Registered nurses' perceptions of nursing

baby massage baby massage ❖ DR ALAN HEATH & NICKI BAINBRIDGE PHOTOGRAPHY BY JULIE FISHER A Dorling Kindersley book LONDON, NEW YORK, MUNICH, MELBOURNE, DELHI Revised edition Senior editor Salima Hirani Senior art editor Hannah Moore DTP designers Pankaj Sharma, Balwant Singh, Karen Constanti Production controller Sarah Sherlock Jacket designer Katy Wall Managing editor Anna Davidson Managing art editors Aparna Sharma, Glenda Fisher Art director Carole Ash Category publisher Corinne Roberts Original edition Project editor Salima Hirani Art editor Vicki Groombridge Photographic art director Toni Kay Production controller Joanna Bull Managing editor Susannah Marriott Deputy art director Carole Ash This book is dedicated to all the children and parents who have attended our Healthy Start Clinics. First published in Great Britain in 2000 by Dorling Kindersley Limited 80 Strand, London WC2R 0RL Revised edition published by Dorling Kindersley Limited 2004 Copyright © Dorling Kindersley Limited 2000, 2004 Text copyright © Alan Heath, Nicki Bainbridge 2000, 2004 Main baby massage photography copyright © Julie Fisher 2000 4 6 8 10 9 7 5 3 1 All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the copyright owner. A CIP catalogue record for this book is available from the British Library ISBN 1 4053 0434 0 Reproduced in Singapore by Colourscan Printed by Printer Portuguesa, Portugal For our complete catalogue, visit www.dk.com IMPORTANT NOTICE Before commencing a massage on a baby or young child, refer to the cautions on page 14. If you have any doubt as to whether or not to massage any part of the child’s body, seek advice from your doctor or a paediatrician. Neither the authors nor the publisher can be held responsible for any damage or injury resulting from the use of baby massage. CONTENTS ❖ INTRODUCTION 7 KEY TECHNIQUES WHY MASSAGE? 12 ❖ PREPARING TO MASSAGE 14 ❖ GETTING STARTED 16 FRONT OF THE BABY Arms and Hands 18 ❖ The Chest 20 ❖ The Abdomen 21 Legs and Feet 22 ❖ Finishing Strokes on the Front 25 BACK OF THE BABY The Back 26 ❖ The Bottom 30 ❖ The Legs 31 Finishing Strokes on the Back 31 HEAD & FACE The Head 32 ❖ The Face 33 STRETCHES Arm Stretches 36 ❖ Leg Stretches 37 Arm and Leg Stretch Sequence 38 ❖ Finishing Strokes 39 EVERYDAY CARE AFTER A BATH 42 ❖ NAPPY CHANGING 44 ❖ SOOTHING TO SLEEP 46 ❖ TODDLER PLAYTIME 48 INDIAN MASSAGE 52 ❖ AFRICAN MASSAGE 54 ❖ CHILDREN WITH SPECIAL NEEDS 56 MASSAGE FOR DIFFERENT AGE GROUPS PREMATURE BABIES 62 ❖ NEWBORN BABIES 68 ❖ OLDER BABIES 72 ❖ TODDLERS 74 EASING COMMON PROBLEMS COLIC & WIND 78 ❖ CONSTIPATION 82 ❖ FRACTIOUS CRYING 84 ❖ TEETHING 86 ❖ DRY SKIN 87 QUESTIONS & ANSWERS 90 INDEX 94 RESOURCES & USEFUL ADDRESSES 95 REFERENCES & ACKNOWLEDGMENTS 96 ❖ 6 INTRODUCTION ❖ T he therapeutic effects of massage on adults have been known for a long time, but only recently in the West have people realized that children also benefit from massage. In parts of Africa, Asia and South and Central America, women have massaged their babies for centuries.The practice is well recognized in the West and in Britain today; it is even offered in health clinics under the National Health Service. Baby massage is an integral part of the help we offer our clients at our Healthy Start Clinics.These crying, sleep, feeding and behaviour clinics were set up to advise and support parents who have difficulties with early parenting challenges. Inexperienced parents attending were too nervous to touch their babies.This led to problems, as infants need plenty of positive touch to feel secure. Others had difficulty understanding their infants. If a baby cries and his parent does not know how to ‘make it better’ (by removing the cause of distress or providing affection), the baby tends to cry more.This frustrates the parent, and a pattern is set for a downward spiral. Some parents cannot cope with an incessantly crying baby, and need effective ways of coping. Others suffered from postnatal depression, a common condition that has a profoundly damaging effect on the bonding process between mother and infant. Often, the relationship is damaged even after the condition is alleviated. Baby massage seemed to be a practical solution to these problems.Through massaging their babies, parents gain confidence in handling them.They learn to watch and interpret their baby’s reaction to touch, which sheds light on the infant’s natural rhythms, and on what he likes and dislikes, making it easier for the parents to understand him, and sometimes, to tolerate their own inability to soothe him. When parents enjoy watching and recognizing their child’s reactions, and respond to them, the baby reacts back. A positive relationship develops between them. Parents who consulted us became visibly more affectionate towards their babies, and their children seemed happier and more self-assured. Parents reported that their babies were calmer, cried less and slept better since they began to massage them. Parents of babies who cried a lot, usually colicky babies, claimed that even when massage did not calm their child, they felt better for trying to do something positive, which made it easier to cope. In the case of postnatally depressed mothers, there is emerging research evidence that baby massage has a beneficial role in developing the relationship between them and their babies. These encouraging results, and the belief that all families can benefit from massage, spurred us on to write this book. Massage can strengthen your baby’s muscles and joints and help relieve the symptoms of some ailments that are common in the early years of life. But most importantly, it allows you to express your love for your child through touch, and helps you establish a relationship with him early on in his life. This book is divided into four chapters.The first chapter, Key Techniques, demonstrates step-by-step all the strokes you need to give your baby a full-body massage, and advises on how to introduce massage into your baby’s routine. Everyday Care suggests ways to incorporate additional positive touch into your daily routine, and shows how baby massage is approached in various cultures.There is also a section on how massage benefits children with special needs. Massage for Different Age Groups outlines the information you need to adapt your massage techniques to suit your child’s developing physical and emotional needs as he grows from infancy into toddlerhood.There are also special strokes for premature babies. Finally, Easing Common Problems shows techniques to help alleviate the symptoms of colic, wind, constipation, teething and dry skin, and strategies to deal with fractious crying. The importance of touch in a child’s emotional, social and physical development is well-documented, and where relevant or illuminating, such information is highlighted in boxes throughout the book to give parents an insight into child psychology.We also reveal the results of research studies, allowing parents the opportunity to draw their own conclusions about what is right for their child. The loving touch you share with your child through massage will enhance your relationship with him. But more than that, it will give him the security he needs to grow into a happy, confident and emotionally secure adult. Nicki Bainbridge RGN RHV B.Sc (Hons) ITEC Nurse and Specialist Health Visitor Dr Alan Heath BA (Hons) M.Sc Ph.D A.F.B.Ps.S Consultant Child Psychologist KEY TECHNIQUES ❖ MASSAGING YOUR BABY IS A WONDERFUL THING TO DO. IT IS SO SIMPLE IN TERMS OF TECHNIQUE, YET SO POWERFUL IN WHAT IT CONVEYS – YOUR LOVE, YOUR UNDERSTANDING AND YOUR ATTENTION. THIS SECTION INTRODUCES THE BASIC TECHNIQUES AND MAPS OUT A HEAD-TOTOE MASSAGE PROGRAMME FOR YOUR BABY. APART FROM A FEW ESSENTIALS, THERE IS NO ‘RIGHT’ OR ‘WRONG’ WAY TO MASSAGE YOUR BABY. INFANT MASSAGE IS ABOUT BEING TOGETHER AND BEING IN TOUCH WITH EACH OTHER PHYSICALLY AND EMOTIONALLY. ❖ KEY TECHNIQUES WHY MASSAGE? ❖ B ABY MASSAGE IS SIMPLE TO LEARN It requires little extra ‘equipment’ and costs virtually nothing, except time.The BENEFITS FOR Positive physical contact between a parent and child makes the baby feel loved and valued.This feeling allows her self-esteem and selfconfidence to develop. ❖ GENERAL WELL-BEING Research shows that babies who are touched lovingly become ill and cry less often than those who are not. Massage can improve circulation and also boost the immune system, as it helps to move lymph fluid around the body, which clears harmful substances from the body. Massage may relieve BENEFITS FOR long- and short-term benefits to infants are great, and massaging their children has a positive impact on parents, too. BABIES ❖ SECURITY 12 and to do. pain and the symptoms of some ailments. It promotes relaxation and can help soothe a crying infant. ❖ PHYSICAL GROWTH Massage promotes physical selfawareness, tones muscles and makes joints more flexible. In this way it is especially beneficial for premature babies (see pages 62–65), those with low birth-weight and children with special needs (see pages 56–59). ❖ SOCIAL SKILLS Touching your baby teaches her about communication. Massage helps you establish a non-verbal PARENTS ❖ RELAXATION When you massage your baby, you focus on her completely and interact with her. Parents report that they find this interaction enjoyable and relaxing. ❖ DEVELOPING SENSITIVITY Because your baby cannot tell you if she likes a stroke or finds the pressure you apply uncomfortable, you must watch her reaction and interpret it. In this way, you learn to ‘read’ or understand her, which improves your parenting skills. ❖ CONFIDENCE BUILDING Parents who are sensitive to their children tend to feel confident in their roles. Also, the physical contact of massage makes them comfortable with handling babies. ❖ PARENT-CHILD RELATIONSHIP The non-verbal communication you share with your baby through massage sparks an interactive relationship with her that you can continue into the future. Massage can also become a regular time of intimacy between you. communication with your child that enhances your early relationship with her, and therefore builds her self-esteem and sociability. RESEARCH EVIDENCE A research study was carried out in Australia in 1992 with fathers and their babies to assess the impact of baby massage on the father-child relationship. A group of first-time fathers were shown how to massage their four-weekold babies, and asked to continue for the duration of the study. A control group of fathers who did not massage their babies was also monitored. It was found that at 12 weeks old, babies who were massaged greeted their fathers with more eye contact, smiling, vocalizing and touch than those in the control group.They showed more orientating responses to their fathers, and less avoidance behaviour.The fathers showed greater day-to-day involvement with their infants. Baby massage allows fathers and babies to enjoy the skin-to-skin contact that mothers often experience through breastfeeding, but fathers often miss out on. By massaging their babies, fathers come to understand their child’s rhythms and responses, and become more confident about handling them. KEY TECHNIQUES PREPARING TO MASSAGE ❖ T HE BEST TIME to massage your baby is avoid scratching his delicate skin. Gather when he is awake and feeling happy.You everything you need around you, so that when should be feeling calm and relaxed yourself, as you begin you can concentrate on the strokes, your baby will pick up and be affected by your and on what your baby needs and likes, mood. Make sure you remove any jewellery making the whole experience as soothing and trim your nails to a suitable length to and pleasurable as possible for both of you. USING OIL WHY USE OIL? Skin-to-skin contact promotes optimum growth and development, so undressing your baby and massaging him naked is a way of encouraging this. Oil helps your hands move 14 over your baby’s body smoothly, allowing you to make long, firm, continuous strokes without causing friction. Oil moisturizes skin, which can prevent or alleviate dryness. WHICH OIL? Use a natural oil, such as sunflower oil or grape-seed oil – these light, low-odour oils are easily absorbed by the skin and help to nurture it. Choose an organic variety if available. Natural oils are less likely than synthetic oils to irritate the skin. In countries where baby massage is a tradition, the oil used depends on availability. People from African and Asian cultures living in the West tend to use readily available oils that are similar to those used traditionally in their homelands, such as olive oil. CAUTIONS ❖ Oiling your baby while massaging him may make him slippery, so beware of dropping him when you lift him up after you finish the massage. Pick him up in a towel until the oil has been absorbed by the skin. ❖ If you suspect that your child may be allergic to nuts or seeds, make sure you use an oil that you know to be free of nut or seed products. ❖ Do not use essential oils (aromatherapy oils) on babies unless directed by a trained aromatherapist. ❖ Do not massage your baby if he has a temperature.This is particularly important if you are unsure of the cause. ❖ If your child has any form of cancer that is being treated actively, do not massage him, as you may spread the disease around the body. However, if your child is receiving palliative care, massage will be beneficial. Check with your doctor if you are unsure. A patch test allows you to make sure your baby is not allergic to, or her skin irritated by, the oil you choose.Typical adverse reactions are a rash or a red, inflamed area. 1 Place a little oil on the inside of your baby’s wrist or ankle. 2 Leave for 20–30 minutes to allow time for a severe reaction to show.To eliminate sensitivity altogether, wait for 12–24 hours. 3 If there is no irritation after this time, proceed with the massage. If irritation does occur, DO NOT use the oil. Lay your baby on a soft towel for the massage, so you avoid staining your clothes or carpet with oil, and can pick him up in the towel after the massage WHAT YOU NEED FOR MASSAGE ❖ A WARM ROOM ❖ TIME Babies lose heat quickly when uncovered and oil tends to reduce body heat, so the room must be warm enough to keep your baby comfortable. 