Infant and Children's Massage and Nurturing Touch BLOG

Idibidi Kids BLOG page contains information on infant and children's massage, helpful massage tips and techniques, articles and more. Idibidi Kids likes to support charities and not-for-profit organisations, particularly those associated with babies and children. Idibidi Kids blog page is also about raising awareness of infant massage to the community and promoting the benefits of infant massage and children's massage, both for the parent/carer and the child. Please visit www.idibidikids.com.au

Monday, January 12, 2009

Reflux in babies and Massage

The Digestive System, Vagus Nerve & How Massage Can Assist Babies with Reflux

By: Natalie Garmson, CIMI, MISI, Ass.Dip Sc, Cert I Aromatherapy

The digestive system and the vagus nerve: a brief overview
Digestion is controlled by the Autonomic Nervous System (ANS), in particular, a branch of the ANS called the parasympathetic nervous system (1). Here you will find the vagus nerve (sometimes referred to as the vagal nerve). The vagus nerve sends signals from the brain to the stomach, pancreas and other digestive organs such as the oesophagus; its main use being to regulate the function of these major organs. The oesophagus is essentially a muscle under the control of the vagus nerve (2). The muscle at the lower end of the oesophagus (closest to the stomach) is the lower sphincter; this valve relaxes and contracts to allow food to pass through to the stomach. It is the lower oesophageal sphincter contracting that prevents the reflux reaction occurring. If this muscle is immature or weak, your child may experience reflux (Gastro-Oesophageal Reflux or GOR for short). Food passes down the oesophagus to the stomach by a series of wave-like contractions, known as peristalsis, forcing the sphincter muscle to contract and relax. The vagus nerve also controls peristalsis (2).

How human touch influences the vagus nerve:
The ANS comprises the sympathetic and parasympathetic branches. When your baby cries and is in pain (a symptom of reflux), the sympathetic branch is stimulated, releasing stress hormones such as adrenaline and cortisol (4). The sympathetic nervous system overpowers the parasympathetic (calm and relaxed) system (3). This is where the power of touch is in your hands. If you consider how massage can be used to effectively relax a tight muscle, normally you would directly massage that area and the muscle would loosen, however this becomes difficult in the case of reflux. When considering how massaging your baby is able to relieve symptoms of reflux, it helps to understand how the skin and the nervous system are connected. Massage on any area of the body is able to assist a reflux baby by stimulation of the vagus nerve and thus an increase in effectiveness of muscle control and regulation (remembering it is the vagus nerve that controls the lower sphincter in the oesophagus). Why is this so? Because the skin and the nervous system develop from the same cell layer (4). An increase in the amount and frequency of skin stimulation (eg pressure via massage) means that the vagus nerve is able to operate faster and more efficiently. This should result in greater muscle control. Remember, relief from reflux won’t happen overnight. Consistency is the key, especially to relieve the symptoms of reflux in infants. The Infant Massage Information Service recommends massaging your baby twice a day for a reflux baby. As Heidi McLoughlin, Infant Massage Trainer from I.M.I.S recalls “I remember one little four month old girl… she had been diagnosed with reflux but her parents had seen no improvement after trying medications and various formulas. After introducing a simple massage routine twice a day, her parents reported complete improvement after only two weeks!” (6).

Did you know?
Touch is the earliest sense to develop in all animal species. (4). Massaging your baby is a wonderful way of communicating to your newborn through positive, nurturing touch. It is amazing to think that by the end of the fourth month of development, the skin is formed. You may also see the skin referred to in text books as ‘integument’ which forms a part of the integumentary system (5).

Recommendations for massaging a reflux baby:
There are a few considerations that need to be taken into account when massaging a baby who suffers from reflux.

(1) Alter the position of your baby for massage. Preferably lay your baby on a forty five (45) degree angle (as opposed to lying on the floor in front of you). You can do this simply by adding some cushions or a pillow, supporting their back and head or using a specially designed reflux sleeping wedge or reflux change mat (eg see http://www.pollywogbaby.com/ sleep wedge or http://www.buboo.com.au/ ). Note: you may want to experiment with the angle at which your baby sleeps. A lower angle (eg 15 degrees) may not be beneficial to assist a baby with reflux. An angle up to 45 degrees is recommended by I.M.I.S.

(2) If you baby’s abdomen is tender or you think he/she may posit, avoid massaging this area.

(3) When massaging your baby’s back, instead of them lying on their tummy on the floor, consider lying your baby on his/her side whilst remaining in a forty five degree angle, or try the cuddle position. This is where you cuddle your baby, using one hand to support their bottom and legs, whilst the other hand massages their back. It is important ensure your body is supported, for example, by leaning back on a sofa whilst sitting comfortably on the floor.

For practical advice and further information about reflux, silent reflux and Gastro-oesophageal Reflux Disease (GORD) and products available for reflux:

http://www.pollywogbaby.com/ Practical Solutions for Infant Reflux and Colic

http://www.reflux.org.au/ Reflux Infants Support Association Inc. Australia

http://www.infantreflux.org/ Infant Reflux Solutions For Your Baby!


References:
1. Nutritional Biochemistry, 2nd ed, Tom Brody, Academic Press, 1999, U.S.A.

2. Smith, Margaret.E, Morton, Dion.G, The Digestive System: Basic Science and Clinical Conditions Elsevier Health Sciences, 2001.

