Thursday, March 4, 2010

Infant Massage: Loving Touch Why?

Infant Massage-"Loving Touch"
By: M. Kay Keller, M.P.A., S.S.W., C.I.M.I.

For International Association of Infant Massage-U.S. Chapter, 1998, Annual Educational Conference

ABSTRACT: Keller, M. Kay; 1998, "Infant massage-loving touch," International Association of Infant Massage~U.S. Chapter Annual Educational Conference.

Infant/Child massage is a form of communication which sets the emotional dance between parent/caregiver and the baby to continue throughout life. The objective of this paper is to provide education on the numerous benefits of parent-infant massage and the variety of circumstances for which it can be used.

Four basic benefits of infant child massage are explored in this paper:
1. Stimulation of all of the physiological systems;
2. Relaxation;
3. Relief;
4. Interaction.
The massage strokes include combinations of Indian, Swedish, and Reflexology strokes. These strokes are introduced to the child beginning with the feet, moving up the infant's body and are repeated three times at first, until the infant becomes use to the tactile stimulation. Parents are instructed to verbally communicate 'hello' and, 'may 'I touch you?' requests before beginning the strokes. Certified infant massage instructors may massage their own child or a substitute doll to demonstrate the strokes to parents in a modeling behavior teaching style. Assessments of behavioral states are included in the demonstration. These behavioral states include: quiet sleep, active sleep, drowsy sleep, quiet alert, active alert and crying states.

Implications for child development are: increased communication, establishing boundaries and emotional attachments of which there are three, according to Roberts, 1987, securely bonded, anxious/ambivalent, and avoidant.

Many professional are exploring the impact of massage on infants. These include and are not limited to: pre-mature babies, teen moms, orphaned/adopted babies, battered infants and abused parents, babies born with birth defects and drug and alcohol exposed infants, infants that are HIV positive, infants that experience colic, sleeping disorders, low birth weight, motor disturbances, physical developmental and mental health disturbances. Massage has been proven to impact children who have asthma, autism, burns, and numerous other childhood illnesses. Adolescents, adults and elderly people have shown improvements under psychological and medical disturbances both when massaged and when giving massages. This need for touch has shown no indifference to the human stage of either development or maturation stages.

INTRODUCTION
Touch and massage are not new to human civilization. Massage can be found as far back as 3,000 years ago. Many cultures used massage as a healing remedy to the body and mind. It was utilized for prevention, intervention and recovery of disease and illness. In modern times, scientists began to question whether or not hormones and other bio-chemical process were stimulated by massage.

Vimala McClure, an anthropologist who visited India during an educational experience, discovered among the people of India, a sense of peace and calmness, drastically contrasted to the abject poverty of the land. She became very conscious of the tenderness in which the people of India treated each other and their children, in spite of their dire circumstances. Ms. McClure noticed the women touched mothers in labor and often as a way of expressing compassion with those who were ill. As she left the country of India, she passed a mother who was sitting in the dirt on the side of the road gently massaging her baby. This indelible impression on Ms. McClure's mind prompted her to self-discovery, and the benefits of massage formed her career as a prominent expert on infant massage. It is no surprise to find her techniques have developed from the Indian massage she was first exposed to and has included, over the years, techniques from the Swedish and Reflexology massage (McClure-Schneider, 1993).

Vimala McClure wrote her first edition of the Infant Massage Instructor's Manual in 1977 and began to share her ideas and experiences with her own children with childbirth educators. The International Association of Infant Massage Instructors began in 1981 by way of a formalized instructors training in Chico, California. The interest and involvement became international when Denmark too joined the group to begin teaching parent-infant massage. The first Board of Directors was formed in 1986 and a nonprofit organization was formed.

This lifetime commitment driven by the vision of fostering and encouraging Infant Massage while combining cultural traditions, to enhance family centered values, intended to pass on to another whole generation, who will express more compassion for their fellow human beings (McClure-Schneider, 1993).

