title: Massage for promoting mental and physical health in typically developing infants under the age of six months.
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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors: Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
authors: Cathy
authors: C
authors: Bennett
authors: Angela
authors: A
authors: Underdown
authors: Jane
authors: J
authors: Barlow
mesh_terms: D002657:Child Development; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008405:Massage; D008603:Mental Health; D017063:Outcome Assessment, Health Care; D010812:Physical Stimulation; D016032:Randomized Controlled Trials as Topic; D019124:Therapeutic Touch
references: Res Nurs Health. 1995 Feb;18(1):27-38
references: 7831492
references: Child Dev. 1996 Oct;67(5):2512-26
references: 9022253
references: Acta Paediatr. 2002;91(5):546-54
references: 12113324
references: Res Nurs Health. 2003 Dec;26(6):424-33
references: 14689459
references: J Am Acad Child Adolesc Psychiatry. 2001 Jan;40(1):27-35
references: 11195558
references: Sao Paulo Med J. 2005 Sep 1;123(5):215-8
references: 16358095
references: J Trop Pediatr. 2008 Feb;54(1):31-5
references: 17962243
references: J Health Popul Nutr. 2002 Jun;20(2):184-8
references: 12186200
references: Annu Rev Psychol. 2007;58:145-73
references: 16903808
references: Zhonghua Yi Xue Za Zhi. 2001 Dec 10;81(23):1420-3
references: 11930611
references: J Child Psychol Psychiatry. 1992 Mar;33(3):543-61
references: 1577898
references: J Dev Behav Pediatr. 2002 Dec;23(6):410-5
references: 12476070
references: J Perinat Neonatal Nurs. 2010 Apr-Jun;24(2):172-81
references: 20442614
references: Semin Neonatol. 2002 Dec;7(6):495-500
references: 12614602
references: Am Psychol. 1989 Feb;44(2):112-9
references: 2653124
references: An Esp Pediatr. 1998 May;48(5):549-50
references: 9656549
references: Stat Med. 2002 Jun 15;21(11):1539-58
references: 12111919
references: Nat Neurosci. 2000 Aug;3(8):799-806
references: 10903573
references: J Affect Disord. 2008 Jul;109(1-2):189-92
references: 18086500
references: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005038
references: 17054233
references: Taehan Kanho Hakhoe Chi. 2006 Dec;36(8):1331-9
references: 17215606
references: J Obstet Gynecol Neonatal Nurs. 2009 Jan-Feb;38(1):22-34
references: 19208045
references: Physiol Behav. 1987;41(6):531-7
references: 3441523
references: Bull Menninger Clin. 2007 Spring;71(2):132-49
references: 17666003
references: Infant Ment Health J. 2011 May;32(3):362-376
references: 28520142
references: Control Clin Trials. 1998 Apr;19(2):159-66
references: 9551280
references: Cochrane Database Syst Rev. 2004;(2):CD000390
references: 15106151
references: Child Dev. 2008 Sep-Oct;79(5):1357-76
references: 18826530
references: Indian J Med Res. 2000 Dec;112:212-7
references: 11247199
references: Taehan Kanho Hakhoe Chi. 2006 Oct;36(6):897-904
references: 17090988
references: Neuropediatrics. 1981 Feb;12(1):45-54
references: 6166893
references: Nurs Res. 1988 Mar-Apr;37(2):70-6
references: 3347522
references: J Child Psychol Psychiatry. 2007 Mar-Apr;48(3-4):288-328
references: 17355400
references: Zhongguo Dang Dai Er Ke Za Zhi. 2007 Oct;9(5):495-6
references: 17937869
references: J Dev Behav Pediatr. 1993 Aug;14(4):230-5
references: 8408665
references: Fam Community Health. 2006 Oct-Dec;29(4):314-9
references: 16980806
references: Am J Ment Defic. 1977 Mar;81(5):417-20
references: 66872
references: Child Dev. 1996 Aug;67(4):1780-92
references: 8890507
references: Monogr Soc Res Child Dev. 1985;50(1-2):110-35
references: 4069124
references: J Pers Assess. 1977 Apr;41(2):150-6
references: 856967
references: Science. 1997 Sep 12;277(5332):1659-62
references: 9287218
references: J Affect Disord. 2001 Mar;63(1-3):201-7
references: 11246096
references: Eur J Neurosci. 2003 Nov;18(10):2903-9
references: 14656341
references: Acta Paediatr Scand. 1987 Nov;76(6):851-60
references: 3321889
references: Altern Ther Health Med. 2000 Sep;6(5):54-63
references: 10979162
references: Lancet. 1997 Aug 2;350(9074):326-9
references: 9251637
references: Child Dev. 1987 Feb;58(1):187-90
references: 3816343
references: Child Dev. 1997 Aug;68(4):571-91
references: 9306636
references: Prev Med. 1998 Mar-Apr;27(2):208-11
references: 9578997
references: PLoS Med. 2005 Dec;2(12):e334
references: 16285839
references: Attach Hum Dev. 2010 Jan;12(1-2):3-141
references: 20390524
references: Pediatrics. 2000 Jun;105(6):E84
references: 10835097
references: J Pediatr Psychol. 1996 Dec;21(6):889-97
references: 8990731
references: J Clin Nurs. 2008 Jul;17(13):1754-61
references: 18592627
references: Adolescence. 2000 Summer;35(138):381-414
references: 11019779