 12 months of life: a systematic review.

This paper is a systematic review on the reference values and changes in infant sleep-wake behaviour during the first 12 months of life. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Seventy-four papers were included, and the reference values and changes in sleep-wake behaviour during the first 12 months of life were identified. Sleep duration during the 24-h period, and day and sleep periods during the night decreased over the first 12 months of life. Night wakings and bedtime/sleep-onset time decreased, while the longest sleep period increased at night during the first 6 months. High discrepancy was noted between studies in the reference values of sleep-wake behaviour, while more congruence was noted regarding changes, especially those occurring in the first 6 months of life. Several methodological differences were identified between studies and may partially explain inconsistencies in the results, including the assessment of different sleep-wake behaviours, the focus on specific ages or age ranges, the use of self-report, observational or direct measures, the recruitment of small or large representative samples, and the countries where the research was conducted. These aspects should be considered in future research and caution should be taken when generalizing results from studies with diverse methodological characteristics. Nonetheless, this review identifies normative reference values and the changes occurring in infant sleep-wake behaviour, and could inform both practitioners and researchers, helping them identify infants with sleep delays or problems.

Preterm newborn pain research review.

This narrative review is based on a literature search of PubMed and PsycINFO for research on preterm newborn pain published during the last ten years. The high prevalence of painful procedures being performed with preterm newborns without analgesia (79%), with a median of 75 painful procedures being received during hospitalization and as many as 51 painful procedures per day highlights the importance of this problem. This review covers the pain assessments that have been developed, the short-term effects of the painful procedures, the longer-term developmental outcomes and the pharmacological and alternative therapies that have been researched. The most immediate effects reported for repeated painful procedures include increased heart rate, oxidative stress and cortisol as well as decreased vagal activity. Lower body weight and head circumference have been noted at 32 weeks gestation. Blunted cortisol reactivity to stressors has been reported for three-month-olds and thinner gray matter in 21 of 66 cerebral regions and motor and cognitive developmental delays have been noted as early as eight months. Longer-term outcomes have been reported at school age including less cortical thickness, lower vagal activity, delayed visual- perceptual development, lower IQs and internalizing behavior. Pharmacological interventions and their side effects and non-pharmacological therapies are also reviewed including sucrose, milk and nonnutritive sucking which have been effective but thought to negatively affect breast-feeding. Full-body interventions have included tucking, swaddling, kangaroo care and massage therapy. Although these have been effective for alleviating immediate pain during invasive procedures, research is lacking on the routine use of these therapies for reducing long-term pain effects. Further, additional randomized controlled replication studies are needed.

Systematic Review of Skin-to-Skin Care for Full-Term, Healthy Newborns.

OBJECTIVE: To determine the effect of skin-to-skin mother-infant holding, touch, and/or massage on full-term, healthy newborns and their primary caregivers. DATA SOURCES: A seven-member scientific advisory panel searched the databases PubMed, CINAHL, and Scopus using the search terms massage, skin-to-skin contact, kangaroo care, touch, therapeutic touch, and full-term newborns for research with human participants published in English with no date parameters. STUDY SELECTION: The initial search yielded 416 articles. After reviewing titles and retaining only articles that met the review criteria, 280 articles remained. The panel co-chairs reviewed and discussed the abstracts of these articles and retained 90 for review. DATA EXTRACTION: Each article was assigned to one panel member and one co-chair for review. Members of the panel met via teleconference to present articles and to determine whether they had scientific merit and addressed the research question. Articles that did not meet these standards were eliminated. Forty articles included relevant evidence: 33 articles on skin-to-skin holding and 7 on infant massage. DATA SYNTHESIS: We created a table that included the purpose, design, and findings of each study. This information was synthesized into a feasibility report by the co-chairs. CONCLUSION: Evidence supports recommendations for skin-to-skin care for all full-term, healthy newborns. Although there is inadequate evidence to recommend massage as standard care for all newborns, massage has been shown to help consolidate sleep patterns and reduce jaundice.