The International Association of Infant Massage Instructors, (I.A.I.M.) 1-888-448-9489 or website: http://www.iaim-us.com., believes babies are aware of their surroundings much sooner than science would have us believe and deserve respect, tenderness, warmth and more importantly a listening heart. Listening to an infant through our parental heart, we hear what we need to hear, to develop early bonding that is loving, healthy and secure (McClure-Schneider, 1993).

Including massage, as a healing tool in a child's life is a natural remedy when one considers skin is the largest and second most important organ of the human beings body (Montague, 1987). It is amazing such a natural instinctual reaction to loving care has been stifled and ignored for so long.

Four Basic Benefits of Massaging Infants

Stimulation
The stability of the nervous system and resistance to disease, sensory, respiratory, circulatory, gastro-intestinal systems and neurological development is greatly enhanced by the stimulation of touch. Skin and brain cells are of the same molecular structure; the difference is skin is the largest organ of the body and the most integrated in the brain and body connection. The brain receives information from the skin of the body continuously, non-stop through out a person's life. The skin is the second most important organ of the body (Montague, 1987). In his book, Touching: the Significance of skin, Ashley Montague states, "A human being can spend his life blind and deaf and completely lacking the senses of smell and taste, but he cannot survive at all without the functions performed by the skin," emphasizing the importance of the skin to the human body.

Observations of both rats and monkeys have shown touch is preferable to their sense of security, even above feeding and nursing interactions. Rats showed a greater recovery rate after surgery and monkeys preferred cuddling and touch to being fed (Hammett, 1921,1922). According to Montague, mammals and birds alike have been studied extensively and found they lick their young to stimulate the digestive system, maintain healthy survival and to increase the mother's ability to nurture.

Natural sensory stimulation speeds myelination of the brain/nervous system (Rorke, 1969;Reinis, 1980). The myelin sheath is a fatty covering around each nerve, like insulation around an electrical wire. It protects the nervous system and speeds the transmission of impulses from the brain to the rest of the body. The process of coating the nerves is not complete at birth; stimulation speeds this process. Jensen (1978) showed rapid neural-cell firing may be a key to the development of intelligence. In addition, enhanced brain-body communication may help prevent and/or relieve colic, which may be due in part to the immature functioning of the nervous system (McClure-Schneider, 1993).

It is not known what causes colic to occur in infants. Colic is an uncomfortable and disturbing condition to both infant and parents, due to the distress of the infant, which shows symptoms of gas and stomach problems (Montagu, Ashley; 1987).

Respiration, which is characteristically shallow, unstable and inadequate in the first weeks after birth is definitely a stimulated reflex through sucking and through physical contact with the mother. Infants who do not suck vigorously, do not breath deeply and those who are not held in the arms sufficiently, particularly if they are bottle-fed babies, in addition to breathing disturbances often develop gastrointestinal disorders. They become air-swallowers and develop what is popularly known as colic. They have trouble with elimination or they may vomit. It seems the tone of the gastrointestinal tract in this early period depends in some special way on reflex stimulation from the periphery. Thus, the touch of the mother has a definite biological implication in the regulation of the breathing and nutritive functions of the child (Ribble, M.A., 1941).

It is believed people who did not receive touch as infants are more susceptible to shallow breathing, upper respiratory, tract and pulmonary problems than people who did receive touch as infants. Children separated from their mothers as infants have been shown to have a higher rate of asthma and people who are having an asthma attacks can be comforted with an arm placed around their shoulders (Montagu, Ashley; 1987).

Children who are brought up with reflexology as part of their everyday family life and who receive, and give, treatments on a regular basis are likely to be more resistant to common ailments such as coughs, colds, and upset stomachs. More than this, the constant demonstration of tender loving care from members of their family helps build their self-esteem and confidence as well as sensitivity toward the needs of others (Gillanders, 1989).

There are many positive reasons why touch is such a healing and bonding experience between the infant and other family members. However, none may be as important as the nurturing and emotional connection, as determined by numerous studies, a lack of empathy and nurturing connection with a baby is what makes a child vulnerable to abuse.

