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Child Development

By Shirley Vanderbilt

Originally published in Massage Bodywork magazine, February/March 2000.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.



A parent's touch holds great power. The soothing massage of a mother's hand can calm a fussy infant. A child's fevered brow may be cooled by the gentle stroke of her father's palm. And in too many unfortunate cases, a child may be physically hurt and abused by a striking blow from his parent. A natural conduit for emotions, touch or the lack thereof transmits important information about the parent/child bond, whether one of acceptance or rejection.

It has been widely held for decades that the absence of nurturing, parental touch significantly influences growth in children, leading to such problems as delayed mental and physical development. Lack of tactile stimulation has also been implicated in the development of childhood diseases, such as skin disorders and asthma.

In Ashley Montegu's classic book Touching: The Human Significance of the Skin, a 1952 study by Dr. Maurice J. Rosenthal is cited which confirmed a theory that infantile eczema is directly related to inadequate maternal cutaneous contact.1 Montegu himself postulated that asthma may also develop as a result of touch deprivation. In following adult identical twins with asthma, Montegu observed that both received little tactile stimulation as children, having lost their mother at birth. One twin improved in symptomatology following prescribed massage therapy, while the other improved following marriage. Montegu proposed that tactile stimulation, missing in the twins' earlier lives but now available to them as adults, provided some alleviation of their chronic asthma. This case was reported in 1953 and as Montegu stated, did "not appear to have stimulated much research on the relation of tactile stimulation to asthma."2

During the 1970s, treatment for childhood chronic illness began a shift toward holistic approaches, sometimes involving family therapy to alleviate emotional stressors and break the psychosomatic cycle of the disease. Stress became increasingly identified as a major contributor to symptomatology in chronic illness in children, if not the root of the disease itself. Professionals recognized that asthma, cystic fibrosis, arthritis, diabetes and cancer all responded to the body's tensions and extremes of emotions. Chronic illness was also recognized as a family experience with parent, child and siblings all suffering the stress of trying to cope with frequent hospitalizations, painful or uncomfortable treatments and restrictions on diet and daily activities.

With the increasing acceptance of alternative therapies during the past decade, the door has finally opened for research into Montegu's and Rosenthal's theories of the interrelatedness of stress, childhood disease and touch. In light of the emerging research, it appears that Montegu's hypothesis may be just the tip of the iceberg.


Touch Research Institute
A leader in the growing field of alternative therapy research, the Touch Research Institute (TRI) at the University of Miami School of Medicine has conducted a series of studies on the effects of massage on infants and children with a variety of medical conditions. The institute, established in 1992 with grant funding from Johnson Johnson and the National Institutes of Health, is directed by Tiffany Field, Ph.D., a renowned authority in the field of touch research. In a 1995 article titled "Massage Therapy for Infants and Children," Field defines massage therapy as "one of the oldest touch therapies" and an approach that is amenable to use with a wide range of conditions.3

The results of TRI's massage research indicate significant influence on medical conditions in all ages including "diminished pain...decreased autoimmune problems...and enhanced immune function."4 Studies focused on children with chronic illnesses have utilized parents to administer nightly massage sessions. It is not so surprising that parents and children involved in the studies experienced a decrease in anxiety during the course of treatment, but what is even more significant medically is the concomitant improvement in the child's symptomatology.

The studies hold great promise for massage as a treatment choice in chronic childhood disease. Massage reduces stress hormone levels and provides an ideal opportunity for positive interaction between parent and child in the midst of the negatives of treatments. By using parents as the massage therapists, the treatments are cost-free and convenient as well.


Pulmonary Function in Asthma
The number of diagnosed cases of asthma continues to rise worldwide, with some 4 million children in the United States being affected. Asthma is the cause of more hospital admissions, emergency room visits and missed days of school than any other chronic childhood illness.5 According to the American Medical Association, "Emotional stress can trigger an asthma attack or make it worse."6 TRI researchers have identified anxiety as the most prevalent psychological state found to induce asthma attacks.7 A recent study at Harvard Medical School measured the effect of primary caregiver stress on children predisposed to allergies and asthma. The findings indicated that "increased (caregiver) stress predicted an increased allergen response" in the study group.8 Thus, stress has been clearly identified as a major factor in the manifestation of allergy symptoms in predisposed children and adults.

A TRI study published in 1997 concluded that massage therapy is effective as a treatment to decrease anxiety and thus improve pulmonary function in children with chronic asthma. During the 30-day study period, 32 children ranging in age from 4 to 14 were randomly assigned to receive either massage or relaxation therapy, administered each evening by their parent. Parents were instructed in the massage or relaxation technique and performed the therapy for a period of 20 minutes just prior to bedtime. The younger children in the massage group experienced an immediate decrease in anxiety and improvement in overall pulmonary function, while the older children receiving massage reported decreased anxiety and improvement in one area of pulmonary function. Over the course of the study, pulmonary functions and attitude toward asthma continued to improve.9


Glucose Levels and Diabetes
Insulin dependent childhood diabetes, known as diabetes mellitus (type I), is a condition in which the pancreas is unable to produce insulin, unlike the typical adult type II "in which the body's response to insulin is diminished."10 As with asthma, diabetes can have a strong emotional component, with blood sugar levels being significantly affected by stress, anxiety and depression. Management of childhood diabetes includes administration of shots and restriction of diet, both usually monitored by a parent and frequently the source of negative interaction between parent and child. Massage therapy administered by a parent can open the door for positive relationships and relieve the anxiety commonly associated with the family's experience of chronic illness.