80ºF (26ºC) is the ideal room temperature. If you feel warm enough in short sleeves, the room is likely to be fine for massage. ❖ THE QUIET-ALERT STATE Massage your baby when he is in the ‘quiet-alert state’.This is when he is awake, alert and bright, or when he is taking an intense interest in things around him, but remains quiet and still. He will be most receptive at this time. Allow 20–30 minutes to perform a full-body massage to begin with. Rushing or trying to fit it in between other activities can be counterproductive as it may unsettle your baby. Once you are both familiar with the massage, you may need less time. ❖ A QUIET, CALM ATMOSPHERE Both of you will enjoy the massage more if you are not distracted by noise from the television or radio, for example.You will ‘tune in’ to each other more effectively, so you can be responsive to your child and notice what he likes and dislikes. Make sure you have a cushion to sit on to help keep your back straight P R E PA R I N G TO M A S S AG E PATCH TEST KEY TECHNIQUES GETTING STARTED ❖ I has never been massaged, it routine, or try to massage her at least three may take her time to get used to it.Try it times a week.You can follow the routine in F YOUR BABY for three to four consecutive days initially, so this chapter, but it is important to be guided you both become accustomed to the strokes. by your baby’s likes and dislikes. Use firm, Once you feel confident and she seems reassuring strokes and make frequent eye comfortable with it, build it into your daily contact with her throughout the massage. WHEN, WHERE AND HOW TO MASSAGE WHEN TO MASSAGE WHERE TO MASSAGE PRESSURE OF STROKES Massage is most effective when babies are in the quiet-alert state (see page 15). Many people like to massage after a bath in a warm room. Respond to your baby’s cues. She is saying ‘yes’ to the massage if she smiles, looks at you and appears happy and relaxed. She is saying ‘no’ if she cries, turns or pulls away, puts a hand over her face or falls asleep. Choose a warm, quiet room where you both feel comfortable. In hot climates, massage can take place out-of-doors, as long as the baby is in the shade. Lay your baby on a towel on a firm surface because this promotes good posture.The floor is a good place – you can sit down to massage and there is no edge for your baby to roll off. Massage strokes should be firm yet gentle, deep and slow. Always be guided by your baby.Watch out for her reactions and change the pressure of your strokes accordingly. Babies find too light a touch unpleasant and irritating. Firm strokes are reassuring, but if your baby’s skin reddens, reduce your pressure. LEARNING TO RELAX 16 Babies absorb the tensions and anxieties of their parents, especially through physical contact. It pays for you to take time out for relaxation before beginning the massage in order for you and your baby to get the most from the experience. Clear your mind of thoughts of chores or other matters and allow yourself to give your full attention to the massage and your baby.The relaxation exercise shown here will help you unwind before you start to massage. 1 Clasp your fingers together and place your hands on your upper abdomen. Close your eyes and inhale deeply – you should feel your abdomen expand. Hold the breath for a few seconds, then exhale slowly. 2 Circle your shoulders backwards several times, then forwards.This helps relieve tension in the back, shoulders and neck. Shake your hands vigorously. Make sure you are comfortable when you massage. Choose a position that allows you to keep your back straight, particularly while you are leaning forwards. If you are massaging your baby on the floor, experiment with the three sitting positions shown here to find the one that suits you best. KNEELING LEGS CROSSED Kneel on the floor with your knees resting on the towel, for extra comfort. Place a cushion on your calves, under your bottom, and sit back. Sit on a cushion with your legs crossed. Place your baby directly in front of you. Lean forwards and give her a few massage strokes to check that this position is comfortable. G E T T I N G S TA RT E D CHOOSING THE RIGHT POSITION LEGS STRADDLED Sit on a cushion with your legs outstretched on either side of your baby.You may need two cushions to keep your back straight, especially when reaching for the top of her body. Try to keep your back straight when you lean forwards to massage Relay positive messages about communication to your baby by giving her loving looks with tender strokes – you will both enjoy this 17 KEY TECHNIQUES FRONT OF THE BABY ❖ O NCE YOU HAVE WARMED THE ROOM and have the oil and a towel ready, undress to your baby which part of her body you are about to massage by placing your hands on it. your baby and take off her nappy. Lay her Look into her eyes, smile, talk to her and ask down in front of you on her back, with her if you can begin.Watch for ‘yes’ and ‘no’ cues feet closest to you, ready to massage the front (see page 16). Responding appropriately helps of her body. Dip your fingers in the oil, then her know you are sensitive to her needs. rub your hands together to warm it. Each Continue to make eye contact and talk to section of the massage begins with indicating her during the massage to reassure her. ARMS AND HANDS 1 EFFLEURAGE STROKES ACROSS THE CHEST Place your hands on the baby’s abdomen, palms facing downwards and fingers pointing up the body – your fingertips should be level with the lower part of the chest. Glide both hands simultaneously up the chest towards the shoulders. Curl the fingers over the shoulders and stroke outwards to take hold of the upper arms. Move directly on to step 2. 2 18 STROKES ALONG THE ARMS Stroke down the arms and over the hands, then pull off at the fingertips. Make sure that both your hands are working simultaneously. Initially, your baby may not straighten her arms at the elbows. As her muscles relax, you can increase the gentle ‘pulling’ pressure of the stroke to straighten her arms. Perform steps 1 and 2 three or four times, or until the arms remain straight, even if momentarily. FRONT OF THE BABY 3 WRINGING THE ARMS Circle your forefinger and thumb of each hand around your baby’s right upper arm. On an older baby, place your hands sideby-side on her upper arm and wrap them around it. Twist your hands very gently in opposite directions in a wringing action. Use enough oil to allow your fingers or hands to slip around your baby’s arm smoothly.Work down the arm in this way, pulling gently at the same time. Stop at the wrist and pull off at the hand with the forefinger and thumb of your left hand. Move on to the left arm. Repeat the stroke twice on each arm. 4 STRETCHING THE HANDS OPEN Support your baby’s hand at the wrist with the palm facing upwards. Stroke the palm from the heel of the hand to the fingertips with the thumb of your free hand, then do the same with your other thumb. Do this once more, then repeat on the other hand. ALTERNATIVE METHOD If you find it hard to open your baby’s hands as shown left, hold her wrist with the palm facing downwards. Place your free thumb on the back of her hand near the wrist, and your fingers in her palm. Press your thumb and forefinger together, and move them towards the fingers. 5 PULLING THE FINGERS Hold your baby’s wrist with the palm facing upwards, fingers towards you. Place your free forefinger and thumb on either side of the base of the finger. Pull along the finger to the tip, squeezing lightly. Pull each digit once, then repeat on the other hand. 19 KEY TECHNIQUES 20 THE CHEST CIRCLES AROUND THE NIPPLES Place the first two fingers of each hand in the centre of your baby’s chest, between the nipples. Move both sets of fingers simultaneously, stroking upwards and outwards, around the outsides of the nipples and back to the centre. Repeat several times. As you massage the chest, increase and decrease the size of the circles you make around the nipples, so that you touch as large an area of the chest as possible FRONT OF THE BABY THE ABDOMEN 1 EFFLEURAGE STROKES DOWN THE ABDOMEN Place one hand horizontally across the abdomen, just below the chest, and stroke firmly down to the base of the abdomen, then lift off gently. Just before this hand loses contact with your baby’s body, place the other hand across the top of the abdomen as before, and stroke down. Repeat several times, with one hand always in contact with your baby’s body. 2 LITTLE CIRCLES AROUND THE NAVEL Place the first two fingers of one hand next to the navel. Press gently, making a circular movement. Release the pressure, slide your fingers around the navel slightly and repeat.Work in a clockwise direction, slowly spiralling outwards until you reach just inside the right hip. 3 LARGE CIRCLES AROUND THE ABDOMEN Starting just inside your baby’s right hip, move the flat of your fingers upwards until they reach the right side of the rib cage, then across to the same point on the left side. Now stroke down to just inside the left hip and across the base of the abdomen back to the right hip. Repeat several times. 21 KEY TECHNIQUES LEGS AND FEET 1 EFFLEURAGE STROKES ON THE UPPER LEGS Hold your baby’s ankle in one hand. Place the other hand horizontally across the top of her thigh, with your fingers pointing inwards. Rotate your wrist outwards and fan your fingers across the thigh, around to the back of the leg, so that you are holding the thigh with your thumb on top and fingers underneath. Move directly on to step 2. EFFLEURAGE STROKES ON THE LOWER LEGS Massage down the outside of the leg to the ankle. Keep holding the ankle and place your free hand back in the starting position, with fingers pointing outwards. Rotate your wrist inwards and stroke down, massaging the inside of the leg in the same way. Repeat steps 1 and 2 several times on each leg. 2 22 FRONT OF THE BABY ▲ 3 WRINGING THE LEGS Place both hands next to each other on one of your baby’s thighs and wrap them around it. Using light pressure, twist your hands very gently in opposite directions in a wringing action.Work down the leg, pulling gently at the same time. Stop at the ankle and pull off at the feet using your forefinger and thumb. Repeat twice on each leg. ▲ CIRCLES ON THE SOLES Hold your baby’s ankle in one hand, with the knee bent and the toes pointing upwards. Place the thumb of your free hand at the centre of the sole, near the heel. Press lightly, making a small, circular motion. Repeat the stroke up the centre of the foot to the base of the toes. Do this twice on each foot. 4 5 CIRCLES ON THE EDGES OF THE FEET Continue to hold your baby’s foot in one hand, knee bent, toes pointing upwards. Place your thumb on the sole directly below the little toe, and your forefinger at the same position on the top of the foot. Squeeze them together, making a small, circular movement at the same time. Glide your fingers a little way down the edge of the foot and repeat the stroke. Continue in this way until you reach the heel, then use the same stroke to massage the other edge of the same foot. Do this twice on each foot. 23 KEY TECHNIQUES By massaging your baby, you get to know the unique pattern of lines on her soles and palms, as well as the feel of her skin and the shapes of her arms and legs 6 STROKING THE ACHILLES’ TENDON Support your baby’s calf in one hand, with the knee bent. Place your free forefinger and thumb on either side of the ankle bone. Stroke towards the heel, squeezing gently. Do this four times, then repeat on the other foot. 8 PULLING THE TOES Hold your baby’s ankle with one hand. Using the thumb and forefinger of your free hand, squeeze the base of the big toe. Pull along the toe up to the tip. Work on each toe in turn, then repeat on the other foot. 7 24 MASSAGING THE TOPS OF THE FEET Hold the ankle with one hand, ensuring the knee is bent. Place the thumb of your other hand on the top of the foot near the ankle, and your forefinger under the foot. Squeeze slightly, hold the pressure, pull down over the foot and off at the toes. ON THE EFFLEURAGE STROKES ALONG THE BODY Place your right hand on your baby’s right shoulder. Using your whole hand, stroke diagonally across the chest and abdomen to her left hip (see below). Continue to stroke down the left leg to the ankle. Do not let go of the ankle until you have placed your left hand on your baby’s left shoulder. Now perform the stroke on the opposite diagonal – down to her right ankle. Repeat this twice. Make sure your strokes are firm, and that one hand is always in contact with your baby. FRONT FRONT OF THE BABY FINISHING STROKES Baby massage provides an opportunity for you and your baby to engage in ‘conversation’ – with smiles, talking and eye contact 25 KEY TECHNIQUES BACK OF THE BABY ❖ F position pleasurable way of familiarizing him with this your baby on his tummy with his feet position. Initially, he may tolerate only a short OR THIS PART OF THE MASSAGE, closest to you. If he is used to sleeping on his stretch of time on his tummy, so perform as back or side, he may not like lying on his much of the back routine as he allows and tummy, but try and encourage him to do build it up slowly. As he will not be able to see so as it will contribute to his gross motor you, talk to him and make reassuring sounds development. Massaging his back can be a to comfort him as you massage. THE BACK 1 EFFLEURAGE STROKES DOWN THE BACK Place one hand horizontally across the top of your baby’s back, just below his neck, and stroke firmly towards you. Lift your hand off when it reaches his bottom, but just before you do, place your other hand in the starting position. Stroke downwards as before. Repeat these strokes several times. 2 26 MASSAGING THE SHOULDERS Place one hand on either side of the neck and stroke along the shoulders towards the arms, using the whole surface of each hand. Repeat several times. Babies and parents often have identical tension spots, so if your own shoulders and neck tend to be tense, make a point of performing this stroke on your baby. LITTLE CIRCLES DOWN THE SPINE Position your thumbs on either side of your baby’s spine, just below the neck. Make small circular movements with your thumbs while moving them down the back towards his bottom. Make sure your thumbs are on either side of the spine, and not on the spine itself. BACK OF THE BABY 3 27 KEY TECHNIQUES 4 PULLING THE SIDES Place your hands horizontally across your baby’s back (see right). Cross your arms and slide your right hand to his left side and your left hand to his right side. Bring your hands back to the starting position simultaneously, pulling the flesh on the sides of the torso gently towards the spine with your fingers. Make these horizontal movements several times, moving your hands up and down his back as you do so, so that you massage the sides along the whole length of the torso. 5 BIG STROKES ACROSS THE BACK AND SHOULDERS Place your hands next to each other on your baby’s back, with your right hand closer to his head. Keeping your left hand in place, move your right hand to your baby’s right side, then diagonally up towards and over the left shoulder.Then glide the hand down to his right hip. Now move your left hand towards his left side, then diagonally up and over his right shoulder (see right), and down to the left hip. Place your hands back in the starting position and repeat the stroke several times. 28 MASSAGING THE BASE OF THE SPINE Place the heel of your hand in the dimple directly above the centre of your baby’s bottom, at the base of his spine. Circle clockwise with gentle pressure several times. BACK OF THE BABY 6 29 KEY TECHNIQUES THE BOTTOM KNEADING THE BOTTOM Position the heel of each hand at the base of each buttock. Circle your hands several times simultaneously, the right hand moving clockwise, the left hand, anticlockwise. Move your hands around the buttocks slightly as you circle. 