3. Sunderland,M. The Science of Parenting. DK Ltd, 2006, London, Great Britain

4. Field, T. Touch M.I.T, 2001, Massachusetts, U.S.A

5. Marieb,E. Human Anatomy & Physiology, 5th ed. Benjamin Cummings, 2001, U.S.A.

6. McLoughlin,H. I.M.I.S Infant Massage Training Manual, “Can Massage Help Reflux?” article, Australia, 2007 (an excert from the R.I.S.A NSW newsletter 2007)

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Sunday, December 14, 2008

Sleep Problems and Babies: How Massage Can Assist Your Baby to Sleep



Do you find your child has difficulty falling asleep, or do they experience sleep problems such as regular waking during the night?

You are not alone! However coined the term “sleep like a baby” must be one of the lucky ones whose baby slept through the night from an early age (or maybe they didn’t have children!). Up to 29 percent(1) of infants experience sleep disturbance and waking during the night by the third month. Sleep problems such as difficulty in falling asleep and night waking may affect up to 35 percent of infants and toddlers(1). How much stimulation an infant receives during the day plays a major part in how efficient they are able to organise their sleep state. Overstimulation can be disruptive to an infant’s sleep. There are many techniques you can use to help settle your little one, but most important is establishing a soothing bedtime routine(2); one that your baby will become familiar with and one that involves working around the same bedtime and routine each night. This indicates to your baby that bedtime is approaching. Babies learn through repetition as repetition builds strong pathways (connections) in your baby’s brain (called synapses). Your baby will feel safe and secure with a familiar routine, especially a soothing and calming one.

Oxytocin and Melatonin in relation to sleep:
Calming your child’s brain releases the hormone oxytocin and the sleep hormone melatonin(2). Oxytocin is a hormone that has many wonderful benefits for your child. It is only released through touch; massaging your baby is the most effective way for your baby to receive the many positive physical effects associated with oxytocin such as improved sleep, balancing blood pressure and relaxation. It is important to learn how to massage your baby correctly (from a certified infant massage instructor such as Natalie Garmson, see http://www.kidsmassage.com.au/ ). Applying the wrong pressure or incorrect technique could increase your baby’s crying or discomfort, only making it worse. Massaging your baby is a skill that is easy to learn. It is fun for both you and your baby and can quite easily fit into your daily routine. Even better, the benefits of massage are felt immediately!
Melatonin is sometimes called the sleep hormone. It is stimulated by a calm environment, low levels of light, soft music or a soft voice. Together, oxytocin and melatonin create the right balance to help regulate your child’s brain to prepare them for sleep. When it is your baby’s bedtime, your role as a parent is to create a relaxing environment, provide lots of reassurance through cuddles, reading a book and through calming touch such as massage. This is an example of a lovely soothing routine to help your child sleep longer and will assist their circadian rhythms (or ‘body clock’) (3). This is why children love routine!
(Please note: whilst massage is a wonderful activity you can do with your baby after a bath, it must be noted that massage after a bath is not recommended for infants under the age of 5 months, as massage is too stimulating for your newborn's nervous system. An alternative is to incorporate massage after your newborn’s daytime nap, often referred to as the ‘quiet alert’ stage).

Massage vs Rocking (Study):
A study was conducted to compare rocking verses massage as a technique to assist babies in falling asleep(1). It was observed that those infants who were massaged were awake whilst being massaged and fell asleep afterwards, whilst the group of infants who were rocked fell asleep whilst being rocked but woke when the rocking ceased. It was also noted that those infants who received massage (as compared to rocking) cried less, had lower stress hormones (through salivary cortisol levels) and showed greater improvement emotionally and socially. Reducing your baby’s stress hormone levels also contributes to an improved immune system. Another point to note is in relation to your baby's sleep association, meaning what they associate or relate going to sleep with. An example is rocking your baby to sleep, as observed in the study, interupts your child's ability to learn how to self soothe themself to sleep.

Sleep problems and babies who cry themselves to sleep:
Your baby cannot simply relax after over-exhaustion or stimulating play. They require your help to relax and adjust their brain chemistry to release oxytocin. Leaving your baby to cry themselves to sleep (note: referring to a 'distressed' cry) means that their stress levels (influenced by the stress hormone cortisol) remain increased in their system(2). High cortisol in your baby’s system when they fall asleep means there is a greater chance they will wake during the night(3). There are many factors that may contribute to your child’s sleep problems, during the first year it is usually related to developmental issues such as teething. At around 3 to 6 months of age, your baby will start to organise its sleep/wake cycle and it may not be until they are 8 months of age that they start to sleep through the night(1). Remember that every child is an individual and influenced partly by nature (their genetic ‘make-up’) and partly by nurture (their surrounding environment and how you nurture and care for them). What you ultimately wish for is a healthy child who sleeps well. It is in the deep sleep (or restorative sleep) state that your child releases growth hormones. Deep sleep also contributes to a strong immune system. Massaging your child on a daily basis and establishing a soothing bedtime routine will assist their health, wellbeing and development. Don’t wait until next week to learn the art of infant massage…. start today!
Article by Natalie Garmson, certified infant massage instructor & mother of 2 boys, Idibidi Kids Massage, Perth, Western Australia.

References:

(1) Field, T. The Amazing Infant, Blackwell Publishing, 2007, Oxford, U.K. p251, 261-3
(2) Sunderland,M. The Science of Parenting, DK Publishing Ltd, London, U.K, 2006, p 66-9, 78-9.
(3) Underdown, A. Barlow,J. Chung,V. Stewart-Brown,S. Massage Intervention for Promoting Mental and Physical Health in Infants Ages Under Six Months, The Cochrane Collaboration, John Wiley & Sons Ltd, 2008. Issue 4.

Further recommended reading:

Touch Research Institute, Miami, USA.
http://www6.miami.edu/touch-research/TRIResearch/infantmassage.htm

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