Prenatal anxiety effects: A review.

This review is based on literature on prenatal anxiety effects that was found on Pubmed and PsycINFO for the years 2010-2016. Prenatal anxiety is thought to have distinct features, although it has been measured both by specific prenatal anxiety symptoms as well as by standardized anxiety scales. Its prevalence has ranged from 21 to 25% and it has been predicted by a number of pregnancy - related variables such as unintended pregnancy, demographic variables such as low acculturation and income and psychosocial factors including pessimism and partner tension. Prenatal anxiety effects on pregnancy include increased cortisol levels, pro-inflammatory cytokines, obstetric problems and cesarean section. Effects on the neonate include lower gestational age, prematurity, less insulin-like growth factor in cord blood, less exclusive breast-feeding and less self-regulation during the heelstick procedure. Prenatal anxiety effects continue into infancy and childhood both on physiological development and emotional/mental development. Among the physiological effects are lower vagal activity across the first two years, and lower immunity, more illnesses and reduced gray matter in childhood. Prenatal anxiety effects on emotional/mental development include greater negative emotionality and in infants, lower mental development scores and internalizing problems. Anxiety disorders occur during childhood and elevated cortisol and internalizing behaviors occur during adolescence. Interventions for prenatal anxiety are virtually nonexistent, although stroking (massaging) the infant has moderated the pregnancy - specific anxiety effects on internalizing behaviors in the offspring. The limitations of this literature include the homogeneity of samples, the frequent use of anxiety measures that are not specific to pregnancy, and the reliance on self-report. Nonetheless, the literature highlights the negative, long-term effects of prenatal anxiety and the need for screening and early interventions.

Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review.

This narrative review based on a literature search in PubMed and PsycInfo on the two terms prenatal and antenatal depression includes empirical studies, reviews and meta-analyses that have been published during the last 5 years on risk factors, developmental effects and interventions for prenatal depression. Risk factor studies that met criteria feature demographic measures (lower socioeconomic status, less education, non-marital status, non-employment, less social support and health locus of control, unintended pregnancy, partner violence and history of child abuse) and physiological variables (cortisol, amylase, and pro-inflammatory cytokines and intrauterine artery resistance). The negative effects include postpartum depression, paternal depression, and prematurity and low birth weight. Negative effects on infants include greater right frontal EEG, amygdala connectivity, cortical thinning and more difficult temperament. In childhood, externalizing and internalizing problems have been reported. The data on prenatal antidepressants (specifically SSRIs) reveal negative effects including internalizing problems as well as a greater risk for autism spectrum disorder. Prenatal interventions that have been effective include interpersonal psychotherapy, peer support, massage therapy, yoga, tai chi, and aerobic exercise. Potential underlying mechanisms are discussed as well as methodological limitations including homogeneity of samples and lack of randomization to intervention groups. Despite these limitations, the literature highlights the need for prenatal depression screening and intervention.

Exclusive breastfeeding at three months and infant sleep-wake behaviors at two weeks, three and six months.

This study assessed infant sleep-wake behavior at two weeks, three and six months as function of feeding method at three months (exclusively breastfed, partially breastfed, and exclusively formula fed infants). Mothers of 163 first-born, full-term, normal birth weight, healthy infants completed socio-demographic, depression, anxiety, and infant sleep-wake behavior measures. No effects were found for sleep arrangements, depression or anxiety, on feeding methods and sleep-wake behavior at three months. At two weeks exclusively breastfed infants at three months spent more hours sleeping and less hours awake during the 24-h period than partially breastfed infants. At three months, exclusively breastfed infants had a shorter of the longest sleep period at night than exclusively formula fed infants. At six months, exclusively breastfed infants at three months spent more hours awake at night than partially breastfed infants, awake more at night than exclusively formula fed infants, and had a shorter sleep period at night than partially breastfed and exclusively formula fed infants. This study showed differences in sleep-wake behaviors at two weeks, three and six months, when exclusively breastfed infants are compared with partially breastfed and exclusively formula fed infants at three months, while no effects were found for sleep arrangements, depression or anxiety.

