There is more to healthy nutrition and development than just the ingestion of nutri-ents, and the provision of correct nutrients and calorific requirements does not always result in optimum results. For example, babies who are deprived of human contact gain weight at a slower rate than babies who are held and stimulated. This maternal deprivation and inadequate stimulation may result in an impaired meta-bolic rate. Inher review of the use of massage on neonates needing special care, Porter (1996) reviews the use of formal and informal massage as a normal activity between mother and baby. She points out that without this stimulation and appro-priate loving touch, even if other needs are met, babies will not thrive and develop normally (Russell 1993). McFadyen (1989) points out that parents often feel disso-ciated from their special care baby and massage is a way in which they are able to participate in the baby's care. In a series of studies (described below) Field and others have demonstrated the value of massage for weight gain in pre-term, full term and medically compromised babies. Research into the mechanism for this effect led the researchers to consider the role of vagal tone. Whilst the baby is being massaged, the vagal nerve slows the heart rate, enhances gastric motility and increases the release of food absorption hormones such as insulin.
Field et al (1986) showed that tactile-kinaesthetic stimulation (or massage) in pre-term babies could have a significant effect on their weight gain, the treat-ment group gaining 47% more weight than the control group; moreover, the treatment group were in hospital for 6 fewer days than the control group.
Scafidi et al (1993) investigated which pre-term infants would benefit most from massage therapy and noted that babies who had experienced more complica-tions before the study started gained more benefit from the massage. Studies conducted on full term babies of clinically depressed mothers (Field 1992), had shown that even a short 15 minute massage twice. a week resulted in marked improvements in the babies' stress levels, as measured by salivary cortisol levels
106 (}-11years
and serotonin levels, and by weight gain and alertness, compared with the con-trol group. Although the difference in weight gain was not significant between the groups, it was important, because babies of depressed mothers have been shown to display growth delays by the age of 1 year (Field 1992). The babies in Field's study maintained their growth trajectory, indicating that massage was a good way for depressed mothers to enhance their children's development. Two further studies on medically compromised babies showed that massage could influence the outcome for babies exposed to HIV virus and cocaine (Scafidi&
Field 1996, Scafidi et aI1996).
Although previous studies had shown no effect with massage, this was due to the type of massage used, which consisted of light strokes; Field used a deeper pressure technique, towhich the babies appeared to respond in a very positive way. In the studies described, the intervention was conducted for 15 minutes in a variety of patterns; for example, for pre-term infants and cocaine-exposed infants, massage was done at the beginning of each of 3 consecutive hours per day over a period of 10 days, whilst the normal infants were massaged for 15 minutes a day, 2 days a week for 6 weeks.
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7 Problems related to elimination
CHAPTER CONTENTS
I
• Introduction 109