30 EFFLEURAGE STROKES DOWN THE LEGS Once you have finished kneading the bottom, move one hand down the leg towards the ankle in a firm, sweeping stroke.When you reach the ankle, begin the stroke on the other leg using your other hand. One hand should always stay in contact with your baby. Repeat several times. FINISHING STROKES ON THE BACK OF THE BABY THE LEGS BACK EFFLEURAGE STROKES DOWN THE BODY Place your left hand on your baby’s right shoulder. Using the whole surface of your hand, stroke diagonally down the back, over the left buttock, and down the left leg to the foot. As you reach the foot, place your right hand on your baby’s left shoulder (see below) and stroke diagonally down the body to the right foot. Repeat twice, using firm strokes, without losing contact with your baby’s body. 31 KEY TECHNIQUES HEAD & FACE ❖ I NITIALLY, BABIES TEND TO RESIST head and face massage, particularly during the first parts of his body. Do this each time you massage him until he is ready for a head massage. Once few weeks of life, and if the delivery was long babies are accustomed to these strokes, they or traumatic.Try this part of the massage for tend to enjoy them greatly, and even more so three to four consecutive days. If your baby as they get older. For this part of the massage, seems unhappy or cries, place still hands on lay your baby on his back with his feet closest his head to reassure him, then massage other to you. Use light strokes with little or no oil. THE HEAD 1 STROKING THE HEAD Cup your hands around your baby’s head with your forefingers on his hairline. Moving your hands simultaneously, stroke backwards over the crown of the head until you reach the base of his skull. Move directly on to step 2. STROKING THE JAW Part your hands and bring them to the sides of his face. Stroke along the jaw line with your fingers until they meet at the chin. Repeat steps 1 and 2 several times. 2 32 HEAD & FACE THE FACE 1 MASSAGING THE TEMPLES On the last stroke across the forehead, place your thumbs in the centre, just above the eyebrows, and glide them across to your baby’s temples gently, but firmly. Now make several small, circular strokes on the temples. STRETCHING THE FOREHEAD Position your thumbs at the centre of your baby’s forehead, just below the hairline. Stroke each thumb outwards in a straight line to the sides of the face. Repeat all the way down the forehead, as if you are drawing a series of lines with your thumbs. 2 STROKING THE UPPER CHEEK BONES Place your thumbs on either side of the bridge of the nose. In a single flowing stroke, move each thumb simultaneously downwards and outwards, along the upper part of the cheek bone to the sides of the face. 4 3 STROKING THE LOWER CHEEK BONES Position your thumbs on either side of the bridge of the nose again, this time slightly lower down. Make a single sweeping stroke with each thumb from this position along the lower part of the cheek bone and out to the sides of the face. 33 KEY TECHNIQUES 34 CIRCLES ON THE TOP JAW LINE Position your thumbs side-by-side on the dip above your baby’s top lip. Pressing lightly, make small, circular movements with the thumbs. Glide each thumb outwards a little and repeat. Do this along the length of the top jaw line and out towards the ears. 5 6 CIRCLES ON THE LOWER JAW LINE Place your thumbs side-by-side just below the centre of the lower lip. Using light pressure, make a circular movement with each thumb, then slide them outwards a little way and repeat. Do this along the lower jaw line, again, towards the ears. ▲ 8 ▲ SQUEEZING THE EARS Hold the outer edge of the upper ear between forefinger and thumb. From this position, make small circular strokes down the outer edge of the ear to the lobe. SQUEEZING THE CHIN Starting at the centre of the chin, hold the flesh at the bottom of the chin between thumb and forefinger and squeeze gently. Repeat along the length of the lower jaw line to the ear, then on the other side of the chin. Alternatively, pinch both sides of the chin simultaneously using both hands. 9 STROKING THE HEAD Repeat the steps for the head massage on page 32 to finish the head and face massage. HEAD & FACE 7 35 KEY TECHNIQUES STRETCHES ❖ O NCE YOU HAVE COMPLETED the main part of the massage – on the front, back, head and face – move on to the stretches. By now, your baby’s muscles are warm and relaxed, so you can stretch the limbs and mobilize the joints safely.These stretches help to develop flexibility. For this part of the routine, lay your baby on her back with her feet towards you. Oil is not necessary. Most babies enjoy the stretches, especially when accompanied by playful noises, such as “weeeeeeee”. ARM STRETCHES 1 36 STRETCHING THE ARMS Hold the back of the wrists with your fingers and place your thumb in your baby’s palms or on the inside of her wrists. Stretch her arms out to the sides, in line with the shoulders and at right angles to the body. Pull gently to straighten the arms. Hold for a few seconds, then move on to step 2. 2 CROSSING THE ARMS Cross your baby’s arms over her chest, crossing your own arms to do this. Hold the position for a few seconds. Repeat steps 1 and 2 several times. Each time you cross her arms, alternate which arm goes on top. CROSSING THE LEGS Take hold of your baby’s ankles, one in each hand. Cross them over at the lower leg.Then grasp the point where they cross with one hand and move the knees up towards the abdomen, bringing the toes near the hips. In little ‘bouncing’ movements, press gently on the legs, easing them towards the abdomen. After a few bounces, cross the legs the other way and repeat. STRETCHES LEG STRETCHES 3 ROTATING THE ARMS UPWARDS Stretch the arms out to the sides as for step 1. Keeping the upper arms (shoulder to elbow) in position, move the hands up towards the head, so that the arms bend at the elbows.The lower arms should be at right angles to the upper arms. Ensure the arms are resting on the towel. 4 ROTATING THE ARMS DOWNWARDS Without changing the position of the upper arms, raise the lower arms into the air so that the wrists are directly above the elbows, then bring them towards you down to the towel.The lower arms should be in line with the torso and the palms should rest on the towel. Repeat steps 3 and 4 several times. 37 KEY TECHNIQUES ARM AND LEG STRETCH SEQUENCE 1 STRETCHING THE LIMBS Hold your baby’s right wrist in your left hand, and her left ankle in your right hand. Pull both arm and leg away from the body gently at a slight angle, so the limbs form a diagonal line at each end of the torso. Hold the stretch for a few seconds, then move on to step 2. Positive eye contact makes a valuable contribution to a child’s developing self-esteem, so encourage it as much as possible – there will be many opportunities during massage FOLDING IN THE LIMBS – FOOT TO HIP Bring the left foot to the right hip (leading with the heel), and the right hand to the left hip, just above the thigh. Ensure the knee is bent. Hold for a few seconds, then move on to step 3. 2 38 STRETCHING THE LIMBS Repeat step 1, pulling your baby’s right arm and left leg away from her body gently. Again, hold the position for a few seconds, then move directly on to step 4. 3 STRETCHES FOLDING IN THE LIMBS – FOOT TO SHOULDER Bring your baby’s right arm straight down to the right hip, and take the left foot up to the right shoulder, again, leading with the heel. If your baby’s foot does not reach the shoulder, do not force it, but take it as far as it will comfortably go. Repeat steps 1 to 4 with the same arm and leg, then twice with the alternate arm and leg. 4 FINISHING STROKES EFFLEURAGE STROKES ALONG THE BODY Place your right hand on your baby’s right shoulder. Using your whole hand stroke diagonally across the chest and tummy to her left hip. Continue the stroke down the left leg, with your fingers underneath the leg and your thumb on top, until you come to the ankle.Then stroke down the foot and off at the toes. Before pulling off, place your left hand on your baby’s left shoulder (see below) and repeat the stroke on the opposite diagonal, to the right toes. Repeat this twice, using firm, sweeping strokes and maintaining contact with your baby’s body the whole time. Listen to your baby and respond to her – if she smiles, smile back; if she cries, pick her up and comfort her 39 EVERYDAY CARE ❖ MASSAGE IS EASILY INCORPORATED INTO YOUR BABY’S DAILY ROUTINE. IN FACT, IT IS, AND HAS BEEN FOR CENTURIES, A VALUED PART OF EVERYDAY CHILD CARE IN MANY CULTURES, PARTICULARLY THOSE OF AFRICA AND ASIA – AND THE TECHNIQUES OF THESE TRADITIONS ARE VERY INSPIRING.THERE ARE MANY WAYS IN WHICH YOU CAN MAKE MASSAGE AND OTHER FORMS OF LOVING TOUCH A SPECIAL PART OF YOUR BABY OR TODDLER’S DAY-TO-DAY LIFE, AND IF YOUR CHILD HAS A SPECIAL NEED, REGULAR MASSAGE CAN BE PARTICULARLY BENEFICIAL. ❖ AFTER P A BATH ❖ ARENTS OFTEN MASSAGE their babies after a bath, when the child is already naked.This is the best time to oil your baby if she has dry skin (see page 87), so carry out a full-body massage following the techniques on pages 18–39 once you have dried her. Even if her skin does not need moisturizing, you may find this the most natural time for massage. If you prefer to give her a full-body massage at a different time, just perform one or two of her favourite strokes, using the time between drying and clothing her to add more intimate moments to your daily routine. SWADDLING Your baby may find it comforting to be wrapped tightly in a towel after a bath, in a similar fashion to the Chinese custom of swaddling. You can begin to massage your baby at this point, through the towel. Make firm, long strokes down her arms (see left), then cup your free hand to stroke her head (see page 47). Holding your baby with her chest to yours, make long, sweeping strokes down her back with the whole of your hand. Lay your baby on a dry towel in a warm room for massage. If performing only a few strokes, try effleurage strokes on her front, back, arms (see page 18) and legs (see page 22).These allow you to touch much of her body and can also be carried out on a sitting older baby. Use oil if you like, but this is not necessary. A F T E R A B AT H USING EFFLEURAGE STROKES STROKING THE FRONT OF THE BODY Lay your baby on her back. Place your hand horizontally across the top of her chest and stroke downwards firmly until your hand reaches the base of her abdomen. Before your hand lifts off, place your other hand in the starting position. Stroke down as before. Repeat several times, making your strokes rhythmical. STROKES DOWN THE BACK OF THE BODY If your baby will lie on her stomach, follow the instructions for Effleurage Strokes Down the Back (see page 26). If she wants to sit up, you might need to support her, as these firm strokes may push her trunk forwards.To do this, place one hand on her chest, and use your other hand to stroke rhythmically down her back. 43 E V E RY DAY C A R E NAPPY CHANGING ❖ Y OU CAN MASSAGE YOUR BABY once or twice during the day when you change his nappy. Once you have cleaned him, and before you put on his nappy, stroke his tummy, legs and feet, with or without oil. Use entertaining noises to engage your baby’s attention to try and keep him still This is a good method of massaging him as he gets older and refuses to keep still for a full massage, but be prepared for the fact that he may not stay still for this either.Try the sequence for a few days, starting with just a few strokes on his tummy and legs, adding more if he tolerates them. If your baby kicks, turns over or protests in other ways, stop – TUMMY MASSAGE Place your palm on your baby’s abdomen. Using gentle pressure, make circular strokes in a clockwise direction with your palm, allowing your fingers to brush over his chest. Repeat several times, or for as long as your baby continues to enjoy it. there are other ways of giving him loving touch, communicating with him and responding to his needs (see pages 72–73). 44 When your baby smiles at you, smile back – he will notice and enjoy it The results of studies carried out in 1977 show that positive touch given in addition to routine handling during daily care (such as feeding and nappy changing) helps to develop child growth, language and social skills. In our practice we have found that this positive touch encourages children to feel loved and secure. FOOT MASSAGE Hold your baby’s ankle in one hand and ensure his knee is bent. Use your free hand to hold the foot with your fingers on top and thumb underneath. Stroke firmly along the foot and pull off at the toes. Repeat several times on each foot. LEG MASSAGE Hold your baby’s ankle in one hand. Place your free hand at the top of his thigh. Grasp the thigh, with your thumb on top and your fingers pointing upwards. Stroke down his leg to his ankle. Hold the ankle with this hand and grasp the other side of his thigh in the same way as before, this time with your other hand. Stroke down the leg to massage this side of his thigh. Repeat several times on each leg. NAPPY CHANGING RESEARCH EVIDENCE E V E RY DAY C A R E SOOTHING TO SLEEP ❖ M ANY PARENTS instinctively use massage to soothe their babies into sleep. A cot, or cuddle her, and use strokes you know she finds particularly relaxing. Use the same routine can be developed before bed- or nap- sequence of strokes each time, keeping the time that acts as a cue for sleep. Once your routine short and simple. Make sure you stop baby is in her nightwear, lie her down in her before she actually falls asleep. STROKING THE TUMMY If your baby is lying on her back, she may enjoy a gentle tummy massage. Place your hand, palm downwards, on her abdomen. Move your hand in circles in a clockwise direction, stroking her with your fingers and the entire surface of your palm. Keep the pressure very light, reducing it gently as she becomes more relaxed and sleepy, until you are hardly touching her at all. If you are holding and cuddling your baby while she falls asleep, massage her head and face gently. Using the back of one of your fingers, stroke her cheek slowly and rhythmically. Look at her and talk or sing to her quietly.To stroke her head, cup it in one of your hands, with your forefinger at her hairline. Now stroke backwards to the base of her neck. Do this gently, and for as long as she finds it soothing. A CHILD PSYCHOLOGIST’S VIEW SLEEPING ALONE Many infants fall asleep only when someone is with them. Cuddling is a vital part of parenting, but it is also important to your child’s developing independence that she learns she can fall asleep alone. At about four months old, establish a sleep-time routine, such as tea, play, bath, bedroom, breast or bottle, and cot.Take her off the breast or bottle while she is still awake but drowsy. Put her into the cot, sit with her, possibly stroking her, until she falls asleep. Over a few weeks, reduce the ‘help’ you give, and begin to move out of the room, encouraging her to settle herself to sleep. SOOTHING TO SLEEP STROKING THE HEAD AND FACE Sing softly to your baby when she is falling asleep 47 E V E RY DAY C A R E TODDLER PLAYTIME ❖ ODDLERS ARE FULL OF ENERGY, T fascinated by life, and determined to assert their own will, so by the time your child reaches this age, you may find it hard to keep her still long enough for a full massage. Instead, try incorporating massage into playtime. Accompany strokes with games and fun noises to hold her attention for as long as possible. Devise games that involve each part of the body so that slowly, over the course of, say, a week, you manage to massage her whole body, or most of it. But, as a general rule, let your toddler’s preferences guide you, and stop before she becomes distracted. STRETCHES 48 Toddlers tend to enjoy dynamic movements such as stretches (see pages 36–39).They also love to count, so turn a stretch sequence into a game, with both of you counting the number of stretches you perform. TO D D L E R P L AY T I M E A CHILD PSYCHOLOGIST’S VIEW ENCOURAGING SELF-CONFIDENCE Your child receives an important message when you massage her lovingly and play games with her: that you are interested in her and want to know how she feels. Assuring her in this way helps her maintain a secure attachment to you, which in turn encourages the development of her self-confidence. Adapt how you position your child for massage as she grows taller – if massaging her head, face, arms or chest, bring her legs on to your lap so you can reach these areas PLAYING WITH THE LEGS AND FEET Try to adapt the strokes shown for the legs and feet (see pages 22–25) into a game such as ‘Climbing up the Legs’ or ‘This Little Piggy’. By incorporating a little suspense into the game, you may hold her attention for that little bit longer. Make sure that your toddler’s legs are supported and her knees are bent. PLAYING WITH THE HANDS Hold your child’s wrist with one hand and use the thumb of your free hand to circle the palm, then pull down each of her fingers and stroke along them in turn with your forefinger and thumb.You could turn this into a game such as ‘Round and Round the Garden’. 