Cochrane Database of Systematic Reviews

Massage for promoting mental and physical health in typically

developing infants under the age of six months (Review)
Bennett C, Underdown A, Barlow J

Bennett C, Underdown A, Barlow J.

Massage for promoting mental and physical health in typically developing infants under the age of six months.
Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005038.
DOI: 10.1002/14651858.CD005038.pub3.

www.cochranelibrary.com

Massage for promoting mental and physical health in typically developing infants under the age of six months (Review)
Copyright 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

[Intervention Review]

Massage for promoting mental and physical health in typically

developing infants under the age of six months
Cathy Bennett1 , Angela Underdown2 , Jane Barlow2
1 Plymouth

University Peninsula Schools of Medicine and Dentistry, Plymouth, UK. 2 Division of Mental Health and Wellbeing,
Warwick Medical School, Coventry, UK
Contact address: Jane Barlow, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Gibbett
Hill Road, Coventry, CV4 7AL, UK. jane.barlow@warwick.ac.uk.

Editorial group: Cochrane Developmental, Psychosocial and Learning Problems Group.

Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 4, 2013.
Review content assessed as up-to-date: 20 December 2011.
Citation: Bennett C, Underdown A, Barlow J. Massage for promoting mental and physical health in typically developing
infants under the age of six months. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD005038. DOI:
10.1002/14651858.CD005038.pub3.
Copyright 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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.
Massage for promoting mental and physical health in typically developing infants under the age of six months (Review)
Copyright 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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.

PLAIN LANGUAGE SUMMARY

Massage for promoting mental and physical health in infants under the age of six months
This review aimed to assess the impact of infant massage on mental and physical outcomes for healthy mother-infant dyads in the first
six months of life. A total of 34 randomised trials were included. Twenty of these had significant problems with their design and the
way they were carried out. This means that the we are not as confident as we would otherwise be that the findings are valid. That is to
say, the findings of these 20 included studies may over- or under-estimate the true effect of massage therapy.
We combined the data for 14 outcomes measured physical health and 18 outcomes measured aspects of mental health or development.
The results show limited statistically significant benefits for a number of aspects of physical health (for example, weight, length,
head/arm/leg circumference, 24-hour sleep duration; time spent crying or fussing; blood bilirubin and number of episodes of illness)
and mental health/development (for example, fine/gross motor skills personal and social behaviour and psychomotor development).
However, all significant results were lost either at later follow-up points or when we removed the large number of studies regarded to
be at high risk of bias.
These findings do not currently support the use of infant massage with low-risk population groups of parents and infants. The results
obtained from this review may be due to the poor quality of many of the included studies, the failure to address the mechanisms by
which infant massage could have an impact on the outcomes being assessed, and the inclusion of inappropriate outcomes for population
groups (such as weight gain). Future research should focus on the benefits of infant massage for higher-risk population groups (for
example, socially deprived parent-infant dyads), the duration of massage programmes, and could address differences between babies
being massaged by parents or healthcare professionals.

Massage for promoting mental and physical health in typically developing infants under the age of six months (Review)
Copyright 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.