Relaxation
Touch is a natural relaxation technique in which tactile contact, eye contact, and heartbeat sounds all send soothing messages to the baby's system, increasing the infants' tolerance for stress. Stress can provide either a positive or a negative impact on a baby's body. At first, stress stimulates hormones in the baby's body actually increase the neural activity, needed for learning. However, if there is no intervention and the stress continues to flood the babies' brain then stress becomes a negative, rather than stimulating growth and learning. The brain instead, shuts down the system thus preventing learning and growth. It essentially goes on overload and cannot handle any more stimulation (Epstein, 1981).

Three of the most important interactions between a mother and her new infant are the tactile contact, eye contact and heartbeat sounds which a baby receives from it's mother right after birth. These signs tell the baby's brain it is safe and can stop producing stress hormones. These signals are as developed as the signals to the mother's body to begin producing milk for her child or the signals to the uterus to contract as the need for housing the baby has ended. Babies have this process interfered with are found to have stress hormones in their bodies for days after their birth. Versus babies whose birth's have taken place in a natural setting where the process was not interrupted, were found to have no stress hormones in their bodies as soon as 24 hours old.

Most of us benefit from a stress cycle ends in relaxing. What takes this benefit away from babies is the belief babies do not encounter stress in spite of the fast pace of our society. This leaves babies with no coping mechanisms and plenty of stress in their little bodies, like being all dressed up with no where to go! Having stress acknowledge by the massaging parent not only validates the baby's experience, it also, provides an increase in the tolerance for the baby's threshold for stimulation which in turn increases their ability to deal with stress in their young lives.

Relief
Touch massage helps to tone the digestive tract, helps move gas and fecal matter into the bowel for expulsion, emotional and physical stress is expressed and relieved. Teething, emotional distress, tension, congestion and illness are all types of experiences in which massage can help to lower the need for the infant to express themselves with crying and screaming.

Included in the instructions to parents for massaging the baby, is to ask the baby to tell them their story, "tell me what is wrong." This action tells both the caregiver and the baby it is permissible for the to cry and unload its' emotional build up.

As was mentioned earlier in this writing under stimulation, colic is another painful experience for both the baby and the caregiver which can become a nightmare if the parent does not know what is wrong and the baby increases it's air intake, increasing the intensity of the pain. Massage helps to tone the digestive tract, helps move gas and fecal matter into the bowel for expulsion, and emotional stress is expressed and relieved.

In 1984, C. Brown wrote in a journal article about technology was introduced which allowed doctors to measure the amount of oxygen tension by placing an electrode in the skin of infants, thus allowing doctors to determine babies do react to stress with changes in their oxygen levels. Massage helps babies to stabilize the oxygen levels and it is more common to see the use of massage when stressful events are occurring to infants in hospitals now.

Interaction
Attachment and bonding, a dance builds trust and intimacy, communication through eye contact, touch, verbal and non-verbal cues, odor, heat and warmth. Human beings bond in reciprocated personal interaction and communication that last throughout time. Touching, cuddling, kissing and prolonged eye contact accomplishes this. Bonding is a poetic, artistic dance between two human beings in which trust and intimacy can build. Physics refers to bonding as a phenomenon throughout the universe. It is known when "two particles of energy are brought into close proximity and are separated later and sent off in opposite directions at the speed of light, a change in the spin or polarity of one will be reflected in a change in the other. As Pearce, (1985) says, bonding is the 'dynamic of relationships, the force relates apparent separations into an underlying stated of unity.' "

Maternal Engagement
Bonding between a mother and the child happens through different experiences. The mother will engage her child by touch, warmth of her body, eye to eye contact, her odor, high pitched voice, bacterial flora (which helps develop antibodies transferred through kissing and physical closeness), breast milk, entrainment (mimics of the speech and cues of the baby's body movements), and rythmicity (in utero rhythms and adaptation to new rhythms).

Infant engagement
The baby will engage the mother through: eye to contact, crying, oxytocin (by sucking the baby stimulates the release of the hormones help her to heal), prolactin (the same behaviors help to release a hormone makes the mother feel more nurturing), odor, and entrainment (the baby mimics the speech and cues of the mother's body movements), (McClure-Schneider, 1993).