49 “ Massage is something you and your together – it’s about sharing feelings, and even thoughts, on an intimate, unspoken level ” baby do E V E RY DAY C A R E INDIAN MASSAGE ❖ I N MANY ASIAN CULTURES, particularly on the Indian sub-continent, baby massage is a traditional part of day-to-day care. Mothers learn the techniques from their own mothers or mothers-in-law. Sometimes, massage begins on the first day of life, but it usually starts when the baby is about five days old, once the umbilical cord stump has fallen off, and continues until the child can walk.Traditionally the oils used are mustard-seed oil in the winter, because it is warming, and coconut oil in the summer because of its cooling properties.There is often no set routine. Mothers start on the areas their baby likes best and work towards what is least enjoyed. Massage strokes and stretches are very like those shown in Key Techniques (see pages 18–39), and they have similar benefits. An Indian mother or grandmother sits on the floor to massage her baby, with her legs outstretched and the baby on her lap 52 Smile and be jolly when you massage your baby, so she learns to associate touch with fun and happiness FOR I NDIAN MASSAGE If you would like to try massaging your baby while sitting in the Indian massage positions, ensure you keep your back straight – support your back against a wall if you need to.Once you are comfortable, place your baby on your lap in either of the positions shown here. Begin with the one that allows you to perform your baby’s favourite strokes, then move on to the other. INDIAN MASSAGE POSITIONS ACROSS THE LAP Use the techniques given for Back of the Baby (see pages 26–31), performing them with your baby lying across your lap. Once she has learned to turn over, she may not want to spend as much time on her back, so this position may be preferable. ALONG THE LAP With your baby in this position, you can easily massage her arms, hands, chest, abdomen and legs (see pages 18–24).You can also perform stretches (see pages 36–39), but you may need to bring her slightly closer to you in order to massage her head and face (see pages 32–35). 53 E V E RY DAY C A R E AFRICAN MASSAGE ❖ D AILY CHILD CARE in many parts of Africa includes baby massage. Techniques differ from one African culture to the next, as do the oils used. Nigerian mothers use kernel or palm oil, whereas in Ghana, shea butter is preferred. Massage, which traditionally takes place after a bath, begins at birth and continues until the child is aged three or four.To begin with, it is carried out daily, but as a child grows older, he is massaged less often, perhaps three or four times a week.The techniques used can be vigorous, as it is felt that strenuous movements develop strength and flexibility. HOT PRESSES 54 In some parts of Africa, a baby is wrapped in a towel and placed on his mother’s lap after a bath. She applies a ‘hot press’ (simply a warmed flannel) all over his body, in order to relax the muscles in preparation for massage. During the first few months, these are also pressed on to the head in the belief that the skull can be teased into an attractive shape. Nigerians massage their babies to help them relax, sleep well and to moisturize the skin.The mother sits in a chair with the baby on her lap. She begins with long, firm, rhythmic strokes over the arms, abdomen, legs, feet and back.The head and face are then oiled with massage strokes. Stretches come next (see below), which are believed to develop strength, flexibility and muscle tone.These are followed by the most strenuous part of the routine, dangling.The baby is held up by one arm at a time (which is believed to strengthen his arms), before being held upside-down momentarily by the ankles. Finally, he is thrown into the air and caught several times, in the belief that this develops alertness. CAUTION Traditionally, babies are dangled by one arm, with no support.This technique, and the confidence to perform it safely, are handed down from mother to daughter. Without the guidance of an experienced demonstrator, use the adapted method shown here. AFRICAN MASSAGE NIGERIAN BABY MASSAGE DANGLING Sit on a chair with your baby on your lap. Place one hand under his bottom to support his weight, and hold his wrist firmly in your other hand. Stand up slowly, taking his weight in your supporting hand. Lift his arm and bring your supporting hand down fractionally – his raised arm will stretch. Pull it upwards gently for a few seconds, then take his weight fully in your supporting hand again. Repeat with his other arm.Always take the majority of his weight in your supporting hand, and gauge his response to ensure he is comfortable. STRETCHES 1 Lie your baby face-down across your lap.Take the arm furthest from your body behind his back and pull it very gently towards the centre of his back, holding it straight at the elbow (see right). Stroke firmly from the shoulder to the wrist and pull off at the fingers. Take the leg furthest from you and bend it at the knee, bringing the heel to the buttocks. Repeat several times, then stroke firmly down the legs. Change your baby’s position so he faces the opposite direction and repeat on his other arm and leg. 2 55 E V E RY DAY C A R E CHILDREN WITH SPECIAL NEEDS ❖ C HILDREN WITH DOWN’S SYNDROME or Cerebral Palsy often have low muscle tone, which massage can help to develop. It can also increase body-awareness; this is useful to visually impaired children, too. If your child has a special need, talk to her physiotherapist or doctor about how to massage her. Remember that she has her own rhythms that deserve respect. MASSAGE FOR SPECIAL NEEDS BENEFITS OF MASSAGE Massage can: ❖ increase a child’s body-awareness ❖ boost muscle tone ❖ encourage non-verbal communication to develop between parent and child ❖ help with bonding and attachment ❖ soothe and calm children and help parents to relax ❖ allow parents to feel they are helping their child positively. PRESSURE OF STROKES 56 Children with special needs often have a sensory difficulty, in that they can be either highly sensitive or insensitive to touch.They need either light or deep pressure, depending on their ‘sensory integration’. Some children actually dislike light touch, so firm pressure is needed. If you are unsure about the pressure of your strokes, watch your baby’s reaction and ask your doctor or physiotherapist for advice. If your child has Down’s Syndrome, his muscle tone may be low. Regular full-body massages, incorporating stretches (see pages 18–39), help to increase muscle tone. Alternatively, he may have high muscle tone; in this case, massage can relax his muscles. If he has physiotherapy, perform a quick massage before the sessions – warming the muscles before physiotherapy may enhance the work done during a session. Some children with Down’s Syndrome may experience hearing impairments, which massage can also help with (see below). In order for children with this condition to make the most of their talents and abilities, they need plenty of stimulation to respond to. Massage can be another form of stimulation that you provide for your child. It is likely that he will enjoy the massage greatly – children with Down’s Syndrome tend to be sociable, and their cheerful and affectionate characters respond well to loving touch. Massage has best results when it is something the two of you do together – a kind of touchcommunication – rather than something you do to your child. Perhaps if your child has a sibling, you can encourage them to massage each other, allowing the whole family to share this form of communication.This can help improve your family relationships and make your child very happy. CASE HISTORY “Jack loves being massaged.When he was nearly two, a friend who had been to baby-massage classes with her baby suggested I massage Jack. She showed me some of the strokes she had learned. I tried them out on Jack, and his pleasure was so obvious that I wanted to learn more. Once I had the OK from my doctor, I went to a local clinic where they teach baby massage, and picked up a few more strokes. Now we do these every day.We have developed our own routine, starting with the strokes Jack likes most, but this is flexible, because Jack sometimes likes to decide which stroke comes next, telling me which one by performing it on me. He likes to massage me as well, and also massages his father and older sister frequently.” CHILDREN WITH SPECIAL NEEDS CHILDREN WITH DOWN’S SYNDROME CHILDREN WITH SENSORY IMPAIRMENTS Massage helps children who are visually impaired build a picture of the world around them, because being touched teaches them to touch, and touch helps them to explore their surroundings. A visually impaired child’s bodyawareness also increases through massage – she learns how long her arms and legs are, and gains a better idea of their shape. Massage can open new pathways of communication between you and your child, which will be a major source of comfort and security for her.Touchstimulation increases the levels of responsiveness of children with sensory impairments, so massage can teach her to engage in social interaction.When you massage your child, make sure you always keep one hand on her body if she has impaired vision, and talk to her to reassure her. If your child has difficulty hearing, talk to her throughout the massage to stimulate her hearing.Tell her what you are doing, to help her link words and sounds to actions. CASE HISTORY “Our doctor suggested I try baby massage to help Isaac become more aware of touch, sounds and smells. I don’t think he knew how to respond to it at first, but now he knows what it is and likes it very much. In fact, I think he looks forward to it. He started reaching out towards sounds, wanting to touch what he was hearing. Although he began crawling later than most ‘normal’ babies, it was not that much later. Other mothers of partiallysighted babies that I know have been inspired by how he’s getting on, and now also use massage.” 57 E V E RY DAY C A R E CHILDREN WITH CEREBRAL PALSY Massage allows children with Cerebral Palsy to experience movements they cannot make alone, and increases their body-awareness. Each child’s requirements are unique, so speak to your child’s physiotherapist to establish how massage can enhance the work done in the sessions. Regular massage enables your child to benefit frequently from movements that stimulate her physical development. Here, we show part of the routine Cordelia and her mother share before a physiotherapy session. MASSAGING THE FOOT By massaging the soles of Cordy’s feet gently with the pads of her fingertips, Cordy’s mother stimulates the muscles along the leg, which react by tightening.This slowly strengthens them. BENDING AND FLEXING THE LEG With the heel supported in one hand, and the knee held in the other, Cordy’s mother bends and flexes Cordy’s leg gently to familiarize her with this ‘walking’ movement. AND SITTING 1 STRETCHING THE ARMS UP Cordy lies on her back with her feet on her mother’s lap. Cordy’s mother holds her wrists gently and stretches her arms above her head. 3 SITTING UP Cordy’s mother helps Cordy come to a sitting position by pulling her arms gently. This stimulates muscles in Cordy’s arms, back and abdomen, and also in her legs, which push against her mother’s lap to maintain balance as she rises up. 2 STRETCHING THE ARMS DOWN Now Cordy’s mother brings Cordy’s arms down to her sides. She repeats steps 1 and 2 several times. These movements stimulate the muscles in the upper arms and along the shoulders. CASE HISTORY CHILDREN WITH SPECIAL NEEDS STRETCHING “Cordy cried for weeks after the birth. Her condition was not detected immediately, so the crying was attributed to all sorts of things.When it was discovered that she had Cerebral Palsy, we were devastated. Her condition became noticeable when she began to move her arms and legs more, as we found she used one side of her body more than the other. Initially, she disliked physiotherapy, probably because she found it difficult, and could not understand what was happening to her. I think it put her off being touched.The physiotherapist said she might relax more if we helped her do some of the movements they did together at home.We turned many of these into a game. She liked those! It did help her to relax, and now she likes to be touched.” 59 60 MASSAGE FOR DIFFERENT AGE GROUPS ❖ AS YOUR CHILD DEVELOPS, SO DO HIS NEEDS.WHETHER HE IS A PREMATURE BABY OR A BOISTEROUS TODDLER, MASSAGE INCREASES YOUR SENSITIVITY TO HIM, ENABLING YOU TO RECOGNIZE HIS REQUIREMENTS, AND DECIDE HOW BEST TO ALTER YOUR APPROACHES IN RESPONSE. ADAPTING YOUR MASSAGE TECHNIQUES, ROUTINES AND THE PRESSURE OF YOUR STROKES TO SUIT YOUR CHILD’S CHANGING PHYSICAL AND EMOTIONAL NEEDS ENCOURAGES YOUR CHILD IN EACH STAGE OF DEVELOPMENT AND GIVES HIM THE SENSE THAT YOU ARE MOVING WITH HIM THROUGH HIS EXPERIENCE OF LIFE. ❖ MASSAGE FOR DIFFERENT AGE GROUPS PREMATURE BABIES ❖ H AVING A BABY who is born prematurely can be very distressing. Parents can in neonatal units are handled frequently as part of their essential medical and nursing have a range of emotions which include care and often find this type of touch shock, denial, guilt, fear, anxiety, anger and disturbing and distressing. Gentle touch helplessness. If your baby is in an incubator, and holding techniques are a way of giving there may be little opportunity for skin-to- love and comfort to a pre-term infant and skin contact or eye contact. Pre-term babies can help parents get to know their baby. BONDING WITH YOUR BABY BEING THERE FOR HIM STILL TOUCH As soon as you can, talk or sing to your baby. Babies find it reassuring to hear their parents’ voices – their mothers’ voices in particular. It has been found that term babies turn towards their mother’s voice in preference to a stranger’s when only a few days old. Even if your baby appears not to respond, he will feel comforted and soothed by your voice.This is especially helpful to his well-being and the process of bonding if he is in an incubator. Premature babies should not be massaged initially. Instead, parents should use a technique known as still touch or resting hands (see below).This is a gentle touch, with the whole hand placed on an area of your baby’s body that you feel comfortable with touching, such as his back, head, arm or leg.This touch may be the first chance you have to be close to your baby. See it as an opportunity to send your love to him. Choose a time when he is RESEARCH EVIDENCE A research study was conducted in 1995 in the USA to identify a type of touch that parents might be able to give their premature babies in the first three weeks of