Appendix B – Massage for Additional Needs

With all additional needs, ensure the parent has approval from their consultant before beginning a massage course and remind parents that anything we do in class does not take the place of medical advice.

Caesarean Section

Babies born by C-section will benefit greatly from massage, as they have not received that early massage through contractions and pushing through the birth canal. Due to the early difficulties with lifting and possibly holding the baby immediately after birth, massage is also a great way to bond with baby. Caesarean babies are also more prone to lethargy and massage provides stimulation. Mothers shouldn’t lift babies with their arms outstretched in front as it puts pressure on the lower abdomen where the scar is.

Talipes

A congenital deformity of the foot, twisting it out of position, commonly turning inwards. The following techniques can help to straighten the foot by relaxing the calf, extending the heel and allowing movement in the foot:

• With baby on their back and you kneeling in front of them, hands well oiled, pull the leg through your hands in our milking technique.
• With your thumb facing down, draw your hand down baby’s calf, turning the foot outwards as you reach the bottom. DO NOT FORCE THIS MOVEMENT.
• Holding the foot in position, massage baby’s calf with the other hand.
• Still maintaining the position of the foot, stroke the muscle on the side of the shin with fingertips.
• Sitting with your knees raised, bring baby up to rest their back on them with legs in a squat position. Knees flexed and feet resting on your chest or belly. Whilst pressing baby’s feet into your chest / belly to flex the ankle and extend the heel, massage the calf. Keep a hand to baby in case they push away.

Repeat this routine twice a day, morning and evening.

 

 

Visual Impairments

Babies with a visual impairment will benefit hugely from massage as they have a great need for communication and stimulation through touch. It will also encourage them to be socially interactive. However, it is important to remember to introduce touch slowly, using light strokes before moving on to the massage touches. They may be more resistant to tummy time as they feel unsure of what is happening around them so it may be helpful to prop them up with a cushion from the waist up and again start slowly. Finally, it is important to talk and sing throughout with your face close to baby’s and maintain contact at all times, it may be helpful for Mum to carry out the massage with her eyes closed to keep this at the forefront of her mind. Development can be slowed with a visual impairment and massage will help them to reach their goals when they should.

Hearing Impairments

Similarly to visual impairments, massage is extremely beneficial. It can help with the bonding between baby and carer, encourages development and aids communication and self-esteem. Again, massage needs to be introduced slowly and gently. Maintain eye contact throughout, explain what you are doing ensuring you are clear with mouthing your words.  Use your touch and facial expressions to convey affection and approval. Show baby that you are enjoying the time together and watch carefully and follow their cues.

Cerebral Palsy

A lack of development of part of the brain that controls movement and posture, this can lead to learning, visual and hearing difficulties that can range from mild to severe. There are three forms:

• Ataxia – Balance difficulties, trouble walking
• Spasticity – stiff muscles, lack of movement control
• Athetosis – involuntary movement of parts of the body

Massage can bring relief of symptoms and an improvement in their quality of life. It can relieve muscle cramps and aid movement, reducing pain. It can also improve circulation. Babies with cerebral palsy often suffer from wind and constipation due to poor posture so this can be relieved by the massage section on the tummy. They may resist being massaged, so follow cues, start slowly, you can begin with massaging clothed and non-obtrusive parts of the body such as the hands and build it up. Encourage parents to massage their babies daily.

Developmental Dislocation (Dysplasia) of the Hip (DDH)

The hip is a “ball-and-socket” joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.  Although DDH is most often present at birth, it may also develop during a child’s first year of life.  Recent research shows that babies whose legs are swaddled tightly with the hips and knees straight are at a notably higher risk for developing DDH after birth. As swaddling becomes increasingly popular, it is important for parents to learn how to swaddle their infants safely, and to understand that when done improperly, swaddling may lead to problems like DDH.

 

In all cases of DDH, the socket (acetabulum) is shallow, meaning that the ball of the thighbone (femur) cannot firmly fit into the socket. Sometimes, the ligaments that help to hold the joint in place are stretched. The degree of hip looseness, or instability, can vary among children with DDH.  Below are the three types of DDH:

• Dislocated-most severe cases of DDH, the head of the femur is completely out of the socket.
• Dislocatable-these cases, the head of the femur lies within the acetabulum, but can easily be pushed out of the socket during a physical examination.
• Subluxatable-mild cases of DDH, the head of the femur is simply loose in the socket. During a physical examination, the bone can be moved within the socket, but it will not dislocate.

DDH can run in families. It can be present in either hip and in any individual. It usually affects the left hip and is predominant in:

• Girls
• First-born children
• Babies born in the breech position (especially with feet up by the shoulders). The American Academy of Pediatrics now recommends ultrasound DDH screening of all female breech babies.
• Family history of DDH (parents or siblings)
• Oligohydraminos (low levels of amniotic fluid)

 

There are some signs to look out for but some circumstances it will not be noticeable from the outside:

• Uneven folds of skin on tops of thigh and Uneven legs
• Less mobility or flexibility on a certain side
• Tip toe walking or duck waddle like

Premature babies

The definition of a ‘premature’ or ‘preterm’ baby is one that is born before 37 weeks. If your baby is born early – also called ‘premature’ or ‘preterm’ – they may need special care as they may not be fully developed.  Babies can be admitted to neonatal services for a number of reasons and babies born before 34 weeks may need extra help with breathing, feeding and keeping warm. they are very small and have a low birthweight.  It’s not known at times what can cause this but complications can increase the risk.  Generally, the earlier a baby is born the higher the risk is of health problems.  There are different levels of prematurity, and generally the risk increases the earlier the birth is – babies at highest risk are those born before week 26.

There are different categories levels of prematurity and these carry their own risks:

• Extremely preterm ( less than 28 weeks)
• very preterm (28 to 32 weeks)
• moderate to late preterm (32 to 37 weeks)

Research has shown that premature babies can benefit immensely from this therapy and it can also increase the bond between child and parent.  Massage therapy has led to weight gain in preterm infants when moderate pressure massage was provided. In studies on passive movement of the limbs, preterm infants also gained significantly more weight, and their bone density also increased. A ground breaking and significant study on baby massage and premature babies was undertaken by Doctor Tiffany Field, the founder of the Touch Research Institute, which seeks to study the effects of positive touch and massage for individuals in society.  The study published in 1986 showed that;

• Premature babies that received gentle touch gained 47% more weight than a comparative group;
• Their development and sensory awareness was enhancing enabling them to leave a medical setting 6 days earlier than a comparative group;
• Further study of the babies who had received massage shown that eight months after birth they had increased motor and cognitive development.
• Massage releases feel good hormones into the body, which increase appetite, enable restful sleep and relaxation. Massage helps to counteract stress and anxiety.

Research conducted by Nils Bergham on the importance of skin to skin contact after birth and the need for a mother and baby to be kept physically close; When babies are held naked against their mother’s skin, it is the closest they can get to being back in the warmth and security of the womb. It is the only place in which newborns have survived for the last million years, and developed toward optimal health. It is in our DNA to crave skin contact. Skin contact after birth supports the maturation of the nervous system as we continue to provide sensations and stimulus into the brain which is familiar to the baby from the womb. This allows a sense of continuing their journey from the safe environment of the womb into the world adjusting easier.