Research at TRI
INFANT MASSAGE
COCAINE
Wheeden, A., Scafidi,
F.A., Field, T., Ironson, G., Valdeon,
C. & Bandstra, E. (1993). Massage effects on
cocaine-exposed preterm neonates. Journal
of Developmental and Behavioral Pediatrics, 14, 318-322.
•
Cocaine exposed preterm neonates were randomly assigned to a control group or
massage therapy group. The massaged infants averaged 28% greater weight gain
per day although the groups did not differ in intake, showed significantly
fewer postnatal complications and stress behaviors than did control infants,
and demonstrated more mature motor behaviors on the Brazelton examination at the end of the 10-day study period.
DEPRESSED
Field, T., Grizzle, N., Scafidi,
F. Abrams, S., Richardson, S., Kuhn, C., & Schanberg,
S. (1996). Massage therapy for infants of depressed mothers. Infant Behavior and Development, 19, 107-112.
•
The infants who experienced massage therapy compared to infants in the rocking
control group spent more time in active alert and active awake states, cried
less, and had lower cortisol levels, suggesting lower stress. Over the 6-week
period, the massage-therapy infants gained more weight, showed greater
improvement on emotionality, sociability, and soothability temperament dimensions, and had greater decreases in stress
neurotransmitters/hormones (norepinephrine,
epinephrine, and cortisol).
FATHER
Cullen, C., Field, T., Escalona, A. & Hartshorn, K.
(2000). Father-infant interactions are enhanced by massage therapy. Early Child Development and Care, 164, 41-47.
•
Infants were given massages by their fathers for 15 minutes prior to their
daily bedtime for one month. By the end of the study, the fathers who massaged
their infants were more expressive and showed more enjoyment and more warmth
during floor-play interactions with their infants.
HABITUATION
Cigales, M.,
Field, T., Lundy, B., Cuadra, A., & Hart, S.
(1997). Massage enhances recovery from habituation in normal infants. Infant Behavior and Development, 20, 29-34.
•
Research shows that touch stimulation can positively affect physiological,
behavioral, and social development among infants. However, empirical evidence
of the effects of touch on infants’ cognitive performance is lacking. In this
study, 56, 4-month-olds were given either 8 minutes of massage, play, or no
stimulation prior to an audiovisual habituation task. Infants who received
massage showed response recovery from habituation during test trials, whereas
those in the other two conditions did not.
Field, T., Schanberg,
S., Davalos, M., & Malphurs,
J. (1996). Massage with oil has more positive effects on normal
infants. Pre and Perinatal Psychology Journal, 11, 75-80.
•
As compared with infants who received massage without oil, infants who received
massage with oil were less active, showed fewer stress behaviors and head
averting, and their saliva cortisol levels decreased more. Also, vagal activity increased following massage with oil versus
massage without oil.
PRETERM INFANTS
Scafidi,
F.A., Field, T.M., Schanberg, S.M., Bauer, C.R., Tucci, K., Roberts, J., Morrow, C., & Kuhn, C.M.
(1990). Massage stimulates growth in preterm infants: A
replication. Infant Behavior and
Development, 13, 167-188.
•
Forty preterm infants were assigned to treatment and control groups. The
treatment infants averaged a 21% greater weight gain per day
, were discharged 5 days earlier, and performed better on the
habituation cluster items of the Brazelton scale.
Treatment infants were also more active during the stimulation sessions than
during the nonstimulation observation sessions
(particularly during the tactile segments of the sessions).
Kuhn, C., Schanberg, S., Field,
T., Symanski, R., Zimmerman, E., Scafidi,
F., & Roberts, J. (1991). Tactile kinesthetic stimulation effects on
sympathetic and adrenocortical function in preterm
infants. Journal of Pediatrics, 119, 434-440.
•
Urine norepinephrine and epinephrine values increased
significantly only in the stimulated babies. Furthermore, urine dopamine and
cortisol values increased in both groups, and serum growth hormone decreased in
both groups.
