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Meta-Analysis
. 2013 Apr 30;2013(4):CD005038.
doi: 10.1002/14651858.CD005038.pub3.

Massage for promoting mental and physical health in typically developing infants under the age of six months

Cathy Bennett  1 , Angela Underdown, Jane Barlow
Affiliations
Meta-Analysis

Massage for promoting mental and physical health in typically developing infants under the age of six months

Cathy Bennett et al. Cochrane Database Syst Rev. .

Abstract

Background: Infant massage is increasingly being used in the community with babies and their primary caregivers. Anecdotal reports suggest benefits for sleep, respiration and elimination, the reduction of colic and wind, and improved growth. Infant massage is also thought to reduce infant stress and promote positive parent-infant interaction.

Objectives: The aim of this review was to assess whether infant massage is effective in promoting infant physical and mental health in low-risk, population samples.

Search methods: Relevant studies were identified by searching the following electronic databases up to June 2011: CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Maternity and Infant Care; LILACS; WorldCat (dissertations); ClinicalTrials.gov; China Masters' Theses; China Academic Journals; China Doctoral Dissertations; China Proceedings of Conference. We also searched the reference lists of relevant studies and reviews.

Selection criteria: We included studies that randomised healthy parent-infant dyads (where the infant was under the age of six months) to an infant massage group or a 'no-treatment' control group. Studies had to have used a standardised outcome measure of infant mental or physical development.

Data collection and analysis: Mean differences (MD) and standardised mean differences (SMD) and 95% confidence intervals (CIs) are presented. Where appropriate, the results have been combined in a meta-analysis using a random-effects model.

Main results: We included 34 studies, which includes one that was a follow-up study and 20 that were rated as being at high risk of bias.We conducted 14 meta-analyses assessing physical outcomes post-intervention. Nine meta-analyses showed significant findings favouring the intervention group for weight (MD -965.25 g; 95% CI -1360.52 to -569.98), length (MD -1.30 cm; 95% CI -1.60 to -1.00), head circumference (MD -0.81 cm; 95% CI -1.18 to -0.45), arm circumference (MD -0.47 cm; 95% CI -0.80 to -0.13), leg circumference (MD -0.31 cm; 95% CI -0.49 to -0.13), 24-hour sleep duration (MD -0.91 hr; 95% CI -1.51 to -0.30), time spent crying/fussing (MD -0.36; 95% CI -0.52 to -0.19), deceased levels of blood bilirubin (MD -38.11 mmol/L; 95% CI -50.61 to -25.61), and there were fewer cases of diarrhoea, RR 0.39; 95% CI 0.20 to 0.76). Non-significant results were obtained for cortisol levels, mean increase in duration of night sleep, mean increase in 24-hour sleep and for number of cases of upper respiratory tract disease and anaemia.Sensitivity analyses were conducted for weight, length and head circumference, and only the finding for length remained significant following removal of studies judged to be at high risk of bias. These three outcomes were the only ones that could also be meta-analysed at follow-up; although both weight and head circumference continued to be significant at 6-month follow-up, these findings were obtained from studies conducted in Eastern countries only. No sensitivity analyses were possible.We conducted 18 meta-analyses measuring aspects of mental health and development. A significant effect favouring the intervention group was found for gross motor skills (SMD -0.44; 95% CI -0.70 to -0.18), fine motor skills (SMD -0.61; 95% CI -0.87 to -0.35), personal and social behaviour (SMD -0.90; 95% CI -1.61 to -0.18) and psychomotor development (SMD -0.35; 95% CI -0.54 to -0.15); although the first three findings were obtained from only two studies, one of which was rated as being at high risk of bias, and the finding for psychomotor development was not maintained following following removal of studies judged to be at high risk of bias in a sensitivity analysis. No significant differences were found for a range of aspects of infant temperament, parent-infant interaction and mental development. Only parent-infant interaction could be meta-analysed at follow-up, and the result was again not significant.