life, when they may be ill and physiologically unstable. In this study, the babies were gently touched by the adult, having still hands placed on the baby’s head and 62 body for fifteen minutes a day.This type of touch seemed to have a soothing effect on these infants; they had calmer sleep, a decreased level of physical activity and showed fewer signs of distress.The researchers reported that this touching had no adverse effects on the heart rate or oxygen saturation levels of the pre-term infant. awake, calm and alert. Place one or two hands on the chosen area and ask your baby if you can touch him before you do. OBSERVING HIS REACTIONS Watch your baby to gauge his reaction to this touch. He will show you, by his actions and facial expressions, whether or not he is enjoying the experience, which will help you understand what level of touch he is able to manage at this time. Keep a constant watch for stress cues and no cues (see page 64). These indicate that he is becoming over-stimulated, tired or distressed. As soon as you see any signs that tell you he has had enough, stop. You can try again the next time you notice he is awake, calm and alert. Before using still touch or massage on your baby, talk to the nursing and medical staff about what you intend to do. It is important to wait until your baby is ready for massage before moving on from still touch.This may be while he is still in the hospital, or you may wait until you take him home.When you do start, begin very slowly, with just one new stroke at a time.You may like to sit on a chair and massage your baby on your lap. Ensure that the massage strokes you use are smaller and gentler than those you might use for a term baby. For instance, use two or three fingers rather than the whole hand.The touch needs to be gentle but firm – too light a touch may be unpleasant and over-stimulating. Before you start the massage warm some oil in your hands. For each new body part, begin by placing your hand on that area and ask your baby if you can massage him. After each stroke, stop and observe how he reacts to it. Watch out for stress cues and no cues (see page 64). If he cries, use still hands to offer comfort and reassurance. If you respond to his cues and start a little at a time, the massage programme will build up and your baby will soon anticipate and enjoy the massage. WHEN NOT TO MASSAGE Massage or touch techniques can be used to soothe and relax most premature infants. However, when you are using touch with your baby it is important that you watch his reactions, especially if he is in an incubator. You should stop the massage immediately if: ❖ your baby’s colour changes ❖ he vomits ❖ his breathing becomes more rapid or stops ❖ his muscles become tense ❖ his pulse rate increases or becomes slow. If any of these changes occur, inform the medical or nursing staff straight away or contact your doctor. FIRST MASSAGE Massage your baby on your lap once he is well enough. Begin by massaging the part of his body you feel most comfortable with touching and which you feel he will most enjoy. Use two or three fingers to massage a premature baby, with firm but gentle strokes. Observe your baby and gauge his reaction to each stroke. P R E M AT U R E B A B I E S BEGINNING MASSAGE MASSAGE FOR DIFFERENT AGE GROUPS AVOIDING OVER-STIMULATION STRESS CUES AND NO CUES It is important that you do not over-stimulate your premature baby with touch or massage. Observe him throughout still touch or massage to watch for when he has had enough. He will have his way of telling you that he is becoming distressed by the massage by using a ‘stress’ cue, or that he wants the massage to stop by using a ‘no’ cue, so that he can rest or sleep, for example. Signs may include: ❖ yawning ❖ sneezing ❖ hiccuping ❖ avoiding eye contact ❖ raising his hand or placing it in front of his face ❖ having an increased or decreased heart rate ❖ breathing too fast ❖ not breathing for periods of time. Notice if your baby tends to use particular stress cues or no cues more than others. Learn to pick up these communications from him and respond to them. By doing so, you will improve both his well-being (by providing him with what he needs in that moment) and your relationship with him, as he will become aware that you are responsive to him and his needs. CASE HISTORY “Ellis and Spencer were born five weeks premature – not unusual for twins.They spent the first week of their lives in an incubator, with tubes all over their tiny bodies.This was very frustrating for me and my husband, as physical contact with them was so limited. All we wanted was to take them home, but we could barely touch them. I used to put my hands through the portholes of their incubators and stroke them gently. If either of the twins was at all grisly, I would stroke his head and eyebrows, and it would calm him. If I made my strokes lighter and lighter, he would eventually nod off. I started to stroke their tummies and tickle them behind their ears, which would often make them attentive. Even now, when feeding either of them, if his concentration wonders, I tickle him under the chin, which seems to focus his attention on the feed. Having that initial contact with the twins, when they were in their incubators, allowed both me and my husband to bond with them.They still enjoy being touched at 10 weeks – it’s part of their bedtime routine. They also find our voices quite calming, and they like to lie on my chest and hear my heartbeat – I think they find it very comforting.” LIMITING STIMULI GENTLE HOLDS 64 Holding your baby’s hand, arm or leg is the ideal physical interaction for a premature baby.Wrap your hands carefully around the hand or limb and simply hold it for as long as your baby is happy with the touch.This gentle communication lets him know that you care for him and provides him with love and security. Although, ideally, it would be lovely to talk or sing to your baby, make eye contact and touch him all at once, he may be able to deal with only one of these forms of stimulation at a time, especially during the early days or weeks. Limit the amount of stimulation he receives at any one time to begin with. Either talk to him or make eye contact with him. If he seems happy with this it may be appropriate to move on to still touch, always watching for his reaction. In this way, progress slowly towards massage. Assess his surroundings – are his senses being over-stimulated by his environment? Is the room too noisy or bright? If he is in an incubator, put a towel over part of it to limit the amount of light shining on him. Once noise is reduced to a minimum and the lighting is dimmed, he may be more able to accept interactions with you. BENEFITS OF MASSAGE AND STILL TOUCH FOR PREMATURE INFANTS Perhaps the most important benefit of still touch and massage for your premature baby is that it helps you both to bond.This is especially helpful if your baby has spent the first days of his life in an incubator.You can give him love, comfort and reassurance through your voice and gentle touch. Massage can also: ❖ have a calming and soothing effect ❖ help to improve weight gain ❖ enhance growth and development ❖ encourage greater responsiveness ❖ improve digestion and metabolism ❖ reduce pain by stimulating the production of endorphins, the body’s natural pain killers. LOVING TOUCH If your baby does not respond positively to massage, there are other ways of giving him love and comfort. Cuddles and soft words will bring you closer together. “ The eye contact between us is incredible. I feel I know exactly what is going through his mind just by the way he looks at me ” Sometimes MASSAGE FOR DIFFERENT AGE GROUPS NEWBORN BABIES ❖ M ASSAGING YOUR NEWBORN BABY is a lovely way to get to know her – her and seeks eye contact with you, which will create a wonderful feeling of intimacy between expressions and reactions to different strokes, you. She may not smile, but you will have a the contours of her body, the feel of her tiny sense of real closeness.This social interaction fingers and toes.You will find that these special enhances your early relationship, setting strong moments of loving touch are times that your foundations for the future. baby comes to anticipate and enjoy. Massaging can also help her progress to the ‘quiet-alert state’ where she becomes calm, receptive, If your newborn allows you to massage her head, take special care over the fontanelles WHEN TO START CLOTHING AND SEATING Baby massage can start on the day your baby is born, as happens in some cultures where infant massage is a tradition. If you feel confident and ready to begin during the first few days after the birth, then do so. Make sure you avoid touching the navel area until the umbilical cord stump has fallen off.This usually happens four to seven days after delivery. Some parents may initially prefer not to undress their babies for massage until both parent and child become accustomed to it. In this case, the baby can be dressed in a vest or babygro. Newborn babies, like older babies, can be massaged on the floor, but, to start with, you may find your baby prefers the comfort and security of your lap. You can either sit on a comfortable chair or on the floor. Place a towel over your lap to make your baby more cosy. If you choose the floor, try leaning against a wall to help you keep your back straight. NEWBORN BABIES INTRODUCING MASSAGE Massage your newborn baby on your lap – she is likely to be small and light enough, and will find it comforting to be physically close to you 69 MASSAGE FOR DIFFERENT AGE GROUPS BUILDING UP A ROUTINE Baby massage is most beneficial for your baby when it forms part of her daily care routine. Do not worry if you cannot fit it in every day. Massaging your baby as little as three times a week will still have positive results.When you introduce the massage routine, start with just a few strokes, slowly building up to a full massage over the course of three to four weeks. Begin with a short five minute session using long, gliding (effleurage) strokes (see right). Make the strokes firm and slow.Watch your baby’s reaction. She will let you know what she likes and dislikes (see page 16). As you both gain confidence, remove your baby’s clothes and massage her using oil. Gradually add more strokes until the routine has developed into a 15–20 minute full-body massage (see pages 18–35), ending with stretches (see pages 36–39). INCORPORATING STROKES There are two ways of adding new strokes to your routine: ❖ Massage each part of the body – the front, back, head and face – incorporating more strokes into each section every time until you are using all the key techniques. ❖ Start on the front of the body (see page 18), move on to the back (see page 26), the head and face (see page 32), then add stretches. LIGHT TOUCH Initially, you may prefer to use light, delicate strokes to familiarize both you and your newborn baby to touch and massage. Use both hands in succession to make slow, light, rhythmical strokes with your finger tips on her arms and legs.Watch your baby’s reaction to this stroke. Some babies prefer a firmer touch straight away. NEWBORN BABIES EFFLEURAGE STROKES Babies find big, firm effleurage strokes reassuring. Use the whole of your palms and the flat of your fingers to stroke over your baby’s abdomen (see page 21), arms, legs and back. Ensure that one hand is always touching your baby. Before you start massaging any part of the body, place both hands on the part you intend to massage and ask your baby if you can begin. Observe her reactions to the massage constantly and respond appropriately. If you sit on the floor, raise your knees to reach your baby more easily IF YOUR BABY DISLIKES IT Some babies enjoy massage straight away; others take a few days to get used to each stroke. Massaging on consecutive days will help, as will massaging her when she is in the quiet-alert state (see page 15).To make her feel secure, place a rolledup towel around her head, from ear to ear. If she seems unhappy or cries, place still hands on the area you are massaging to comfort her. If she settles you can continue or try another stroke. If not, stop, wrap her in a towel, pick her up and give her a reassuring cuddle. Resume the massage once she has relaxed, or try again the next day. A CHILD PSYCHOLOGIST’S VIEW DANCE OF COMMUNICATION Babies have a strong motivation to connect with people. Even when your baby is very young, she will react to your voice and your touch, so use them to communicate your feelings for her. As she begins to recognize the things you do, she will respond to them in her own way. And as you learn to recognize her responses, and respond back, the two of you establish a ‘dance of communication’, long before your baby uses language. This ‘dance’ may start with the two of you gazing at each other, then move on to smiling at each other. Slowly, your baby will begin to imitate your expressions, until eventually, her communications become vocal and you begin to hear emerging words. To encourage your baby’s developing communication skills, keep the ‘dance’ alive. Give her sounds, words, expressions and caresses to respond to, and continue to return her responses.You will enjoy these ‘conversations’ as much as your baby does, especially as her progress becomes evident. By paying such close attention to her, you will also learn to recognize your baby’s rhythms – when she likes to be calm and quiet and when she wants to be stimulated.You can then respond to her appropriately. 71 MASSAGE FOR DIFFERENT AGE GROUPS 72 OLDER BABIES ❖ NCE YOUR BABY IS ROLLING OVER, sitting O massage him, you must be flexible. If he rolls up or crawling, you will find it hard to over from his back on to his front, for instance, give him a full-body massage, as he will rarely massage his back.This wriggling may continue lie still. Go with this. If you still want to until your child is two or three years old. MASSAGE, TOUCH AND COMMUNICATION Some older babies are happy to be massaged while sitting up.With your baby in this position, you can massage his arms (see pages 18–19), his back (see pages 26–29), and perform arm stretches (see below) – many babies enjoy these. If he resists massage, do not persist: he is telling you he does not want it. MASSAGE SITTING UP 1 Sit on the floor with your baby facing you. Stretch your baby’s arms straight out to the sides. Pull the arms outwards gently and hold the position for a few seconds. Cross your baby’s arms over his chest, with his right arm over his left arm. Repeat step 1, then cross his arms again, this time with left arm over right. Repeat steps 1 and 2 several times. 