The baby engages the caregiver through eye contact almost from the first at birth, and parents are drawn to gazing into the infants eyes when first introduced to the new being at birth. A lot of information gathering goes on as the infant stares at the mother, the outline of her face, the familiarity of her voice, her smell, and her touch serve to convince the baby it is indeed, in the arms of its' mother. The hormones are released in the mother's body by the skin-to-skin contact between her and her infant serve to contract the uterus, bring the milk supply in, and relax the mother so she can best respond to her infant (Montagu, Ashley; 1987).

The cries of the infant are so powerful as to trigger the let down of the mother's milk during her nursing cycle. This same cry distinguishes for the mother the cry of her own newborn and of others. While this cry is a positive indication of bonding and health in the baby it is often distressing to the parent. This is where infant massage is an intervention tool, teaching the parents to relax when the baby is crying, giving the baby permission and support while crying, and reinforcing the parents reaction to the babies cry by listening inside themselves to hear what the baby truly needs.

During infant massage it is recommended parents use unscented oil as the mother and baby find it easy to recognize each other through smell alone. Mothers who were exposed to their babies for as little as two hours were able to pick out their child’s clothes from another's just by smell alone. This ability has been shown to continue for years after the baby has grown (Montagu, Ashley; 1987).

Entrainment
Computer studies analyzing movies of moms and their babies revealed the babies had movements, which corresponded with their sounds. Each sound has it's own movement attached to it. The researchers postulated language is imprinted in the womb as a biological programming (Condon and Sander, 1974).

According to Hoffman, 1985, the baby's midbrain processes the interactions of the muscle movement and correlates them with emotional interpretation then, the cerebral cortex gives structure and expression to this phenomena. This is evident when children of the age of two are asked to say, "hand," they will move their hand as they vocalize the word. It is this movement the mother recognizes and when mother and baby are synchronized both feel the closeness.

Touch
It is instinctual for a mother to stroke the baby in a soothing manner after the baby is born, thus stimulating myelination of the nervous system and the five sensory mechanisms (Dunbar,1976; Grossman,et al.1981; Tulman, 1985). Cuddling, caressing, and stroking your baby are natural expressions of your joy in their being and an essential part of the bonding process. In some parts of the world, mothers make a full-body massage a part of the baby's daily routine (Gillanders, 1989).

Babies learn about their bodies through kinesthetic feedback from their bodies, their muscles tell their brains where their hands or arms are located. Massaging a baby stimulates kinesthetic feedback and thus increases an infant's sense of self (McClure-Schneider, 1993).

Demonstration of the Strokes
Before the massage of the baby begins, it is important parents are encouraged to develop cues signal the baby the massage is about to begin. The cues are simple, just the laying of the baby on a familiar blanket, the swishing of the oil or cream in the parents hands up where the baby can see and hear.

It is best to begin with the feet and legs, as this is less threatening to the child. Begin the massage by asking the baby's permission to touch the baby and at each transition from one part of the body to a new part, ask again the baby's permission to touch. This is so very important to begin the parent and child interaction with this permission asking and giving, even though the infant won't respond the parent begins to look to the infant for non-verbal and verbal cues of communication.

Each stroke need be repeated only three times until the infant becomes use to being massaged. Reflexology instructions may be included into the massage techniques. The family guide to reflexology, by Ann Gillianders 1989, a book highly recommended to include more precise strokes aimed at releasing tension and crystalline deposits accumulated at specific stress points in our bodies. This is important as these deposits, when released, actually provide relief from numerous ailments are induced by physical and emotional stress.

There are three different types of massage techniques are integrated into this instruction. These are Swedish, Indian and Reflexology techniques. Swedish massage techniques involve a reverse milking motion in which strokes are made upward toward the heart from the extremities. The use of the whole hand is also used in many of the techniques to cover as much skin as possible and make the kneading motion needed to relax muscles. Indian massage techniques are just the reverse of Swedish techniques of a milking motion in which both hands are used to stroke away from the heart and towards the extremities in a milking motion. It resembles a long stroking alternating between hands. While one hand is finishing the stroke the other is alternating, by starting the stroke. Indian massage also involves rolling the fingers and toes between your hands or fingers, depending upon the size of the child being massaged. Reflexology techniques are accomplished with a precise pressure is applied with fingers or thumbs to a specific area to release stress and produce a release in the muscles where they may have bunched up.

