Massage intervention for promoting mental and physical health in infants aged under six months

  • Review
  • Intervention

Authors


Abstract

Background

Infant massage is increasingly being used in the community for low-risk babies and their primary care givers. Anecdotal claims suggest benefits for sleep, respiration, elimination and the reduction of colic and wind. Infant massage is also thought to reduce infant stress and promote positive parent-infant interaction.

Objectives

The aim of this review was to assess the effectiveness of infant massage in promoting infant physical and mental health in population samples.

Search methods

Searches were undertaken of CENTRAL 2005 (Issue 3), MEDLINE (1970 to 2005), PsycINFO (1970 to 2005), CINAHL (1982 to 2005), EMBASE (1980 to 2005), and a number of other Western and Chinese databases.

Selection criteria

Studies in which babies under the age of six months were randomised to an infant massage or a no-treatment control group, and utlising a standardised outcome measuring infant mental or physical development.

Data collection and analysis

Weighted and standardised mean differences and 95% confidence intervals are presented. Where appropriate the results have been combined in a meta-analysis using a random effects model.

Main results

Twenty-three studies were included in the review. One was a follow-up study and thirteen were included in a separate analysis due to concerns about the uniformly significant results and the lack of dropout. The results of nine studies providing primary data suggest that infant massage has no effect on growth, but provides some evidence suggestive of improved mother-infant interaction, sleep and relaxation, reduced crying and a beneficial impact on a number of hormones controlling stress. Results showing a significant impact on number of illnesses and clinic visits were limited to a study of Korean orphanage infants. There was no evidence of effects on cognitive and behavioural outcomes, infant attachment or temperament. The data from the 13 studies regarded to be at high risk of bias show uniformly significant benefits on growth, sleep, crying and bilirubin levels.

Authors' conclusions

The only evidence of a significant impact of massage on growth was obtained from a group of studies regarded to be at high risk of bias. There was, however, some evidence of benefits on mother-infant interaction, sleeping and crying, and on hormones influencing stress levels. In the absence of evidence of harm, these findings may be sufficient to support the use of infant massage in the community, particularly in contexts where infant stimulation is poor. Further research is needed, however, before it will be possible to recommend universal provision.

摘要

背景

對於6個月以下的嬰兒,按摩對心智和身體健康的促進

嬰兒的按摩,越來越常使用在社區中低風險性的嬰兒和他們的主要照護者上,並宣稱對於睡眠、呼吸、腸胃脹氣和疼痛改善上有益處。嬰兒按摩也被認為可以減少嬰兒的壓力,促進正向的父母嬰兒互動。

目標

這篇回顧的目的,在評估嬰兒按摩,對於增進一般嬰兒人口身體和心智健康方面的效果。

搜尋策略

搜尋以下的資料庫: CENTRAL 2005年 (第3期) ,MEDLINE (1970年 至 2005年) ,PsycINFO (1970年 至 2005年) ,CINAHL (1982年 至 2005年) ,EMBASE (1980年 至 2005年) ,和其他西方與中文的資料庫。

選擇標準

收納的試驗必須符合以下條件: 小於6個月的嬰兒,被隨機分配到有接受嬰兒按摩,或沒有接受治療的控制組,使用標準化方式量測嬰兒心智和身體的發育。

資料收集與分析

加權過的和標準化平均差異,以及95% 信賴區間都被呈現出來。當結果合適時使用隨機效果模式 (random effects model) ,將試驗合併執行統合分析 (metaanalysis。

主要結論

共有23個試驗被收納進這個回顧。其中ㄧ個為追蹤性試驗,另外有13個試驗,因為顧慮其一致顯著結果、低退出率,而被獨立出來進行分析。另外9個試驗所提供的基本資料,指出嬰兒按摩對於生長沒有效果,但是證據某些程度顯示,對於母嬰互動、睡眠和放鬆、減少哭鬧、和控制壓力的賀爾蒙,是有益處的影響。只有一個針對韓國孤兒院嬰兒的研究,顯示在疾病數量和看醫師次數上,有顯著的影響。對於認知、行為預後、嬰兒的依附、脾氣上是沒有證據顯示有效果。至於那13個極可能有偏差的試驗,在對於成長、睡眠、哭鬧和膽紅素的濃度上,有著一致而顯著的益處。

作者結論

按摩對於成長有意義影響的唯一證據,是來自於一些選擇偏差的高風險性的研究。另有一些證據顯示在母嬰互動、睡眠、哭泣、和壓力相關的賀爾蒙等方面的益處。既然沒有造成傷害的證據,這些結果也許足夠支持在社區裡使用嬰兒按摩,特別是在嬰兒刺激不足的情況下。至於推廣成全球性普遍的建議之前,還需要更進一步的研究。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

本文獻目標在於評估對6個月以下之健康嬰兒進行嬰兒按摩,對於心智和身體健康預後的影響。總共有23個隨機對照試驗被收納進來。其中有13個試驗因為被認為有偏差的高風險性,而被分開來分析。另有一個試驗只有顯示追蹤的結果。只能針對剩餘的,只提供極少數預後結果的試驗來合併分析。這9個試驗顯示,嬰兒按摩在成長方面沒有影響,但是在母嬰互動、睡眠、放鬆、減少哭泣有改善,並且能有益的影響一些生理過程。在一個針對韓國孤兒院嬰兒的研究,顯示在疾病數量和看醫師次數上,有意義的影響。對於嬰兒的依附、脾氣、心理和心智發展上,沒有證據顯示有效果。這些結果提供了初步的證據,支持現行社區中所教導執行的6個月以下嬰兒按摩,但證據還不足以列為全球性普遍的建議。在不同族群的相對益處,以及在母嬰互動、生理機制方面的牽涉影響,還需要更多的研究。對於嬰兒按摩的不同方法所帶來的相對益處比較,什麼是教導父母的最好方式,以及最適合的按摩頻率和強度,也需要進一步的研究。

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 infants in the first six months of life. A total of 23 randomised controlled trials were included. Thirteen of these that were assessed to have a high risk of bias and were analysed separately. One study reported follow-up data only. It was only possible to combine the results of the remaining studies for a very small number of outcomes. The results of nine studies suggest that infant massage has no effect on growth, but provides some evidence suggestive of improved mother-infant interaction, improved sleep and relaxation, reduced crying and a beneficial impact on a number of physiological processes. Results showing a significant impact on number of illnesses and clinic visits were limited to a study of Korean orphanage infants. There is no evidence of any impact on infant attachment, temperament, psychomotor or mental development. These results provide tentative evidence to support current practice with regard to the teaching of infant massage in the community during the first six months of life, but fall short of the evidence needed to recommend universal provision. Further research is needed to identify the relative benefits in different population groups, its influence on outcomes such as mother-infant interaction, and the physiological mechanisms involved. Further research is also needed to identify the relative benefits of the different approaches to infant massage, the best approach to teaching parents and the optimum frequency and intensity.

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