2 PHYSICAL CLOSENESS SEPARATION ANXIETY Although massage is a lovely way to be physical with your baby, it is important that you do not continue if he would rather not be massaged. You can find other ways of being close to him. Sing songs or rhymes that involve actions such as bouncing him on your knee. Or you can simply cuddle him on your lap. Around the time that massage becomes less possible, you may notice that your child begins to experience ‘separation anxiety’. He may cry each time you leave the room and want to be carried for long periods of time.This happens because he wants to feel secure in exploring the world and is testing his security – you. If you give him the feeling of security he needs now, it will help him to become confident and independent in time. Pick him up and take him with you if you move across or out of the room. Do not see this as a tie or a chore, but as an opportunity to be close and to help him feel safe. As your baby becomes older, he will start initiating communication. He will try and indicate to you what he does and does not like, by refusing the breast or a spoonful of food, for example. Respond to his communications in a way that makes it clear that he is understood. If he shows he is not enjoying a massage stroke, try another that you know he likes. At this stage of his development, he needs to know that you can understand what he is trying to express, and can give him what he needs from you. Use physical touch to let your baby know that you understand his needs, particularly if he shows anxiety about being separated from you Your baby’s needs will continue to develop – responding to them appropriately can be a challenge. During the first eight to nine months, he needs you to be consistent and reliable, so he knows you are there for him. A CHILD PSYCHOLOGIST’S VIEW RESPONDING TO HIS NEEDS If you respond consistently to your baby’s requirements, he will know he can rely on you to understand and meet his needs.This has a positive impact on his emotional and psychological development. A sense of security during infancy is the foundation for a healthy emotional life. OLDER BABIES COMMUNICATING THAT YOU UNDERSTAND HIS NEEDS MASSAGE FOR DIFFERENT AGE GROUPS TODDLERS ❖ HEN YOUR CHILD STARTS TO WALK, a W and having his hair stroked.When you talk to massage routine becomes impossible; him, touch his arm or leg gently. Stroke his it will be difficult to get him to sit still, let tummy or back as part of his bedtime routine, alone lie still.You can reintroduce massage together with kisses and cuddles. Play games when your toddler is two and a half to three and sing songs that involve touch, smiles and years old, depending on his personality. Until eye contact.You will enjoy giving him this then, communicate with him using other touch attention as much as he loves to receive it, techniques. He will love cuddles on your lap and he will know you love and value him. GROWING INDEPENDENCE ASSERTING HIS WILL To test his growing independence, your toddler will frequently try to assert his will. Often, parents mistake this behaviour as willfulness in the adult sense, and feel they have somehow failed in their parenting. But this is not the case. It is a natural step in every child’s development. However, toddlers often do not know what they want or what is best for them.That is why they need their parents to help them. LETTING HIM CHOOSE Even if he has enjoyed massage for many months, a toddler may suddenly decide “Not today”.This is fine.You have to insist on some things – a warm coat on a cold day, for instance – but massage can wait. Your toddler may allow you to massage parts of his body: his back, face or arms, until you find he is enjoying the process he initially refused. But if he continues to refuse, be sensitive to his wishes. 74 Cuddles, games and eye contact are valuable ways of showing your toddler that you love him and enjoy being with him THE MESSAGE OF TOUCH When you touch your child lovingly and play with her, you show her you are interested in her and how she feels.This assurance helps her maintain a secure attachment to you, which encourages her self-confidence. ROUTINES AND BOUNDARIES If your toddler lets you massage her and enjoys a certain stroke in particular, go ahead and repeat it. This shows her she can influence you, and that you notice what feels good to her. A little later in her development she may begin making demands for what she wants, using words such as “more” or “again”. This is a good time to establish boundaries.Your efforts to understand and respond to your baby’s needs reap rewards at this stage, as you must be able to distinguish between what she needs and what she simply wants in order not to deny your child anything essential.When appropriate, say “No”, but be prepared for her to test the boundaries. For example, she may try to extend her bedtime routine by asking for “one more story”.This is when parents know best – one or two stories are enough! Keeping boundaries and routines is part of good parenting – do it gently and clearly. TODDLERS A CHILD PSYCHOLOGIST’S VIEW Demonstrate to your child how to stroke your arm or leg, then let her do it to you COPY CATS Toddlers enjoy imitating what adults do – this is one of the ways they learn about the world. Just as your toddler likes to imitate you cooking, washing up or driving, she may enjoy imitating massage. If she does, encourage her to ‘massage’ you. Later she may like to massage her teddy bear, or help you massage her baby brother.This teaches her that positive touch is as normal a part of life as washing up or driving. 75 76 EASING COMMON PROBLEMS ❖ IT IS UNLIKELY THAT YOUR CHILD WILL PASS THROUGH INFANCY AND EARLY CHILDHOOD WITHOUT ENCOUNTERING SOME OF THE MINOR AILMENTS, OR OTHER SOURCES OF DISTRESS, THAT ARE COMMON TO THESE AGE GROUPS. BABY MASSAGE CAN HELP TO EASE THE PAIN AND DISCOMFORT CAUSED BY SOME OF THESE PROBLEMS, BUT EVEN WHEN IT DOES NOT, MANY PARENTS OFTEN FIND IT WORKS WELL AS A COPING STRATEGY WHEN A CHILD IS UNWELL. IT ALLOWS YOU TO FEEL YOU HAVE TRIED YOUR BEST TO HELP. BABIES SENSE THIS CONCERN, AND CAN BE COMFORTED BY IT. ❖ EASING COMMON PROBLEMS COLIC & WIND ❖ C OLIC CAN START when a baby is five days old and continue daily until he is helpless, exhausted and very distressed 12 to 14 weeks old.The baby feels a severe themselves.They may also feel disillusioned, abdominal pain that nothing seems to ease, as the reality of colic is far from the vision of causing him to cry for long periods of time. parenthood they might have had. Certain Commonly, the crying is worse during the massage strokes can help to relieve colic evenings. Babies with wind experience similar temporarily or expel wind. By bringing some pain and often cry until the wind is passed. relief to their baby, parents may also feel more After carrying a distressed and inconsolable able to cope with the ongoing situation. COPING WITH COLIC SIGNS AND SYMPTOMS Typically, babies with wind or colic: ❖ are difficult to wind ❖ become fretful when lying on their backs ❖ bring their knees up to their chests frequently ❖ are less distressed when held in an upright position ❖ arch backwards ❖ have a distressed cry that does not stop when they are picked up, or stops, then recommences. THINGS TO TRY 78 baby around for hours, parents often feel As each baby is different, techniques that relieve one baby may not work for another. You could try: ❖ holding positions (see opposite) ❖ carrying your baby positioned over your shoulder AND WIND ❖ movement – putting your baby in to a rocking baby seat or rocking him in your arms, walking him around in a sling, pushing him in a pram or taking him for a drive ❖ giving him a deep, warm, relaxing bath; take him in the bath with you – this may calm you both ❖ over-the-counter medication ❖ homeopathic remedies ❖ cranial osteopathy. SUCKING Windy and colicky babies like to suck, as this reduces pain. It provides a distraction and also helps the body to produce endorphins, which help to relieve pain naturally. Some babies like to suck on a dummy; others prefer their own or a parent’s finger. As sucking offers temporary relief, some parents feed their babies very frequently, especially if breastfeeding. Once breast-feeding is established, stick to two- or threehourly feeds to allow time for digestion. Cooled boiled water, from a spoon or a beaker, may help to bring up wind before a feed. RESEARCH EVIDENCE Research has found that colic can damage parent-baby relationships. Parents lose confidence as their efforts to soothe their colicky baby are fruitless. Because they feel inadequate, when their baby expresses a need, they respond with confusion rather than positive action. Massage can relieve colic temporarily, but it can also aid in breaking the cycle of ineffectuality, as parents feel their actions do, in some way, help their baby. FOR PAIN RELIEF There are various massage strokes (see pages 80–81) that may ease your baby’s colic or help him to pass wind. Perform the strokes when he is not distressed, or at least, not too distressed. If lying on his back increases your baby’s pain, place him on your lap, with his head by your knees and his feet by your hips, and raise your knees so he is lying at an angle.You can massage him with his clothes and nappy on, but you may achieve better results if he is naked.Wait for at least 30 minutes after a feed before you massage.The holding positions shown here may also bring temporary relief to babies with colic or wind. COLIC & WIND TECHNIQUES HOLDING POSITIONS BOUNCING YOUR BABY ON YOUR ARM Stand with one arm outstretched and place your baby on your forearm, with his head nearest to your hand and his legs straddling your upper arm. Position your free hand firmly on his back to keep him steady. Press the heel of your lower hand into his abdomen, just below the ribs. Now bounce your outstretched arm up and down gently.This may relieve your baby’s stomach pain and bring up wind. CARRYING YOUR BABY UPRIGHT Stand and hold your baby upright against your chest, facing outwards. Position one arm around him across his abdomen, below his ribs, to support his weight. Place your free hand over his nappy between the front of his thighs to help keep him balanced. Walk around, bouncing gently, or bounce on the spot.This may relieve pain in your baby’s stomach and gut and bring up wind. You may find it easier to position his bottom on your hip so your arm does not support all his weight. 79 AND WIND ▲ EASING COMMON PROBLEMS STROKES TO EASE COLIC 1 MASSAGING THE SIDES OF THE ABDOMEN Position your baby on his back with his feet nearest to you. Place your hand on one side of his abdomen, fingers pointing downwards. Pull the flesh up towards the navel, then repeat the stroke with your other hand. Continue in this way, using both hands consecutively in a rhythmic action, then repeat on his other side.This helps to empty the stomach of its contents. LITTLE CIRCLES AROUND THE NAVEL Hold the first two fingers of one hand together and place them next to your baby’s navel. Press gently, making a circular motion, then release the pressure. Slide your fingers clockwise around the navel a few centimetres and repeat. Continue in this way, spiralling outwards until you reach the inside of your baby’s right hip (see page 21).This stroke moves the contents of the small intestine along the gut.Working in a clockwise direction follows the natural flow of the gut. 2 ▲ CYCLING MOVEMENTS WITH THE LEGS Hold your baby’s ankles and bend one knee up to his abdomen, then straighten the leg. As you pull it straight gently, bend his other knee up to his abdomen. Repeat this ‘cycling’ movement slowly and rhythmically a few times.This motion can help your baby to expel wind. 4 80 LARGE CIRCLES AROUND THE ABDOMEN Place your hand on your baby’s abdomen, just inside his right hip. Stroke up firmly with the flat of your fingers and your palm until you reach the right side of the rib cage. Leading with your fingers, stroke across the diaphragm to the same point on your baby’s left side. Now stroke down to just inside his left hip, then across the base of the abdomen to the starting position (see page 21). Repeat several times.This stroke encourages the contents of the colon to move forwards. 3 6 MASSAGING THE BASE OF THE SPINE Turn your baby over to lie on his front, with his feet nearest to you. Place the heel of your hand in the dimple just above the centre of his buttocks. Move the heel of your hand in a clockwise direction, pressing gently. Repeat several times. This stroke helps your baby to expel wind. CASE HISTORY “David got colic and cried a lot, so I took him to a baby-massage session at our local child health clinic, hoping it would help. It did.When I put him on the floor to massage him, he immediately cried.The health visitor showed me a way of holding him on my forearm, with my hand pressing into his stomach, and when I did this, he stopped crying straight away. All the mothers, myself included, were very impressed. I use this ‘miracle cure’ often when David cries with colic now.” COLIC & WIND BENDING THE KNEES SIMULTANEOUSLY Take hold of your baby’s ankles, one in each hand. Bend both his legs to bring his knees up to his abdomen. Hold his legs in this position for a few seconds, then straighten them gently. Repeat slowly several times.This action may help to relieve abdominal pain caused by wind. 5 EASING COMMON PROBLEMS 82 CONSTIPATION ❖ F ROM TIME TO TIME, your baby may suffer from constipation. Massaging her clothed, but is more effective if she is naked. Allow at least one hour after a feed before abdominal area can be an effective way of performing the strokes shown here. For this both relieving and preventing this.The massage sequence, lie your baby on her back massage can be done when she is fully with her feet nearest to you. COPING WITH CONSTIPATION SIGNS AND SYMPTOMS THINGS TO TRY ❖ SENSIBLE ADVICE ❖ NO STOOLS Besides abdominal massage, there are other options you should consider to relieve constipation or to prevent it from occurring: ❖ PLENTY OF FLUIDS Make sure your baby is drinking enough fluids. Freshly-squeezed orange juice can help to move the bowels. Give your child two to four fluid ounces of diluted orange juice a day. Squeeze some oranges, strain the juice and dilute it to a ratio of one part orange juice to four parts boiled and cooled water. ❖ A HEALTHY DIET Does your baby’s diet include all she needs to prevent constipation? Up to four months, she should have breast or formula milk and juices. From four months, give her baby rice, cornmeal, pureed fruit and vegetables and stewed dried fruit. From six months, introduce cereals, pulses and other grains gradually. Fibre and fluids help prevent constipation, but do not omit fat from the diet. Ask your health visitor for advice if necessary. Constipation can be a common problem with babies and young children. If it occurs, it tends to be recurring.Your doctor or health visitor will be able to give you useful advice and support in coping with a constipated baby. A constipated child will frequently strain to pass a stool, but does not always achieve it. ❖ HARD STOOLS When a stool is passed, it is hard, often resembling a solid pellet. ❖ CRYING A hard stool can be painful to pass, so babies often cry just before and while passing a stool. ❖ TIME LAPSE BETWEEN STOOLS If your child has not passed a stool for over three days, it is possible that she is constipated. It is normal for babies and young children to pass stools three times a day, and also normal not to ‘go’ at all for up to three days, and sometimes even longer if they are being breast-fed. ❖ STRAINING Although it is a sign of constipation, ‘straining’ is not always a reliable indicator, as babies often go red in the face when pushing out a stool. If your child strains when passing a stool, then passes a soft, wellformed one, she is not constipated. CASE HISTORY “Rhian first became constipated when she started on solids. I tried giving her diluted orange juice as well as breast feeds, and stewed prunes and apricots, but nothing seemed to help. I found it very upsetting seeing her straining so much. Sometimes, she did not pass a stool for five or seven days. My sister massaged her children and offered to show me some strokes on the tummy which she felt might help. Amazingly, it worked! I would massage her tummy and then, when she started to strain, bend her knees up to her tummy and bring them back down again. I now use the massage each time Rhian is constipated, and also regularly to try and prevent it.” 1 LARGE CIRCLES AROUND Starting just inside the right hip, move your flat fingers and palm up to the right side of the rib cage, then across to the same point on the left side. Stroke down to just inside the left hip, then along the base of the abdomen to the right hip. Repeat several times.This shifts the contents of the colon. LITTLE CIRCLES AROUND THE NAVEL Place the first two fingers of one hand next to the navel. Press gently, making a circular motion, and release. Slide the fingers around the navel slightly and repeat.Work in a clockwise direction, spiralling outwards until you reach the right hip. This follows the flow of the small intestine, moving its contents along the gut. 3 CYCLING MOVEMENTS WITH THE LEGS Hold your baby’s ankles and bend one knee, bringing it up towards her abdomen. Now pull the leg gently until it is straight, and bend her other knee up to the abdomen as before. Repeat this ‘cycling’ motion slowly and rhythmically several times. This action may encourage a bowel movement. 