Scafidi, F.,
Field, T., Schanberg, S.M. (1993). Factors that
predict which preterm infants benefit most from massage therapy. Journal of Developmental and Behavioral
Pediatrics, 14, 176-180.
•
Preterm infants were randomly assigned to a massage therapy or control group.
The massage therapy infants gained significantly more weight per day than the
control infants. Seventy percent of the massage therapy infants were classified
as high weight gainers whereas only forty percent of the control infants were
classified as high weight gainers. The control infants who, before the study,
consumed more calories and spent less time in intermediate care gained more
weight. In contrast, for the massage group, the pattern of greater caloric
intake and more days in Intermediate care before the study period along with
more obstetric complications differentiated the high from the low weight
gainers, suggesting that the infants who had experienced more complications
before the study benefited more from the massage therapy.
Field, T., Diego, M., Hernandez-Reif,
M., Deeds, O., Figueiredo, B. & Ascencio, A. (2006). Moderate Versus Light Pressure Massage
Therapy Leads to Greater Weight Gain in Preterm Infants. Infant Behavior and Development, 29, 574-578.
•
Sixty-eight preterm infants were randomly assigned to a moderate or to a light
pressure massage therapy group to receive 15 massages three times per day for 5
days. Behavior state, stress behaviors and heart rate were recorded for 15min
before and during the first 15-min therapy session. Weight gain was recorded
over the 5-day therapy period. The moderate versus light pressure massage group
gained significantly more weight per day. During the behavior observations the
moderate versus light pressure massage group showed significantly lower
increases from the pre-session to the session recording on: (1) active sleep;
(2) fussing; (3) crying; (4) movement; and (5) stress behavior (hiccupping).
They also showed a smaller decrease in deep sleep, a greater decrease in heart
rate and a greater increase in vagal tone. Thus, the
moderate pressure massage therapy group appeared to be more relaxed and less
aroused than the light pressure massage group which may have contributed to the
greater weight gain of the moderate pressure massage therapy group.
Diego, M. A., Field, T., Hernandez-Reif,
M., Deeds, O., Ascencio, A., Begert,
G. (2007). Preterm infant massage elicits consistent increases in vagal activity and gastric motility that are associated
with greater weight gain. Acta Paediatrica, 96, 1588-1591.
•
Massaged infants exhibited consistent short-term increases in vagal activity and gastric motility on both the first and
the last days of the 5-day study that were associated with weight gain during
the 5-day treatment period.
Hernandez-Reif,
M., Diego, M. & Field, T. (2007). Preterm infants show reduced stress
behaviors and activity after 5 days of massage therapy. Infant Behavior & Development, 30, 557-561.
•
The preterm infants in the massage therapy group received three 15-min massages
each day for 5 consecutive days, with the massages consisting of moderate
pressure stroking to the head, shoulders, back, arms and legs and kinesthetic
exercises consisting of flexion and extension of the limbs. The preterm infants
receiving massage therapy showed fewer stress behaviors and less activity from
the first to the last day of the study.
Field, T., Diego, M., Hernandez-Reif,
M., Dieter, J., Kumar, A., Schanberg, S. & Kuhn,
C. (2008). Insulin and Insulin-Like Growth Factor I (IGF-1) Increase
in Preterm Infants Following Massage Therapy. Journal of Developmental and Behavioral Pediatrics, 29, 463-466.
•
To determine if massage therapy increased serum insulin and insulin-like growth
factor 1 (IGF-1) in preterm neonates. Forty-two preterm neonates were randomly
assigned to massage therapy (body stroking and passive limb movements for
three, 15-minute periods per day for 5 days) or a standard treatment control
group. On days 1 and 5, the serum collected by clinical heelsticks was also assayed for insulin and insulin-like growth factor-1 (IGF-1), and
weight gain and kilocalories consumed were recorded daily. Despite similar
formula intake, the massaged preterm neonates showed greater increases during
the 5 day period in: 1) weight gain; 2) serum levels of insulin; and 3)
insulin-like growth factor-1 (IGF-1). Increased weight gain was significantly
correlated with insulin and IGF-1.