Authors' conclusions: These findings do not currently support the use of infant massage with low-risk groups of parents and infants. Available evidence is of poor quality, and many studies do not address the biological plausibility of the outcomes being measured, or the mechanisms by which change might be achieved. Future research should focus on the impact of infant massage in higher-risk groups (for example, demographically and socially deprived parent-infant dyads), where there may be more potential for change.

PubMed Disclaimer

Conflict of interest statement

Angela Underdown ‐ has no conflicts on interest in relation to this review. Jane Barlow ‐ NIHR Health Technology Assessment awarded a grant to Warwick Medical School which paid for my time in working on the update of this review. Cathy Bennett ‐ is the proprietor of Systematic Research Ltd and received a consultancy fee for her work on this review.

Figures

1
1
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
1.1
1.1. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 1 Weight.
1.2
1.2. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 2 Weight: subgroup analyses (duration of intervention).
1.3
1.3. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 3 Length.
1.4
1.4. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 4 Length: subgroup analyses (duration of intervention).
1.5
1.5. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 5 Head circumference.
1.6
1.6. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 6 Head circumference: subgroup analyses (duration of intervention).
1.7
1.7. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 7 Mid arm circumference.
1.8
1.8. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 8 Mid leg/thigh circumference.
1.9
1.9. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 9 Abdominal circumference.
1.10
1.10. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 10 Chest circumference.
1.11
1.11. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 11 Hormones: cortisol.
1.12
1.12. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 12 Hormones: norepinephrine.
1.13
1.13. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 13 Hormones: epinephrine.
1.14
1.14. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 14 Hormones: serotonin.
1.15
1.15. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 15 Hormones: 6‐sulphatoxymelatonin secretion.
1.16
1.16. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 16 Biochemical markers: Bilirubin (7 days PN).
1.17
1.17. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 17 Crying or fussing time.
1.18
1.18. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 18 Crying frequency (times).
1.19
1.19. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 19 Sleep/wake behaviours (Thoman).
1.20
1.20. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 20 Behavioural state immediately post‐intervention (Thoman).
1.21
1.21. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 21 Sleep duration over 24hr period.
1.22
1.22. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 22 Mean increase in 24h sleep.
1.23
1.23. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 23 Mean increase in duration of night sleep.
1.24
1.24. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 24 Mean increase in duration of day sleep.
1.25
1.25. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 25 Mean increase in duration of first morning sleep after massage.
1.26
1.26. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 26 Sleep (total hours per night).
1.27
1.27. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 27 Number of naps (total number of naps).
1.28
1.28. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 28 Number of naps in day.
1.29
1.29. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 29 Number of naps at night.
1.30
1.30. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 30 Night Wake Frequency (times).
1.31
1.31. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 31 Night wake duration.
1.32
1.32. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 32 Blood flow (post intervention).
1.33
1.33. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 33 Formula intake.
1.34
1.34. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 34 Illness.
1.35
1.35. Analysis
Comparison 1 Infant massage versus control ‐ physical development, Outcome 35 Illness and clinic visits.
2.1
2.1. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 1 Infant temperament meta‐analyses.
2.2
2.2. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 2 Infant temperament (CCTI) post intervention.
2.3
2.3. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 3 Infant temperament (Infant behaviour questionnaire (IBQ) post intervention).
2.4
2.4. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 4 Infant temperament questionnaire (revised RITQ (Carey)) post‐intervention 4 months.
2.5
2.5. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 5 Infant temperament questionnaire (revised RITQ (Carey)) follow‐up 8 months.
2.6
2.6. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 6 Infant Care Questionnaire post‐intervention.
2.7
2.7. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 7 Infant Care Questionnaire follow‐up 1 year.
2.8
2.8. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 8 Infant attachment (Q set).
2.9
2.9. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 9 Child behaviour (HOME).
2.10
2.10. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 10 Eyberg Child Behaviour Inventory (ECBI) ‐ Intensity domain.
2.11
2.11. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 11 Eyberg Child Behaviour Inventory (ECBI) ‐ Problem domain.
2.12
2.12. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 12 Mother and child interaction meta‐analysis ‐ Total NCATS and Murray Global.
2.13
2.13. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 13 Nursing Child Feeding Assessment Scale (NCAFS) ‐ Total.
2.14
2.14. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 14 Nursing Child Assessment Teaching Scale (NCATS) ‐ Mother.
2.15
2.15. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 15 Nursing Child Assessment Teaching Scale (NCATS) ‐ Child.
2.16