2 THE ABDOMEN C O N S T I PAT I O N STROKES TO EASE CONSTIPATION 4 BENDING THE KNEES SIMULTANEOUSLY Hold your baby’s ankles and bend both her knees at the same time, bringing them up towards her abdomen. Hold her legs in this position for a few seconds, then pull them down gently until they are straight. Repeat slowly a number of times.This technique can help to open your baby’s bowels. 83 EASING COMMON PROBLEMS FRACTIOUS CRYING ❖ B ABIES CRY ON AVERAGE for two hours in every 24. Often, the cause of distress is some cases, nothing soothes screaming babies, obvious and easily remedied, but at other which can be most frustrating for parents. times, it can be unclear.Whatever the reason, Massage may calm your crying baby, but even if your baby cries, pick him up and cuddle if it does not, you could find that, between him.The results of research studies indicate bouts of crying, both you and your baby enjoy that the quicker a parent responds to a crying massage and are relaxed by it. COPING WITH A CRYING BABY REASONS FOR DISTRESS ❖ BATHING Typically, babies cry because they: ❖ are hungry ❖ need a nappy change ❖ desire a cuddle ❖ are tired and need to sleep ❖ want a change of position/scene ❖ are over-stimulated ❖ feel pain or are uncomfortable. Water can be soothing, so try giving your baby a bath. ❖ HANDING HIM OVER If you are tense, your baby may sense this and cry more. He may relax if he is held by someone else, which also gives you a chance to rest. ❖ SWADDLING Being contained can make babies feel secure. It is important that his arms are bent, with hands placed up by the mouth so he can selfsoothe by sucking his fingers. THINGS TO TRY ❖ PHYSICAL CLOSENESS 84 baby, the sooner the child stops crying. In Babies may be soothed by cuddling. Sing to your baby while holding him. You may feel it is wrong for your baby to fall asleep in your arms. Do not worry about this – responding to his needs is more important. ❖ MOTION Walk your baby around the house in your arms or a sling. Push him in a pram, or take him out for a drive. ❖ DISTRACTIONS Try distracting your baby with a mobile, a musical toy, or a peep at the world through the window. INCONSOLABLE BABIES If your baby cries for long periods, and you do not know why, your confidence may be undermined and you may feel upset, frustrated and tired. If you feel angry with your baby for crying, or overwhelmed, put him in a safe place, such as his cot, and take a few minutes away to calm down. Contact your doctor or health visitor for advice. RESEARCH EVIDENCE Some parents may feel it is wrong to respond to a baby each time he cries, as this might ‘spoil’ him and give him unrealistic expectations of life. Recent research suggests that this point of view is counterproductive.The results of one study state that crying babies are soothed when lifted on to a caregiver’s shoulder, and that they also become visually alert, showing that this attention is nurturing. Investigation into child psychology has established that by responding to a baby’s needs, parents actually help to build his confidence (see pages 72–73). Nature also supports these theories: the same study reports that mothers are naturally compelled to attend to their crying babies and to stay close until they are calm.The study also found that mothers can distinguish a ‘pain’ cry from a less serious one. And it is also true that most adults want to ‘do something’ about a crying baby. FOR FRACTIOUS BABIES If your baby is accustomed to massage, you may be able to use it to help him calm down when he is crying. If he has not been massaged before, massage him a few times between bouts of crying to familiarize him with the strokes. Try using the strokes that you know he usually enjoys most of all. Effleurage strokes are soothing and reassuring, as they are long, firm and rhythmical.The strokes shown below concentrate on the abdomen and the back of the baby, but you can also try effleurage strokes on the front and back of the legs (see pages 22 and 31), as well as on the arms (see page 18). If your baby continues to cry, stop the massage, wrap him in a towel to keep him warm, and pick him up.You may be able to massage him between bouts of crying, but do not try it if he becomes distressed. Hold your baby to comfort him when he is crying, and try to distract him from his distress by singing a song or showing him a toy or colourful object 1 EFFLEURAGE STROKES DOWN THE ABDOMEN Position one hand across the abdomen, below the chest. Stroke down to the base of the abdomen, placing your other hand in the starting position as you do so. Just before the first hand lifts off, begin the stroke as before with the second hand. Repeat several times, with one hand always in contact with your baby’s body. 2 EFFLEURAGE STROKES DOWN THE BACK Place one hand across the back, just below the neck, and stroke down until you reach the bottom. Place your other hand in the starting position before the first hand lifts off. Stroke down as before with the second hand. Repeat several times. CASE HISTORY “I took Laura to the crying clinic at four weeks. She had been crying almost continuously since she was two days old. By this time I was exhausted (as she wasn’t sleeping much) and at the end of my tether.The health visitor came to see us at home.When Laura wasn’t crying, she showed me how to perform a full-body massage on her. I could see almost instantly that Laura loved it. Now I massage her a few times a week, and when she cries – it usually calms her down. She is much happier these days, and sleeps better. I think the massage really helped her.” F R AC T I O U S C RY I N G MASSAGE EASING COMMON PROBLEMS TEETHING ❖ M OST BABIES EXPERIENCE pain or discomfort when their teeth come these strokes before teething begins if possible, so that your baby is familiar with them and through, as their gums become swollen. allows you to perform them on him when his Massage helps because pressure can soothe gums are uncomfortable. Also, try performing swollen gums.The strokes shown here may a full-body massage on your baby: this ease your baby’s teething pain temporarily, and stimulates the production of endorphins in encourage him to relax if he is fretful. Practise his body, which may help to alleviate pain. RECOGNIZING TEETHING SIGNS AND SYMPTOMS Babies who are teething may: ❖ chew their fingers or put them in their mouths ❖ have red cheeks ❖ experience a temperature ❖ suffer from red or inflamed gums ❖ have red skin in the nappy area. CASE HISTORY “I took Rebecca to baby-massage classes when she was six weeks old. A couple of the strokes the teacher showed us involved pressing the gums through the skin, above and below the lips. She said these strokes might ease teething pain.When Rebecca began teething, I tried those strokes. She enjoyed them and stopped being grizzly for a while afterwards, smiling and laughing again. I think they distracted her from the pain.” 86 1 CIRCLES ON THE UPPER GUM LINE Place your thumbs next to each other on the dip above the top lip. Press gently with each thumb making a small, circular motion, then release the pressure. Move your thumbs outwards a little and repeat. Do this along the length of the upper lip, continuing along the top jaw line to the sides of the ears. CIRCLES ON THE LOWER GUM LINE Position your thumbs next to each other just below the centre of your baby’s lower lip. Press gently, making small circular movements with your thumb, then release. Slide your thumbs outwards a little way and repeat. Work along the length of the gum line in this way, then continue along the lower jaw line and up to the sides of the ears. 2 D RY S K I N DRY SKIN ❖ S OMETIMES BABIES ARE BORN with dry, flaky skin on the face, hands, feet, or all over allow it to penetrate the skin deeply. Use a natural oil such as almond oil. Rub it into the the body. In other cases, patches of dry skin affected area once or twice a day. If you are develop over time, typically on the elbows, oiling your baby’s face, avoid the eye area. upper arms, nappy area or between the Consult your doctor if the dry skin does not eyebrows. Regular oiling usually clears the clear within a few days, or if it becomes red, problem and by massaging the oil in, you inflamed, or worse in any way. OILING YOUR CHILD’S SKIN Olive, sunflower or grape-seed oil are good for dry skin. Place some on your hands, rub them together, and glide them over the affected area. Avoid oils that contain nut products, especially if there is a history of nut-allergy in your family. Dry skin may indicate sensitive skin, so watch for reactions to creams, soaps and detergents, and switch to a non-biological washing powder. CASE HISTORY “Daniel was a little overdue. When he was born, he had very dry skin all over his face and body. I was surprised at how scaly his skin was. My daughter also had dry skin when she was born, but not nearly as bad as Daniel’s. I rubbed almond oil into his skin twice daily from when he was a few days old. I had already massaged my daughter, so I knew oil was good for dry skin. Daniel’s skin soon became soft and velvety.” Rub oil gently into the affected areas with firm, gliding strokes CRADLE CAP AND ECZEMA Massaging a natural oil into the skin can relieve dry-skin conditions such as eczema and cradle cap. With cradle cap, massage a natural oil into the scalp daily, allowing the skin to absorb the oil.The dry skin eventually lifts away from the scalp. Brush it gently with your fingers, or run a comb through your baby’s hair to help shift loosened dry skin. If your baby has eczema, massage oil into her skin to moisturize it. Do not massage the skin if it is broken, cracked, inflamed or very red. If you suspect your child has eczema, seek medical advice. 87 “ Massage is simple in terms of technique, yet powerful in what it conveys : your love, understanding and attention” QUESTIONS & ANSWERS QUESTIONS & ANSWERS ❖ Q A Can I massage my baby when he has his clothes on? Q A Should I continue to massage my baby if he has a cold or fever? Q A If my child has a cut or a bruise, should I stop massaging her? Yes, particularly if he is newborn and if you feel both of you would like to be introduced to the massage strokes slowly. But do try and progress to removing his clothes. Children gain from any positive touch, but skin-toskin contact – your bare hands against your baby’s skin – is the most beneficial. Avoid massaging your child if he has a fever or cold. Many children do not want a massage when unwell, but enjoy lots of reassuring strokes and cuddles. Avoid the bruised or cut area, which may be sore and painful to the touch. If your baby has a scar, do not massage the area until the scar has healed. But do continue to massage other areas of her body. Q A 90 My baby has eczema. Can I massage him? Yes you can. Use a natural oil, such as olive or sunflower oil, to moisturize your baby’s skin. Choose organic oil if possible. If his skin is cracked or broken, do not massage the area until it has healed. Q A Is massage recommended for asthmatic children? Q A Can I use essential oils to massage my baby? An asthmatic child can benefit from massage, especially if the condition is stress or anxiety related. Massage may help her to relax, which could prevent asthma attacks or reduce their severity. Never massage your child during an attack, but do give her reassuring strokes on her arms, legs or head to help her feel less frightened. It is not advisable to use essential (aromatherapy) oils on babies or young children. Few essential oils are suitable, and those that are should be diluted in a base oil. Never use any essential oil on your child unless instructed by a trained aromatherapist. My child has very sensitive skin and is allergic to washing powders and soaps. Is it safe to use oil? What type of oil should I use? Q A natural oil is less likely to irritate sensitive skin than a synthetic variety. Select a light oil such as sunflower or apricot oil, choosing an organic variety if available.The more naturally the oil is produced, the better. Before using any oil, make sure you carry out a patch test on your child (see page 15) to ensure she is not sensitive to the oil you choose. A My baby is allergic to nuts.Will she be affected if I massage her with a nut oil? Q Do not use a nut oil under any circumstances as it may well affect your child.Try a natural oil such as grape-seed or olive oil. Some vegetable oils may contain nut products, so before using any oil, make absolutely certain that it is free of these. If the ingredients label is unclear, contact the manufacturer for further information. Once you have chosen an oil, make sure you perform a patch test on your baby (see page 15) to eliminate the possibility of sensitivity. If you have any doubts, massage your baby without oil – it is the loving touch you give her that is most important. A Q A My baby has recently had surgery. Is it safe to massage her? Check with your surgeon before massaging your baby post-operatively. In many cases, once a child has recovered from surgery, massage is very beneficial to the baby and her parents.The touch is soothing to the child, and massaging their baby helps parents overcome anxieties about handling an infant in a delicate state. Avoid massaging the general area of the operation until the scar has healed – your doctor can give you more advice on this. QUESTIONS & ANSWERS QUESTIONS & ANSWERS QUESTIONS & ANSWERS ❖ Q A My baby often falls asleep when I massage her. Is this bad? Some babies do fall asleep during massage, especially if snuggled up to their parent.This is fine until your baby is about four months old, after which time you should help her fall asleep with less and less physical contact, so she can put herself back to sleep when she wakes up in the night. If she is accustomed to falling asleep during massage, she is unlikely to go back to sleep alone. How can I tell if I’m using the right or wrong pressure for my massage strokes? Q Your baby’s skin will redden if the pressure is too firm.This is obvious on fair-skinned children, but be aware that it is less obvious on dark skin. If your child cries, pulls away or seems uncomfortable when you massage her, it may be that