Diego, M. A., Field, T. &
Hernandez-Reif, M. (2008). Temperature increases in preterm infants during massage therapy. Infant Behavior & Development, 31, 149-152.
•
A greater increase in temperature was noted for preterm infants receiving
massage therapy versus the control group; even though the incubator portholes
remained open during the 15 min massage therapy session but not for the control
group over an equivalent time period.
Diego, M. A., Field, T. &
Hernandez-Reif, M. (2009). Procedural pain heart rate responses in massaged preterm infants. Infant Behavior & Development, 32,
226-229.
• Heart
rate (HR) responses to the removal of a monitoring lead were assessed in 56
preterm infants who received moderate pressure, light pressure or no massage
therapy. The infants who received moderate pressure massage therapy exhibited
lower increases in HR suggesting an attenuated pain response. The heart rate of
infants who received moderate pressure massage also returned to baseline faster
than the heart rate of the other two groups, suggesting a faster recovery rate
Field, T., Diego, M., Hernandez-Reif,
M., Dieter, J., Kumar, A., Schanberg, S. & Kuhn,
C. (2008). Preterm infant massage therapy research. Infant Behavior & Development, 33, 115-124.
• In this paper, preterm infant massage therapy
studies are reviewed. 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.
PRETERM NEONATES
Field, T., Schanberg,
S. M., Scafidi, F., Bauer, C. R., Vega Lahr, N.,
Garcia, R., Nystrom, J., & Kuhn, C. M. (1986). Tactile/kinesthetic stimulation effects on preterm neonates. Pediatrics, 77, 654
658.
•
The stimulated neonates averaged a 47% weight gain, were more active and alert
during sleep/ wake behavior observations, and showed more habituation,
orientation, motor and range of state behavior. Their hospital stay was also 6
days shorter, saving the hospital approximately $3,000 per infant.
Scafidi, F.,
Field, T., Schanberg, S., Bauer, C., Vega Lahr, N.,
Garcia, R., Poirier, J., Nystrom, G., & Kuhn, C.M.(1986). Effects of tactile/kinesthetic
stimulation on the clinical course and sleep/wake behavior of preterm neonates. Infant Behavior and Development, 9, 91-105.
•
Forty preterm infants were placed in a control or treatment group. The treated
infants averaged a 47% greater weight gain per day and spent time more awake
and active during sleep/wake behavior observations. On the Brazelton scale the treated infants showed more mature orientation, motor, habituation,
and range of state behaviors.
Morrow, C., Field, T., Scafidi,
F., Roberts, J., Eisen, L., Larson, S., Hogan, A.,
& Bandstra, E. (1991). Differential
effects of massage and heelstick procedures on transcutaneous oxygen tension in preterm neonates. Infant Behavior and Development, 14, 397-414.
•
During the heelstick procedure, transcutaneous oxygen tension declined an average of 14mmHg. When compared to
tactile-kinesthetic massage, transcutaneous oxygen tension during heelstick lower than during stimulation.
PRETERM NEWBORNS
Field, T., Scafidi,
F., & Schanberg, S. (1987). Massage
of preterm newborns to improve growth and development. Pediatric Nursing, 13, 385-387.
•
Stimulation enhanced weight gain and responsiveness, and may affect later
growth and development.
Field, T., Hernandez-Reif, M., & Diego, M. (2006). Newborns of depressed mothers who received moderate versus light pressure
massage during pregnancy. Infant Behavior
and Development, 29, 54-58.
•
Compared to the group of neonates whose mothers received light massage,
neonates whose mothers received moderate pressure massage spent a greater
percent of the observation time smiling and vocalizing, and they received
better scores on the orientation, motor, excitability, and depression clusters
of the Brazelton scale.
RATPUPS
Pauk,
J., Kuhn, C., Field, T., & Schanberg, S. (1986). Positive effects of tactile versus kinesthetic or vestibular
stimulation on neuroendocrine and
•
The study demonstrates that neither kinesthetic nor vestibular stimulation
effects changes associated with maternal deprivation. Results indicate that
tactile interactions between rat pups and their mothers modulate pup
physiology.