Infant sleep problems and interventions: A review.

Infant sleep problems have been the focus of a growing literature over the last few years. The current review is based on literature searches of Pubmed and PsycInfo for studies published over the last few years including randomized controlled trials, systematic reviews and meta-analyses on infant sleep problems and resulting developmental effected, risk factors and interventions. Several risk/protective factors for sleep problems have been identified including health literacy, TV in the room, feeding, close contact and arousing activities at bedtime, intolerance for infant crying, co-sleeping, maternal depression and infant temperament. Cross-cultural differences have been noted both for infant sleep problems and parents' perceived distress by those problems. A number of interventions have been tried to ameliorate infant sleep problems including consultations, teaching sessions on extinction and bedtime fading, internet-based interventions and nighttime massages by parents. Some of these studies have shown improvements and others have suggested only short-term or negligible effects. Significant methodological problems exist with this literature including the almost sole use of parent report as well as the mixed age samples and the potential confounding variables.

Fetal heart rate variability mediates prenatal depression effects on neonatal neurobehavioral maturity.

This study analyzed the mediating role of fetal heart rate variability (FHR) on prenatal depression and neonatal neurobehavioral maturity. A sample of 104 pregnant women was recruited and divided into two groups according to their Edinburgh Postnatal Depression Scale (EPDS) scores (depressed/non-depressed). FHR variability in response to speech stimuli was assessed at term (between 37 and 39 weeks gestation). The neonates were then assessed on the Neonatal Behavioral Assessment Scale (NBAS) during the first 5days after birth. The fetuses of non-depressed pregnant women showed higher HR variability than the fetuses of depressed pregnant women in response to speech stimuli, and later as neonates they performed more optimally on the NBAS (on autonomic stability and total scores). FHR variability mediated the relationship between the mother's prenatal depression and the neonatés NBAS performance. Prenatal depression effects on neonatal behavior may be partially explained by its adverse effects on fetal neurobehavioral maturity.

Mothers massaging their newborns with lotion versus no lotion enhances mothers' and newborns' sleep.

Sleep is frequently interrupted in newborns and their mothers. Massage therapy is noted to facilitate sleep in adults and infants. Infant massage has also been more effective with oil versus no oil. In this study 76 mothers of newborns were randomly assigned to a massage with lotion versus a massage without lotion group and a non-massage control group. The mothers were then taught a simple newborn massage and were asked to massage their newborns daily for 15min at bedtime for one month. The Brief Infant Sleep Questionnaire was adapted for newborns and for mothers, and the mothers completed the questionnaires on their newborns' and their own sleep behaviors (the same behaviors for both mothers and newborns). The 3 groups were compared on the mothers' and their newborns' sleep behavior changes from birth to one month. By the last day of the study, the lotion massage group versus the other two groups showed a shorter latency to sleep and longer sleep for the mothers and fewer nightwakings and longer sleep for their infants. This may relate to the lotion group mothers massaging their infants more frequently as the number of massages was correlated with the total time sleeping and negatively correlated with nightwakings for both the mothers and the infants on the last day of the study. And, the mothers' and the infants' sleep behaviors were significantly correlated.

Massage therapy research review.

In this review, massage therapy has been shown to have beneficial effects on varying conditions including prenatal depression, preterm infants, full-term infants, autism, skin conditions, pain syndromes including arthritis and fibromyalgia, hypertension, autoimmune conditions including asthma and multiple sclerosis, immune conditions including HIV and breast cancer and aging problems including Parkinson's and dementia. Although many of the studies have involved comparisons between massage therapy and standard treatment control groups, several have compared different forms of massage (e.g. Swedish versus Thai massage), and different active therapies such as massage versus exercise. Typically, the massage therapy groups have experienced more positive effects than the control or comparison groups. This may relate to the massage therapy providing more stimulation of pressure receptors, in turn enhancing vagal activity and reducing cortisol levels. Some of the researchers have assessed physical, physiological and biochemical effects, although most have relied exclusively on self-report measures. Despite these methodological problems and the dearth of research from the U.S., the massage therapy profession has grown significantly and massage therapy is increasingly practiced in traditional medical settings, highlighting the need for more rigorous research.

