Infant massage

Infant massage is a type of complementary and alternative treatment that uses massage therapy for human infants. This therapy has been practiced globally, and has been increasingly used in Western countries as a treatment for infants, though the scientific evidence supporting its use is limited. Research in pre-term infants and low birth weight infants have found weak evidence that massage might improve weight gain, but these results are based on possibly biased studies and therefore no recommendation can be made for universal use at this time. Research into the effectiveness of massage therapy on full term infants has found some tentative evidence for some benefits such as sleeping and crying in infants, though the evidence is not strong enough to recommend universally, and more research is needed.

History
Ayurvedic medicine in ancient India taught the use of infant massage. It was also has been encouraged in China during the Qing dynasty. At present it is part of traditional childcare in South Asia and elsewhere where daily massage by mothers is seen as "instilling fearlessness, hardening bone structure, enhancing movement and limb coordination, and increasing weight". Other areas where infant massage is regularly used are African countries and areas in the former Soviet Union. In Western culture, infant massage has been increasingly used in neonatal intensive care units for pre-term infants who are in stressful environments and have limited tactile stimulation.

Full term infants
A Cochrane review of studies on the benefits of massage therapy for infants less than 6 months of age (and were not pre-term or underweight) found tentative evidence of benefit for mother-infant interaction, sleeping and crying, and on stress hormone levels. The evidence for these benefits, however, came from a relatively small number of studies, and no meta-analysis could be performed on these outcomes. Other evidence of physical health benefits such as weight gain were only found in studies that were at high risk of bias. The study found no evidence to suggest massage affects mental health outcomes such as infant attachment, temperament or mental development. This level of evidence may be enough to support community use of massage therapy, but more research is needed before it can be universally recommended.

Preterm infants
A Cochrane review of studies looking at massage therapy for pre-term and low birth weight found that the evidence for benefits was weak. While a meta-analysis of studies found that massage was associated with increased weight gain and decreased length of stay in the hospital, the reviewers had "serious concerns" about the methodological quality of the studies, specifically raising the concern of publication bias. These concerns weakened the credibility of the studies, and led the reviewers to conclude there was not enough evidence to recommend widespread use of massage for pre-term or low birth weight infants. The review also suggested those neonatal intensive care units that have nurses provide massage therapy to reconsider whether it is cost-effective use of their time to do so.

Proposed mechanisms
Various mechanisms have been proposed as to suggest how massage therapy might benefit infants. For pre-term infants, it has been suggested that any weight gain may be due to improved metabolic efficiency or by reducing the adverse reaction of stress through decreasing stress behavior or stress hormones. Other possible mechanisms include increased vagal activity and secretion of insulin and gastrin as well as improved parent-infant relationships.

Safety
Reviews of the literature have found no significant risks for adverse events with massage theory with either full term or pre-term infants. One study found that the use of certain oils in traditional societies such as mustard oil or olive oil might adversely affect pre-term newborn skin barrier function, while integrity and permeability while other oils that are linoleate-enriched such as sunflower seed oil may improve them.