Massaging newborns also provides the relaxation needed to encourage a restful and deep sleep. In studying the behavior of newborn infants, researchers have found predictable states, both in sleeping and wakefulness (Wolff, 1965; Brazelton, 1976).

1) Quiet sleep. Eyes are firmly closed and still, little or no motor activity. Respiration is primarily abdominal.
2) Active sleep. Eyes are closed but may move (rapid eye movements). Body activity from twitching to writhing and stretching. Facial movements include frowning, smiling, sucking, and sometimes "laughing" noises.
3) Drowsy. Eyes may open and close or be partially open, still and dazed.
4) Quiet alert. Body and face relatively inactive, face is relaxed, eyes open and bright, observant.
5) Active alert. Lots of activity, irregular respiration, cries, moans, grunts, fussing.
6) Crying. Much activity, sustained crying (Wolff, 1965; Brazelton, 1976).

These are just simple descriptions of the states and other variables such as pleasure and pain responses should not be disregarded.

Implications for child development are: increased communication, establishing boundaries and emotional attachments.

Establishing boundaries is a multi-faceted experience for the caregiver and the infant. Having the caregiver ask permission to touch the child sets the stage for the infant to expect touch is a permissible event is allowed as long as the infant is comfortable with touch. This impact is considerable, when one considers the necessity for a child to know what good touch and bad touch is. For them to begin to be able to set boundaries with adults from such an early age, reinforces the belief no one has the right to touch their bodies without their permission.

Physical boundaries are also established developmentally, as an infant does not understand their feet are connected to their body or their arm is connected to their shoulder at an early age. Think about how many times you have witnessed a baby playing with it's feet, put it's toes into it's mouth and chew on them, then look startled and amazed they felt pain in their toes! By massaging the baby over and over again, it helps the baby determine where its' body stops and starts and where the caregivers begins. The bonds of trust and love, the lessons of compassion, warmth, openness, and respect, which are inherent in the massage routine, are carried with the child into adulthood. Early bonds, which are warm and close, contribute to positive values and positive adult behavior (McClure-Schneider, 1993).

The types of bonding result from the attachment process between a caregiver and the baby are: securely bonded, anxious/ambivalent, and avoidant (Roberts, 1987).

Securely bonded
These people believe it's easy to get close to others and have no problem with mutual dependence. They have happy, trusting relationships; their romances last the longest and end in divorce least often of the groups studied. They had close, secure relationships in infancy and were held, kissed and 'coddled.'

Anxious/Ambivalent
These people want to be close to others but they tend to attract people who are unable to be close. They worry about people leaving them, tend to be very jealous and have intense emotional ups and downs. These were the largest group - perhaps a reflection of the "don't spoil the baby" attitudes of the baby-boom generations. They were loved as infants but their caregivers were ambivalent and confused, giving them mixed messages about their worth, their safety, and the trustworthiness of the world.

Avoidant
These people feel uneasy when people get too close. They have trouble trusting or depending on others, and are afraid of intimacy. They tend to give the message, "I love you/go away." They were neglected in infancy, punished for 'bad' behavior, made to be independent and "strong," and told it wasn't nice to express emotion (Roberts, 1987).

Sibling Involvement and Bonding Issues
The attachment and bonding issues do not just involve the parents of a newborn baby; they also involve the other siblings may have been born prior to this infant. Using massage combined with reflexology, including other siblings in the process, can establish "nurturing, loving bonds with the new member of the family," (Gillanders, 1998).