2.16. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 16 Maternal sensitivity ‐ warm to cold (Murray).
2.17
2.17. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 17 Maternal sensitivity ‐ non‐intrusive to intrusive (Murray).
2.18
2.18. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 18 Maternal sensitivity ‐ remoteness (Murray).
2.19
2.19. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 19 Infant interactions ‐ infant performance ‐ attentive to non attentive (Murray).
2.20
2.20. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 20 Infant interactions ‐ lively to inert (Murray).
2.21
2.21. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 21 Infant interactions ‐ happy to distressed (Murray).
2.22
2.22. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 22 Parenting stress (PSI Abidin) child characteristics subscale.
2.23
2.23. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 23 Psychomotor Development Indices (PDI) meta‐analysis post‐intervention.
2.24
2.24. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 24 Bayley Psychomotor Development Index (PDI) follow‐up.
2.25
2.25. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 25 Mental Development Indices (MDI) meta‐analysis post‐intervention.
2.26
2.26. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 26 Bayley Mental Development Index (MDI) follow‐up.
2.27
2.27. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 27 Gessel/Capital meta‐analysis (post intervention).
2.28
2.28. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 28 Gessel Developmental Quotient (post intervention).
2.29
2.29. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 29 Capital institute Mental Checklist (post intervention).
2.30
2.30. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 30 Gessel Developmental Quotient (follow‐up 6 months).
2.31
2.31. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 31 Attachment patterns (strange situation procedure).
2.32
2.32. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 32 Distractibility (toy) follow‐up 1 year.
2.33
2.33. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 33 Habituation.
2.34
2.34. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 34 Seconds to habituation.
2.35
2.35. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 35 Trials to habituation.
2.36
2.36. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 36 Post habituation.
2.37
2.37. Analysis
Comparison 2 Infant massage versus control ‐ mental health and development, Outcome 37 Habituation test.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Field 1996 {published data only}
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Jump 1998 {published data only}
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Ke 2001 {published data only}
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Kim 2003 {published data only}
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Liu C 2001 0 to 2 months {published data only}
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Liu C 2001 3 to 6 months {published data only}
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Liu CL 2005 {published data only}
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Liu DY 2005 {published data only}
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Lu 2005 {published data only}
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Maimaiti 2007 {published data only}
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Na 2005 {published data only}
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Narenji 2008 {published data only}
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O'Higgins 2008 {published data only}
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Onozawa 2001 {published data only}
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Oswalt 2007 {published data only}
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Shao 2005 {published data only}
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Shi 2002 {published data only}
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Sun 2004 {published data only}
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Wang 1999 {published data only}
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Wang 2001 {published data only}
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White‐Traut 2009 {published data only}
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Xua 2004 {published data only}
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Ye 2004 {published data only}
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Zhai 2001 {published data only}
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Clarke 2000 {published data only}
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Cullen 2000 {published data only}
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Darmstadt 2002a {published data only}
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Im 2007 {published data only}
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Jump 2006 {published data only}
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Lee 2006 {published data only}
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Li 2002 {published data only}
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Oswalt 2009 {published data only}
    1. Oswalt KL. Effects of Infant Massage on HIV‐Infected Mothers and their Infants [PhD thesis]. Vol. 1 online resource (vii, p 58), Birmingham, AL: University of Alabama at Birmingham, 2009.
Pardew 1996 {published data only}
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Park 2006 {published data only}
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Peláez‐Nogueras 1997 {published data only}
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Peláez‐Nogueras1997b {published data only}
    1. Peláez‐Nogueras M, Field T, Hossain Z, Pickens J. Depressed mothers' touching increases infants' positive affect and attention in still‐face interactions. Child Development 1996;67(4):1780‐92. - PubMed
Scafidi 1996 {published data only}
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Serrano 2010 {published data only}
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References to other published versions of this review

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