TRI began research on diabetes in 1994, with a pilot study involving 13 children receiving nightly massage by their parents. The immediate effects of nightly massage were decreased anxiety in both parent and child and a lowering of depressed moods. At the end of the one-month study, "the parents' insulin and food regulation scores improved, and the childrens' blood glucose levels decreased to the normal range."11


Pain of Juvenile Rheumatoid Arthritis
Another common chronic disease of childhood, juvenile rheumatoid arthritis (JRA), is a painful inflammation of joints which may persist for months or years.12 The chronicity of the disease and the stress inherent to the family may contribute to increased anxiety in the child.

Pain control is sometimes a problem as the effects of anti-inflammatory drugs are limited and narcotics are not considered appropriate.

The results of TRI's study on JRA were published in 1997. Twenty children, ages 5 to 14, were randomly assigned to a massage or relaxation modality administered at bedtime by the parent. During the 30-day trial, massage proved more effective than relaxation in reducing anxiety in parent and child, as well as reducing stress hormone levels.13 Participant pain also decreased, as assessed by self-report, parent report and physician observation. The success of massage in reducing pain may have been due to an increase in serotonin or a pain-blocking mechanism.


Stress and Skin Disorder
Atopic dermatitis, more commonly known as eczema, is a chronic skin rash that may feature scaly red areas or blisters.14 As stated earlier, touch deprivation has been implicated in the development of eczema and other allergic reactions. This mechanism, notes Field, may be related to the "skin and the thymus needing stimulation for the production of their immune cells."15 Stress is also considered a factor in eczema outbreaks and the condition itself can lead to significant anxiety and depression over physical appearance.16

In TRI's study on atopic dermatitis, parents in the study group utilized prescribed topical medications in place of oil for their child's daily massage sessions. Children in the control group received standard application of topical medications without massage. At the end of the one-month study of 28 subjects, the massage group showed marked improvement in clinical condition, a reduction in anxiety and an improvement in affect and activity level, whereas the control group showed improvement only on measurement of scaling of skin. Parents administering massage also reported decreased anxiety levels and improvement in their attitude toward their child.17


Management of Cystic Fibrosis
One of the most life-threatening of chronic childhood illnesses, cystic fibrosis (CF) "is an inherited genetic disorder that causes persistent lung and digestive problems."18 Only 25 percent to 50 percent of CF children will survive to early adulthood, with a smaller number living into their 40s.19 In addition to the stress of such overwhelming odds, daily management of the disease takes its toll on the emotional state of child and family. Adjustment problems have been reported in "as many as 60 percent of mothers and 62 percent of children."20 Researchers at TRI surmised that massage would prove to be an effective treatment in decreasing anxiety levels in parents and children of CF by providing a positive mode of interaction. As with diabetes, parents of CF children have the daily task of performing uncomfortable and unwanted medical procedures on their children. Postural drainage may be required up to four times a day along with administration of multiple medications.

The TRI study on cystic fibrosis included 20 children assigned randomly to either a 20-minute nighttime reading session with their parent or massage administered by the parent. Those receiving massage exhibited the expected decrease in anxiety, as well as improved mood and peak air flow readings following the month-long trial. Parental anxiety level also decreased immediately after the massage sessions, further contributing to the improved adjustment of the child.21


Making the Connection
While more research is needed to clearly define the connection between stress, illness and touch, some basic mechanisms have become obvious. Massage therapy has an impact on psychological and physiological functions of the body by reducing anxiety, lowering stress hormones, enhancing mood, decreasing pain and improving immune response. The data suggests that massage stimulates the parasympathetic nervous system that in turn decreases the sympathetic response. The result is a more relaxed, physiologically balanced state. Another mechanism considered to be involved in the process of change is increased vagal nerve activity. This nerve activates the lungs, heart and most of the abdominal organs, influencing food absorption hormones such as insulin and gastrin, and increasing attentiveness. And finally, regarding pain control, there is a suspected gating mechanism. The gate theory is based on the premise that longer tactile nerve fibers stimulated by touch have a shorter transit time to the central nervous system than pain signals, thus closing the gate and blocking transmission of pain.22


Continuing the Research
These studies on chronic childhood illness are but a few of the more than 50 published reports from TRI researchers. Another 18 studies are ongoing, including several in the area of pediatric medical issues. Massage is being studied as a means of increasing serotonin and signs of alertness in comatose children. As a treatment for cerebral palsy, it is hoped that massage will increase motor function and social interaction, enhance muscle flexibility and help with posture. Evidence that massage decreases stress and enhances immune function also gives hope for use of this therapy in treating childhood cancer and enhancing family adjustment to coping with the disease.