LITERATURE REVIEW
Touch in relationship to development and behavioral functions, was first researched by Hammett. This study showed when rats were gentled and petted after undergoing removal of thyroid and parathyroid glands, they survived longer than those rats underwent the surgery but only received cage cleaning and feeding. The latter rats were apprehensive, high strung, tense, resistant, and timid and exhibited fear and rage by biting. The rats were gentled and petted were more relaxed and yielding. They were not easily frightened and felt secure in the hands of whoever held them. When the parathyroid and thyroid of 304 animals from both groups were removed alone, then 76of the irritable rats died, and only 13of the gentled rats died. The critical elements of this 1922 study were gentle touching of rats made the difference between life and death; gentling produced gentle, unexcitable animals, and lack of gentling resulted in excitable and fearful animals(Hammett,1922).

The infamous studies of infant monkeys allowed us to discover monkeys who were given a choice between a mother made of wire who offered food and a soft cuddly mother who offered no food, the monkeys chose to be with the soft cuddly mother over the mother who provided food (Harlow, 1958).

Numerous studies since the Hammett and Harlow studies have continued to define and expand the impact and benefits of touch on human beings. In 1976, Rice conducted controlled research on premature infants, touch was the variable. This experiment concluded premature infants who were massaged, gained weight faster and made quicker neurobiological developments (Schneider, 1996).

In 1980, Hansen and Ulrey paired infant massage with infants who experienced motor problems and their mothers. They found parents and their babies had more positive interactions and their expectations of the infants became realistic and positive (Schneider, 1996).

The next decade brought the studies of Tiffany Field, in 1986, which looked at the effects of infant massage. Babies were massaged three times a day for 15 minutes over 10 days. She found premature babies: gained weight 47more than babies in the control group who received no massage; had higher Brazelton scores; were alert and active; were hospitalized 6 days less than the controlled group of babies (savings to the hospital, $3,000 per infant); received higher scores on testing for the first year after birth than the babies in the control group (Schneider, 1996). These same findings occurred when Dr. Fields repeated this research with babies who had been cocaine-exposed and were pre-term.

A year later research by White-Trout in 1987, concluded the same results as the Field study in 1986. Then in 1990, Scafidi, examined the physiological and biochemistry of infants who were massaged. The results were the same as prior studies by Rice, Field, and White-Trout, with the addition of the chemical effects in the bodies. The catecholamines, norepinephrine, epinephrine increased in these infants, thus increasing their sense of safety and well being. Research by Unvas-Mosberg in 1989, revealed stimulating the inside of the mouth of newborns and the breast of the mother, increased the release of gastrointestinal food absorption hormones such as gastrin and insulin (Schneider, 1996).

Since the beginning study of touch by Montague, the Miami University Touch Institute, Director, Dr. Tiffany Fields, has continued in the research and development of massage and its benefits to human development. Research such as a comparative study of American pre-school children and adolescents and French pre-school children and adolescents revealed French children touch each other much more frequently than American adolescents during personal interaction (Fields, 1981).

Two pilot studies were completed in Miami and in Paris with forty adolescents by observation at McDonalds restaurants. Even when American adolescents were highly involved with each other in intimate relationships, i.e. best friends, touching occurred only 2of the time. The report of high levels of intimacy between these adolescents was inversely correlated to the observations of touch levels between them. The types of touching were more of a self-touch or self-soothing nature, hair twirling, twirling rings on fingers etc.

Cross culturally, the French adolescents showed a positive correlation between intimacy and touch. Even casual friends were quite touch oriented in their interpersonal styles. French teens were observe touching one another's backs, stroking an arm, hanging their arm around another neck or just leaning on each other. This behavior was not restricted to opposite sex encounters and was observed between the sexes as well.

The samples of teens at McDonalds restaurants were chosen in similar middle socioeconomic neighborhoods in which high schools were located. The ethnic compositions of both neighborhoods were similar. A research assistant recorded the behaviors of the teens, which observed:

(1) types of touching - peer touching (physically leaning on peer, stroking, kissing, hugging) and self-touching (playing with hands or hair);
(2) location on body where touch occurred (head and shoulders, arms and hands);
(3) apparent purpose of touching (affection, self-stimulation);
(4) activity engaged in (eating, talking, drinking, smoking); and
(5) affect (positive and negative facial, verbal, and physical).