Yoga research review.

This paper is a review of empirical studies, review and meta-analysis publications on yoga from the last few years. The review includes demographics/prevalence of yoga as a practice, bibliometric analyses of the yoga publications and the use of yoga for physical fitness and cognitive function. Most of the studies reviewed here involve yoga effects on psychiatric and medical conditions. These include pregnancy, prenatal and postpartum depression; stress, PTSD, anxiety, and obesity; cardiovascular conditions including hypertension; pain syndromes including arthritis, headaches and low back pain; autoimmune conditions including asthma, type II diabetes and multiple sclerosis; immune conditions including HIV and breast cancer; and aging problems including balance, osteoporosis and Parkinson's. The methods and results of those studies are briefly summarized along with their limitations and suggestions for future research. Basically yoga has been more effective than control and waitlist control conditions, although not always more effective than treatment comparison groups such as other forms of exercise. More randomized controlled studies are needed in which yoga is compared to active exercise groups. Having established the physical and mental health benefits of yoga makes it ethically questionable to assign participants to inactive control groups. Shorter sessions should be investigated for cost-effectiveness and for daily practice. Multiple physical and physiological measures need to be added to the self-report research protocols and potential underlying mechanisms need to be further explored. In the interim, the studies reviewed here highlight the therapeutic effects of yoga, a practice that could come to be called yoga therapy.

Infant sleep-wake behaviors at two weeks, three and six months.

Although infant sleep-wake behavior presents several developmental changes during the first six months, literature lacks on reference values and few studies have explored the role of individual change and stability on infant sleep-wake behavior during the first six months. This study aimed (1) to describe infant sleep-wake behaviors during the 24-h period, day and night, at two weeks, three, and six months, (2) and to explore developmental changes and the role of individual change and stability on infant sleep-wake behaviors from two weeks to six months. Ninety-four primiparous mothers completed measures on infant sleep-wake behaviors at two weeks, three and six months. Significant developmental changes were found on infant sleep-wake behaviors from two weeks to six months. Two-week-old infants sleep 13.3h, spend 8.7h awake, awake 6.1 times, have 0.4h of latency to sleep, and 3.2h of longest sleep period. Three-month-old infants sleep 13.0h, spend 9.2h awake, awake 5.5 times, have 0.4h of latency to sleep, and 5.2h of longest sleep period. Six-month-old infants sleep 12.2h, spend 10.0h awake, awake 5.2 times, have 0.4h of latency to sleep, and 5.6h of longest sleep period. Significant individual change and stability were also found on infant sleep-wake behaviors from two weeks to six months. Despite significant developmental and individual changes, individual stability explains a significant amount of the variance on infant sleep-wake behaviors over the first six months of life.

Knee osteoarthritis pain in the elderly can be reduced by massage therapy, yoga and tai chi: A review.

BACKGROUND AND METHODS: This is a review of recently published research, both empirical studies and meta-analyses, on the effects of complementary therapies including massage therapy, yoga and tai chi on pain associated with knee osteoarthritis in the elderly. RESULTS: The massage therapy protocols have been effective in not only reducing pain but also in increasing range of motion, specifically when moderate pressure massage was used and when both the quadriceps and hamstrings were massaged. The yoga studies typically measured pain by the WOMAC. Most of those studies showed a clinically significant reduction in pain, especially the research that focused on poses (e.g. the Iyengar studies) as opposed to those that had integrated protocols (poses, breathing and meditation exercises). The tai chi studies also assessed pain by self-report on the WOMAC and showed significant reductions in pain. The tai chi studies were difficult to compare because of their highly variable protocols in terms of the frequency and duration of treatment. DISCUSSION: Larger, randomized control trials are needed on each of these therapies using more standardized protocols and more objective variables in addition to the self-reported WOMAC pain scale, for example, range-of-motion and observed range-of-motion pain. In addition, treatment comparison studies should be conducted so, for example, if the lower-cost yoga and tai chi were as effective as massage therapy, they might be used in combination with or as supplemental to massage therapy. Nonetheless, these therapies are at least reducing pain in knee osteoarthritis and they do not seem to have side effects.