REVIEWS
Schanberg, S.,
& Field, T. (1987). Sensory deprivation stress and supplemental
stimulation in the rat pup and preterm human neonate. Child Development, 58, 1431-1447.
•
The data suggest that the effects of maternal deprivation in the rat pup are
regulated by a specific form of tactile stimulation. Only brush stroking of
maternally deprived rat pups returned growth parameters to normal. Other forms
of stimulation, including kinesthetic and vestibular stimulation, were
ineffective in restoring normal functions. Other data are presented
demonstrating that very small neonates given tactile-kinesthetic stimulation,
gained more weight per day, and show more mature habituation, orientation,
motor, and range of state behaviors on the Brazelton assessment.
Field, T. (1994). Infant Massage. The Journal of Perinatal Education, 3, 7-14.
•
Compared to preterm infants who are not massaged, massaged infants gain 47%
more weight, remain awake and active a greater percentage of the observation
time, better performance on the Brazelton scale, and
are hospitalized on average 6 days fewer than control infants. Similar effects
pertain to preterm infants prenatally exposed to cocaine and HIV. Although, these infants also show reduced stress behaviors
following the study period. Depressed mothers massaging their infants
and grandparent volunteers as massage therapists also suggest that both the
infant and person giving the massage can reap benefits, such as fewer anxiety
and stress levels. These studies also suggested that infant’s drowsiness, quiet
sleep, alertness, and tracking increased, while activity and fussiness
decreased following the massage.
Field, T. (2001). Massage therapy facilitates weight gain in
preterm infants. Current Directions in
Psychological Science, 10, 51-54.
•
Studies from several labs have documented a 31 to 47% greater weight gain in
preterm newborns receiving massage therapy (three 15-min sessions for 5–10
days) compared with standard medical treatment. Although the underlying
mechanism for this relationship between massage therapy and weight gain has not
yet been established, possibilities that have been explored in studies with
both humans and rats include (a) increased protein synthesis, (b) increased vagal activity that releases food-absorption hormones like
insulin and enhances gastric motility, and (c) decreased cortisol levels
leading to increased oxytocin.
Field, T. (2010). Massage therapy facilitates weight gain in
preterm infants. Current Directions in
Psychological Science, 10, 51-54.
• 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 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.
SLEEP
Field, T., & Hernandez-Reif, M., (2001). Sleep problems in infants decrease
following massage therapy. Early Child
Development and Care, 168, 95-104.
•
Infants and toddlers with sleep onset problems were given daily massages by
their parents for 15 minutes prior to bedtime for one month. Based on parent
diaries the massaged versus the control children (who were read bedtime
stories) showed fewer sleep delay behaviors and had a shorter latency to sleep
onset by the end of the study. Forty-five minute behavior observations by an
independent observer also revealed more time awake, alert and active and more
positive affect in the massaged children by the end of the study.
SURVEY
Field, T., Hernandez-Reif, M., Feijo, L., &
Freedman, J. (2006). Prenatal, perinatal and neonatal
supplemental stimulation: A survey of neonatal nurseries. Infant Behavior and Development, 29, 24-31.
•
A recent survey was conducted on stimulation of mothers and babies during
pregnancy and the neonatal period. The survey was responded to by 82
neonatology staff members from Neonatal Intensive Care Units (NICUs) at
hospitals in the United States. Some forms of stimulation were extremely common
including (1) skin-to-skin following birth in the delivery room (83% of
hospitals); (2) containment (swaddling and surrounded by blanket rolls) in the
NICU (86%); (3) music in the NICU (72%); (4) rocking in the NICU (85%); (5)
kangaroo care (98%); (6) non-nutritive sucking during tubefeedings in the NICU (96%); and (7) breastfeeding in the NICU (100%). Other forms of
stimulation occurred less frequently including (1) pregnancy massage (19%); (2)
labor massage (30%); (3) the Doula (assistant who comforts during labor and
delivery) (30%); (4) waterbeds in the NICU (23%); and (5) preterm infant
massage in the NICU (38%).