The subjects were observed for 20-minute periods, and the behaviors were recorded at ten second intervals. The results from the study showed American teens were more prone to self touch, more prone to touch on the arms and hands, less affection towards others and more towards self. Activities of American teens showed more eating and drinking and less smoking and talking, interpersonal non-verbal communication were mostly negatively expressed rather than positively expressed.

Research has indicated inadequate touch early on in life and again in the teen years could contribute to violent behavior as adults. Cultures in which there is more physical affection shown to young children, had lower incidences of adult physical violence and the opposite as well (Prescott, 1990). There has been shown to be a lower incidence of violence in French children than American children, this could be the explanation for the differences in the cultures (Jourard, 1966).

Other possible explanations such as, children who are touched less by their parents are less attached and more likely to have more negative interactions and receive physical punishment by their caregivers. Both of which have been found to be related to aggressive behavior in children.

A similar study conducted with American and French preschoolers indicated the same results as the teen study. Preschoolers in France were not inclined to play aggressively or violently, as were American preschoolers. Indeed, children in the French restaurants were found to behave more as if they were small adults than preschoolers, compared to the American children which were much more aggressive and violent towards their caregivers. Although there were no differences shown in the amount of dialogue between the caregiver and the children there was indeed a major difference in the non-verbal behavior and interpersonal exchanges (Field, 1999)

SUMMARY
Many professionals are exploring the impact of massage on infants. These include and are not limited to: Pre-mature babies, Teen moms, Orphaned/Adopted babies, battered infants and abused parents, babies born with birth defects and drug and alcohol exposed infants, infants are HIV positive, infants experience colic, sleeping disorders, low birth weight, motor disturbances, physical developmental and mental health disturbances.

Massage has been proven to impact children who have asthma, autism, burns, and numerous other childhood illnesses. Adolescents, adults and elderly people have shown improvements under psychological and medical disturbances both when massaged and when giving massages. This need for touch has shown no indifference to the human stage of either development or maturation stages.

Parents who experience the premature birth of a baby are under a great deal of stress. There are numerous decisions to be made about the infant's physical and medical care. The parents are also experiencing incredible emotions of loss and grief for their expectations of a health and normal delivery. These unexpected events can lead to depression, anxiety, anger, loneliness and an extreme sense of helplessness. They are not sure of what is expected of them as parents or how to aid the baby. More and more the medical field has become attentive to the needs of parents and their premature infants. They have come to encourage touch and interaction between the premature infants and their caregivers (Schneider, 1996).

Adolescent parents are often unprepared for parenting and the change in their role from a care free teen to of a parent with overwhelming responsibility for another human life. They are exposed to negative judgments from others and receive little social support. Learning the art of infant massage can increase their self esteem, confidence as a parent, and acceptance of themselves and their child. Setting up a positive communication style between the caregiver and the infant validates the baby's needs. This has been shown to be an inhibitor to negative punitive behavior by the caregiver to the infant in other situations.

The most significant experience any human is exposed during pregnancy and after birth is the process of parenting. Stephen J. Bavolek's research on nurturing behaviors indicates when nurturing behaviors are present, abusive and/or neglectful behaviors are not. Nurturing infants and children through touch massage is a promotion of healthy family dynamics and an incredible upbringing for a child who is fortunate to experience a nurturing environment.

Babies who are born blind will especially benefit from infant massage. An infant born without the sense of sight still has the sense of smell, hearing, taste and touch. It is important for a baby who is born blind to receive touch as a way of experiencing object permanence. This is the only way a baby who is blind comes to understand the sense of others in the world as well as things they touch. Talking to the baby during massage and naming the parts you are massaging enables a baby to perceive a sense of body image. Touching and holding the baby who is blind helps them to eventually understand they are a part of a world, not a world inside of themselves (Harrell, 1984).