As the research continues, current surveys indicate that alternative therapies are used increasingly as a treatment choice by pediatric patients with chronic and life-threatening illness. In a 1997 report from the Woman's and Children's Hospital in Australia, 55 percent of the clinic's childhood asthma population used alternative therapies, with massage accounting for 20 percent of this use.23 Two previous surveys reported 70 percent of children with JRA and 46 percent of children with cancer as using alternative treatments.24 In British Columbia, a pediatric oncology study showed 42 percent of 366 respondents used alternative and complementary therapies, including massage and therapeutic touch.25

These surveys reflect a growing awareness of the critical importance of touch in the healing process. Jim Burke, a former CEO of Johnson Johnson, in postulating on the relationship of touch and disease, said, "I think you are going to find that there are whole sets of diseases that come from touch deprivation. I think we will develop models suggesting that we can enhance the immune system by touch. I have no doubt that people who are well loved from birth to death have less disease. I would bet everything I own on that."26

Shirley Vanderbilt is a staff writer for Massage Bodywork magazine.

References
1. Montegu, Ashley, Touching: The Human Significance of the Skin (New York: Harper Row, 1971), 272.
2. Ibid, 284.
3. Field, Tiffany, M.D., "Massage Therapy for Infants and Children," Journal of Developmental and Behavioral Pediatrics 6,2 (Apr., 1995): 105.
4. "Wellness Research Centers Established," touchpoints, 5,3 (Spring 1998): 3.
5. Wray, Betty B., M.D.,Taking Charge of Asthma (New York: John Wiley and Sons,1998), 177.
6. Traisman, Edward S., American Medical Association Complete Guide to Your Children's Health (New York: Random House,1999), 420.
7. "Massage effects on asthmatic children," touchpoints, 2,1 (Winter 1995): 3.
8. "Caregiver stress increases allergen response in children." http://www.ama-assn.org/special/asthma/newsline/reuters/10186942.htm (18 Oct. 1999).
9. Field, T., Ph.D., Henteleff, T., B.S., Hernandez-Reif, M., Ph.D., Martinez, E., B.S., R.C.P.T., Mavunda, K., M.D., Kuhn, C., Ph.D. and Schanberg, S., M.D., Ph.D., "Children with asthma have improved pulmonary functions after massage therapy," Journal of Pediatrics 132,5 (May 1998): 854-858.
10.Traisman, 471.
11. Field, "Massage Therapy for Infants and Children," 109.
12. Tucker, Lori B., M.D., DeNardo, Bethany A., M.P.H., P.T., Stebulis, Judith A., M.A., Schaller, Jane G., M.D., Your Child with Arthritis (Baltimore: The Johns Hopkins University Press, 1996): 541.
13. Field, T., Hernandez-Reif, M., Seligmam, S., Krasnegor, J. and Sunshine, W., "Juvenile Rheumatoid Arthritis: Benefits from Massage Therapy," Journal of Pediatric Psychology 22,5 (Oct. 1997): 607-617.
14. Traisman, 424.
15. Field, T., "Touch Deprivation," touchpoints, 5,3 (Spring 1998): 2.
16. Schachner, L., M.D., Field, T., Ph.D., Hernandez-Reif, M., Ph.D., Duarte, A., M.D. and Krasnegor, J., B.A., "Atopic Dermatitis Symptoms Decreased in Children Following Massage Therapy," Pediatric Dermatology, 15,5 (Sept.-Oct. 1998): 390-391.
17. Ibid, 390-394.
18. Traisman, 465.
19. Traisman, 466.
20. Hernandez-Reif, M., Ph.D., Field, T., Ph.D., Krasnegor, J. B.A., Martinez, E., B.S., R.C.P.T., Schwartzman, M., M.D. and Mavunda, K., M.D., M.P.H., "Children with Cystic Fibrosis Benefit from Massage Therapy," Journal of Pediatric Psychology, 24, (Apr. 1999): 176.
21. Ibid, 180.
22. Field, T., "Massage Therapy for Infants and Children," 110-111.
23. Andrews, L., Lokuge, S., Sawyer, M., Lillywhite, L., Kennedy, D. and Martin, J., "The use of alternative therapies by children with asthma: A brief report," Journal of Paediatric Child Health, 34,2 (Apr. 1998): 131.
25. Fernandez, C.V., Stutzer, C.A., MacWilliam, L. and Fryer, C., "Alternative and complementary therapy use in pediatric oncology patients in British Columbia: prevalence and reasons for use and nonuse," Journal of Clinical Oncology, 16,4 (Apr. 1998): 1279-1286.
26. Field, T., "Touch Deprivation," 3.




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