Knee arthritis pain is reduced and range of motion is increased following moderate pressure massage therapy.

BACKGROUND: The literature on massage therapy effects on knee pain suggests that pain was reduced based on self-report, but little is known about range of motion (ROM) effects. METHODS: Medical School staff and faculty who had knee arthritis pain were randomly assigned to a moderate pressure massage therapy or a waitlist control group (24 per group). Self-reports included the WOMAC (pain, stiffness and function) and the Pittsburgh Sleep Quality Index. ROM and ROM-related pain were assessed before and after the last sessions. RESULTS: The massage group showed an immediate post-massage increase in ROM and a decrease in ROM-associated pain. On the last versus the first day of the study, the massage group showed greater increases in ROM and decreases in ROM-related pain as well as less self-reported pain and sleep disturbances than the waitlist control group. DISCUSSION: These data highlight the effectiveness of moderate pressure massage therapy for increasing ROM and lessening ROM-related pain and long-term pain and sleep disturbances.

Neck arthritis pain is reduced and range of motion is increased by massage therapy.

BACKGROUND: The literature on the effects of massage therapy on neck arthritis pain is mixed depending on the dose level, and it is also based on self-report. In the present study an attempt was made to enhance the effects of weekly massage therapy by having the participants massage themselves daily. And in addition to self-reports on pain, range of motion (ROM) and the associated ROM pain were assessed before and after the first massage session and pre-post the last session one month later. METHODS: Staff and faculty members at a medical school who were eligible for the study if they had neck arthritis pain were randomly assigned to a massage or a waitlist control group (N = 24 per group). The massage group received moderate pressure massages weekly by a massage therapist plus daily self-massages. The waitlist control group received the same schedule massages one month after being control subjects. RESULTS: The massage group showed significant short-term reductions after the first and last day massages in self-reported pain and in ROM-associated pain as well as an increase in ROM. Comparisons between the massage group (N = 23) and the control group (N = 14) on the last versus the first day data suggested significantly different changes including increased ROM and reduced ROM-associated pain for the massage group and reduced ROM and increased ROM-associated pain for the control group. These changes occurred specifically for flexion and right and left lateral flexion motions. DISCUSSION: These data highlight the importance of designing massage therapy protocols that target the most affected neck muscle groups and then assessing range of motion and related pain before and after the massage therapy. Comparisons with other studies also suggest that moderate pressure may contribute to the massage effects, and the use of daily self-massages between sessions may sustain the effects and serve as a cost-effective therapy for individuals with neck arthritis pain.

Massage therapy research review.

Moderate pressure massage has contributed to many positive effects including increased weight gain in preterm infants, reduced pain in different syndromes including fibromyalgia and rheumatoid arthritis, enhanced attentiveness, reduced depression and enhanced immune function (increased natural killer cells and natural killer cell activity).Surprisingly, these recent studies have not been reviewed, highlighting the need for the current review. When moderate and light pressure massage have been compared in laboratory studies, moderate pressure massage reduced depression, anxiety and heart rate, and it altered EEG patterns, as in a relaxation response. Moderate pressure massage has also led to increased vagal activity and decreased cortisol levels. Functional magnetic resonance imaging data have suggested that moderate pressure massage was represented in several brain regions including the amygdala, the hypothalamus and the anterior cingulate cortex, all areas involved in stress and emotion regulation. Further research is needed to identify underlying neurophysiological and biochemical mechanisms associated with moderate pressure massage.