The Center for Substance Abuse Treatment (CSAT) recommends promoting positive mother-infant interaction for infants have been exposed to substance abuse during the pregnancy. CSAT recommends instructions upon discharge from the hospital to include being taught to: assess the baby, interpreting his or her cues for more or less interaction and entrainment; care and handle the baby in a way he or she is not over stimulated by the noises in the environment; utilize graduated interventions to quiet a fussy irritable baby; appreciate the baby's gifts to see, hear, and engage with their caregiver. All of these recommendations are included in parent infant massage classes.

Special needs infants are often touched less and experience less interaction between them and their caregivers. These same children with special needs become less responsive to their caregivers and their environment. Massage has been found to increase the level of interaction between the caregiver and the child, and between the child and his or her environment. This has great implications in the development of the child's social skills and ability to relate to their peers (Schneider, 1996).

DISCUSSION
Massage is so impactful upon human beings because we are so sensitive to touch. The molecular structure of skin cells is identical to those of brain cells. In the study of neurology, the proportional size of an organ is related to the number of functions the organ performs for the human body. The skin is the largest organ and weighs approximately 10 pounds in an adult, covers 20 square feet. "Skin the size of a quarter contains more than 3 million cells, 100 to 340 sweat glands, 50 nerve endings, and 3 feet of blood vessels," (Schneider, 1996).

The sensory feedback the brain receives from the skin is continuous, even when the body is sleeping. Montagu stated "next to the brain, the skin is the most important of all our organ systems. A human being can spend his life blind and deaf and completely lacking the senses of smell and taste, but he cannot survive at all without the functions performed by the skin...Montague suggested we get to know the skin intimately because it has great powers and abilitiesare not yet fully explored (Schneider, 1996).

The concluding results of massage are universal. Massage creates a sense of well being and safety due to the structure of the human body and the molecular structure of the skin. The studies and education has been conducted on this subject has shown the skin is directly connected to the brain and touch has a positive effect upon the chemicals are released into the brain.

Children and infants who are massaged, sleep better and deeper, they play better, feel better about themselves and the world around them. Massage has been shown to increase the bonding and attachment between the child and caregiver, thus creating a prevention mechanism for child abuse/neglect.

Current ongoing studies at the Touch Institute in Miami, are too numerous to list, and the topics vary from colicky babies to rape and spouse abuse. Numerous published studies have shown massage to be beneficial to people with diabetes, skin disorders, eating disorders, people suffering with depression and other mental illness, and the elderly.

Studies regarding the elderly and massage showed not only did they receive the same benefits from massage as infants and children, giving massages to children and infants also benefited them.

PROGRAM, POLICY AND PROFESSIONAL IMPLICATIONS
When administrators are truly faced with the stark facts of reality:

- 80of child abuse is drug and alcohol related,
- more teens are being incarcerated than are entering college,
- 25-35 year old males are the highest of homicide victims,
- every 3 minutes a woman is raped,
- 1 of every 4 women are molested and or raped by the age of 18.

Nothing we have done so far has worked. The prisons are not full of people who experienced childhoods full of nurturing behaviors. The definition of insanity - is to keep doing the same thing over and over again, and getting the same result. No problem can be resolved at the same level it was created, according to Einstein.

The development of policy which incorporates nurturing behaviors in interpersonal relationships is the only answer we have to these problems.

WORKS CITED

Bavolek, Stephen J., Kline, D.F., and McLaughlin, J.A. 1979. "Primary prevention of child abuse: Identification of high-risk adolescents," Child Abuse and Neglect: The International Journal 3 (3):1070-1080.

Brown, C; 1984. "The many facets of touch,” Johnson and Johnson Pediatric Round Table No. 10 New York: Elsevier Science Pub. Co. Center for Substance Abuse Treatment, 1993. "Improving treatment for drug-exposed infants," Treatment Improvement Protocol, (TIP) Series No. 5, 18.

Dunbar, J.; 1976. "First encounters with mothers with their infants," Maternal Child Nursing Vol. 5 (1), 1-4.

Epstein, H; 1974. "Phrenoblysis: special brain and mind growth periods," Developmental Psychobiology New York: John Wiley and Sons.
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