you are using too much pressure. Be aware of using too little pressure – this will give your child a tickling sensation. If you are unsure, use the pressure you would apply to rub cream into your face. A Q A 92 I have just had a Caesarean.When can I start massaging my baby? As soon as you feel you are able to. It may be hard to find a comfortable sitting position for massage, so keep the sessions short until your scar has healed. I have a bad back and find the massage positions on the floor uncomfortable.What should I do? Q Your back pains may be caused by incorrect posture. When sitting on the floor, ensure you keep your back straight and bend forwards from the hips. Sitting on more cushions may help you to do this. If the floor is too uncomfortable, sit on a chair with a towel across your lap and your baby on the towel. Always keep one hand on your baby so she does not roll or slip off your lap. However, this position will not be safe once she is moving, rolling over or is too big for your lap. A When I massage my young baby, my toddler becomes jealous.What can I do about this? Q It is not unusual for a toddler to be jealous of a young sibling, especially if physical contact is involved. If your toddler would like to be massaged herself, make a regular time for it, when your baby is asleep or settled, so she feels she gets the same special attention from you as your baby does. Or ask her if she would like to ‘help’ you massage the baby. Show her how to rub oil gently into the baby’s arms and legs, then praise her for doing it well. Perhaps she would enjoy massaging ‘her baby’ – a favourite teddy bear or doll – while you massage yours. A Q A I recently adopted a toddler. Can massage help us to bond? Massage may certainly be one of the ways in which you establish a bond between you and your child. Before you begin, you must familiarize yourself with what the toddler does and does not like. Some children do not like to be touched, particularly by people they do not know well. Be warm, open and approachable.When he comes to you by himself, you will know that he is comfortable being close to you. At this point, start to touch him more and more. Stroke his hair, put your hand on his shoulder or an arm around him when you talk to him, especially if you are telling him what a good boy he is. Start to massage him when you feel confident that he can relax and enjoy it. My child is close to the end of her toddlerhood. Is there an age when I should stop massaging her? Q The time to stop massaging your child is when she gives you the cue. If she seems to be losing interest and often wriggles, sits up, rolls over or walks away during massage; if she cries or asks you not to do it, then respect her wishes and stop. If she continues to enjoy it, massage her for as long as you like, even into adulthood – it can be a special time of closeness between you then, too. A INDEX INDEX ❖ A abdomen circular strokes 21, 46, 80, 83 and colic 80 and constipation 82–3 effleurage strokes 21, 85 see also tummy massage Achilles’ tendon 24 adopted child 92 African massage 54–5 allergies 14, 15, 87, 90 see also nut oil apricot oil 90 arm and leg stretch sequence 38–9 arms and hands 18–19 effleurage strokes 18 Indian massage 53 stretching 36–7, 38–9 wringing 19 aromatherapy oils 14, 90 asthmatic children 90 B 94 back 26, 28 base of spine 29, 81 effleurage strokes 26, 85 Indian massage 53 back of baby 26–31 back pain (parent) 92 see also posture bathing 84 massage after 16, 42–3, 54 benefits for babies 12 for parents 7–8, 12 for premature babies 65 for special needs children 56, 57 for toddlers 49 birth-weight, low 12 body-awareness 12, 58 bonding 68 adopted child 92 and premature babies 62, 65 see also smiling/talking bottom 30 breast-feeding 78 buttocks 30 C Caesarean 92 cancer 14 cautions 14, 55, 65 Cerebral Palsy 56, 58–9 cheek bones 33 chest 18, 20 chin 35 circular strokes 20, 21, 30, 46, 80, 83 feet 23 jaw line 34, 86 spine 27, 29 clothing 79, 82, 90 coconut oil 52 colic 78–81 communication 12, 57, 64, 73 constipation 82–3 cradle cap 87 cranial osteopathy 78 crossing, legs and arms 36–7 crying 7, 84–5 colic 78 constipation 82 cuddling 47, 65, 74, 84 cuts/bruises 90 D dangling 55 diet 82 distraction 84 distress, reasons for 84 Down’s Syndrome 56, 57 dry skin 87 see also moisturizing dummies 78 E ears 35 eczema 87, 90 effleurage strokes 18, 21, 26 after bathing 43 finishing strokes 25, 31, 39 newborn babies 70–1 endorphins 78, 86 essential oils 14, 90 eye contact 12, 18, 25, 66, 74 see also smiling/talking F face 33, 47, 53 feet 23–4, 45, 58 fever/cold 14, 90 fingers 19 see also hands finishing strokes 25, 31, 39 fluids 82 forehead 33 frequency of massage 16 front of baby 18–25 GH games 48–9, 74 grape-seed oil 14, 87, 90 gums 86 hands 19, 49, 53 head 32, 35, 47, 53 holding positions, for colicky baby 79 homeopathic remedies 78 hot press 54 I illness 12, 77–83 see also fever/cold inconsolable babies 84, 85 incubator 62, 65 independence, child’s 74 Indian massage 52–3 JK jaw line 32, 34, 86 jealousy of sibling 92 joints, flexibility 8, 12, 36 kernel oil 54 L lap, massage on 53, 55, 63, 69, 79 legs 45, 49 bending/cycling movements 80, 81, 83 effleurage strokes 22, 31 stretching 37–9 wringing 23 see also Cerebral Palsy M mealtimes 79 medication 78 moisturizing 42, 55, 87 motion, calming 84 muscle tone 8, 12 and special needs, children 56, 57, 58 mustard-seed oil 52 N nappy changing 44–5 newborn babies 16, 68–71 Nigerian massage 54, 55 no cues 16, 64 nut oil 14, 87, 90 O oils 14 African massage 54 and dry skin 87 Indian massage 52 natural and synthetic 14, 90 see also allergies older babies 72–3 older children 92 see also toddlers olive oil 14, 87, 90 PQ pain relief 12, 77 colic 78, 79–81 palm oil 54 parent-child relationship 7–8, 12, 78 patch test 15, 90 physical closeness 12, 72, 84 see also cuddling; touch physical growth 12 positions for massage (parent) 16–17,52–3, 69 postnatal depression 8 posture 15, 17, 53, 69, 92 premature babies 12, 62–5 preparing to massage 14–15 pressure of strokes 16, 18, 56, 63, 70, 92 R rashes 15 relaxation 55 and asthmatic children 90 before massage 16 of parents 12 room temperature 15, 16 rotating, arms 37 routines bedtime 47 and boundaries 75 and massage 70 S self-confidence 12, 49 self-soothing 84 sensitivity, parents developing 12 sensory impairment 56, 57 separation anxiety 72 shea butter 54 shoulders 26, 28 sides 28 sitting, child 43, 72 skin irritation 15 sleep 46–7, 84, 92 smiling/talking 18, 25 see also bonding special needs, children with 12, 56–9 spine 27, 29, 81 squeezing 35 still touch 62, 65 straining (constipation) 82 stress/anxiety 90 stress cues 64 stretches 36–9 African massage 55 Cerebral Palsy 59 Indian massage 53 toddlers 48 sucking 78 sunflower oil 14, 87, 90 surgery, massage after 90 swaddling 42, 84 synthetic oils 14, 90 T teething 86 television 15 temperature 14, 90 temples 33 toddlers 48–9, 74–5 touch, importance of 7, 9, 45, 62, 65, 75 see also still touch tummy massage 44, 46 see also abdomen INDEX see also effleurage strokes pulling fingers 19 sides 28 toes 24 quiet-alert state 15 UVWY umbilical cord 52, 69 vegetable oils 90 visual impairment 56, 57 well-being 12 see also illness wind 78–81 wringing arms 19 legs 23 yes cues 16 RESOURCES & USEFUL ADDRESSES Every family with a child under five years old in Britain has access to a health visitor. She or he can offer advice and support, from the antenatal period onwards, on family health, local services and issues concerning parenting. If you are unsure of who your health visitor is, contact your local health clinic or doctor’s surgery. Also, your local library will have a list of groups, clinics and advice centres in your area. Active Birth Centre 25 Bickerton Road London N19 5JT Tel: 020 7281 6760 www.activebirthcentre.com The Active Birth Centre is renowned for its innovative work with expectant and new parents.A list of Active Birth teachers and an information pack are available from the centre on request. National Childbirth Trust Alexandra House Oldham Terrace London W3 6NH Tel: 0870 4448707 www.nct.pregnancyand babycare.com The Trust provides free literature on subjects such as pregnancy, childbirth and early parenthood. Details on local support groups are also available. La Leche League of Great Britain 27 Old Gloucester Street London WC1N 3XX Tel: 020 7242 1278 www.lalecheleague.org The League holds a list of local counsellors that are available nationwide to offer mothers free advice on breast-feeding. The Osteopathic Centre for Children 109 Harley Street London W1N 1DG Tel: 020 7486 6160 www.occ.uk.com This registered charity offers paediatric osteopathy, which can be beneficial to newborns and children with a wide range of problems, such as colic, asthma and recurrent ear infections, as well as for children with special needs. NHS Direct Tel: 0845 4647 This 24-hour nurse-led telephone helpline provides information on health problems and services for all ages.Where the service is not available, advisors can refer you to local helplines. Parentline Tel: 0808 8002222 This national network of helplines gives advice on family and step-family relationships. IAIM (International Association of Infant Massage) 56 Sparsholt Road, Barking, Essex IG11 7YQ Tel: 07816 289788 www.iaim.org.uk This world-wide organisation promotes nurturing touch and the parent-child relationship through training, education and research.The certified infant massage instructors work in hospitals and the community with individuals and groups. Contact directly for a list of local classes or instructors or for more information. National Council for One Parent Families 255 Kentish Town Road London NW5 2LX Tel: 0800 0185026 www.oneparentfamilies. org.uk Offers free publications to lone parents on housing, benefits, maintenance, divorce, pregnancy, holidays, returning to work and other practical matters. Health issues are not covered, but advisors can refer callers on to relevant sources. 95 R E F E R E N C E S & AC K N OW L E D G M E N T S REFERENCES page 12 “...babies who are touched lovingly become ill and cry less often than those who are not.” Informed by ❖ G.S. Liptak, et al, ‘Enhancing Infants’ Development and Parent-Practitioner Interaction with Brazelton Neonatal Assessment Scale’, Pediatric, July 1987, vol. 72, no. 1, p. 71–78. ❖ E.S. Haris, et al, ‘Quality of Mother Infant Attachment and Pediatric Health Care Use’, Pediatric, August 1989, vol. 84, no. 2, p. 248–54. ❖ D. Iwaniec et al, ‘Helping Emotionally Abused Children who Fail to Thrive’, Early Prediction and Prevention of Child Abuse, edited by K. Brown, et al, Wyley & Sons, 1991. ❖ S.K. Dihigo, ‘New Strategies for the Treatment of Colic: Modifying the Parent/Infant Interaction’, The Journal of Pediatric Health Care, 1998, vol. 12, no. 5, p. 256–62. “A research study was carried out...with fathers and their babies...” Informed by ❖ K. Scholz & C.A. Samuels, ‘Neonatal Bathing and Massage Intervention with Fathers, Behavioural Effects 12 Weeks after Birth of the First Baby: The Sunraysia Australia Intervention Project’, International Journal of Behavioural Development, 1992, vol.15, no.3, p. 67–81. page 45 “...positive touch given in addition to routine handling...” Informed by ❖ E. Lozoff et al, ‘The MotherNewborn Relationship: Limits of Adaptability’, The Journal of Pediatrics, July 1997, vol. 99, no. 1, p. 1–12. ❖ L. Casler, ‘The Effects of ExtraTactile Stimulation of a Group of Institutionalised Infants’, Genealogy and Psychological Monograph, 1965, vol. 71, p. 137–75. Cited in G. Westland (1993), ‘Massage as a Therapeutic Tool: Part 1’, British Journal of Occupational Therapy, vol. 56, no. 4, p. 129–34. page 62 “A research study was conducted in 1995 in the USA...” Informed by ❖ Lynda Harrison, Linda Olivet, Kathy Cunningham, Mary Beth Bodin and Cindy Hicks, ‘Effects of Gentle Human Touch on Preterm Infants: Pilot Study Results’, Neonatal Network, March 1996, vol. 15, no.2, p. 35–42. ❖ D. Nelson, et al, ‘Effects of Tactile Stimulation on Premature Infant Weight Gain’, Journal of Obstetric, Gynaecological and Neonatal Nursing, May/June 1986, p. 262–67. ❖ T. Field, et al, ‘Massage of Preterm Newborns to Improve Growth and Development’, Pediatric Nursing, November/December 1987, vol. 1, no. 6, p. 385–87. ❖ R.C. White-Traut & M.B. Goldman, ‘Premature Infant Massage – Is It Safe?’, Pediatric Nursing, 1988, vol. 14, no. 4, p. 285–89 ❖ L. Paterson, ‘Baby Massage on the Neonatal Unit’, Nursing, December 1990, vol. 4, no. 3, p. 19–21. page 78 “...colic can damage parent-baby relationships.” Informed by ❖ S.K. Dihigo, ‘New Strategies for the Treatment of Colic: Modifying the Parent/Infant Interaction’, The Journal of Pediatric Health Care, 1998, vol. 12, no. 5, p. 256–62. page 84 “...the quicker a parent responds to a crying baby...” Informed by ❖ E. Lozoff et al, ‘The MotherNewborn Relationship: Limits of Adaptability’, The Journal of Pediatrics, July 1997, vol. 99, no. 1, p. 1–12. “...this point of view is counter-productive.” Informed by ❖ I. St. James-Roberts, et al, ‘Stability and Outcome of Persistent Infant Crying’. Infant Behaviour and Development, 1998, vol. 21, no. 3, p. 411–35. “...crying babies are soothed when lifted on to a caregiver’s shoulder....mothers are naturally compelled to attend to their crying babies... mothers can distinguish a pain cry...” Informed by ❖ E. Lozoff et al, ‘The Mother-Newborn Relationship: Limits of Adaptability’, The Journal of Pediatrics, July 1997, vol. 99, no. 1, p. 1–12. Julie Fisher, whose fun, calm and relaxed manner resulted in beautiful pictures. Alan Heath: For their help, support, patience, guidance and advice, I would like to thank Drs. Eve Rossor, Gill duMont and Aideen Naughton, and Annie Humphris, Jane Thorpe, Janet Abbot, Christine Prior, Geraldine Finney and Jane Schofield. Nicki Bainbridge,Georgie Caine, Allen and Tanis Clarke, Ziz and Zoe Chater, Carey Combe and Cordelia Hawkins, Arden Devine, Mysanwy and Chen Dew, Lee-Ann and Amirah Edwards, Thor and Jasper Haley, Donna Harding and Star Epiphany, Margarita Foncenada and Gabriella GrantFoncenada, Lisa Greenspan and Silas Parker, Ophelia Jackson, Michele, Kamilah and Tariq Jogee, Jeremy, Spencer and Ellis Roots, Isobel Stewart, Claire Trotman and Jasmine Graham, Jackie Vanhorne and Shannon Vanhorne-Quartey, Tomos Vaughan-Streater and Johnathan Ward. Make-up Artists Amanda Clarke and Elizabeth Burridge. Additional Photography p. 6, 50, 66, 76, Liz McAulay. ACKNOWLEDGMENTS AUTHORS’ ACKNOWLEDGMENTS 96 Nicki Bainbridge: I would like to thank Alan Heath; Sonia Prazeres, my babymassage teacher; Jane Scofield, Meena Davis and Mary Magowan of Community Health South London; my clients, who have taught me much; my mother Rosemary Bainbridge for her faith in me, her enthusiasm and encouragement; my husband Richard Hatton for his love, support and flexibility; my children Daisy and Edward for their amenability while I wrote this book, and for teaching me so much about massage and touch; Ruth Bryan, Barbara and Graham Hatton for their help with child care; the team at Dorling Kindersley and all those who worked on the photo shoots, including PUBLISHER’S ACKNOWLEDGMENTS Dorling Kindersley would like to thank Nicola Cox and Conrad van Dyk for DTP design work, Sue Carlton for the index, Clare Hacking for proofreading, Mark Weyman, and Habitat and PHP (Perfectly Happy People) for providing props. Models Melanie and Jason Ashenden, Robina Aslam and Sophia Maria O’Reilly,