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Touching the Littlest Clients

By Karrie Osborn

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



Sometimes the most daunting tasks are the most rewarding. Cultural barriers surrounding touch, old habits promoting unhealthy environments, a lack of resources and funds, and the overabundance of unwanted children made Vonda Jump's work all the more difficult. A Utah State University research associate in the College of Education, Jump didn't mind the obstacles. In fact, they made her more determined to discover whether or not touch could change a child's life. Her research subjects: The children of Ecuador's orphanages.

The work Jump has done, while still inconclusive and only one of many looks at the benefits of touch on children, is important in two ways: (1) its anecdotal evidence seems to imply that a simple change of philosophy surrounding touch can make a world of difference; and (2) this study represents one of the rare occasions when a researcher from outside the field of touch therapies embraced massage as a legitimate therapy worth investigating.

So how exactly does a researcher from the College of Education find herself studying the effects of massage on a Third World country's orphaned children?

Jump's journey began with a simple book on baby exercises that devoted a meager two pages to massage. As a young mother, she devoured the information and started applying the massage strokes to her newborn daughter. "Doing massage with Bianca made a difference," Jump said. "It felt like I was more in tune with her. You get to know your baby's body so well, their likes and dislikes." Another benefit was Jump's ability to understand when young Bianca was about to become ill, especially important with a preponderance of ear infections attacking the infant. And, of course, maybe the most important benefit was on the child herself: "She loved it."

Jump then took her new-found conviction to the next level. Already working with at-risk children, she grabbed at an opportunity to study infant massage. "Since it had an impact on me personally, I wanted to share it. I decided this is what I want to do."


The Trek to Ecuador
The path leading to Ecuador began when one of Jump's students wrote from the Central American country one summer. "I think massage could really help these babies down here," she wrote her mentor. Jump immediately saw her doctoral research project take shape. Jump was familiar with the University of Miami's Touch Research Institute and the research of Tiffany Field, Ph.D., surrounding the positive impact of massage on premature infants1, children with diabetes2 and children with asthma3. Her research question was a natural progression: Could massage positively affect the often-compromised health of children in Ecuadorian orphanages?

With her research agenda in place, Jump's motivation and desire weren't problematic, but finding financial backing was. It took her more than two years to finance the project. The trip was delayed nearly four additional months by the Sept. 11 terrorist attacks. Finally, in February 2002, Jump started her journey.


Time to Observe
Jump included two orphanages in her study, both from Quito, Ecuador. One was a Catholic orphanage with 31 babies; the other was a private facility with eight children (six were in the study). All the children were from 1 month to 2 years old.

Having overcome the obstacles of finance and global events, Jump was ready to spend her first two weeks in Ecuador observing the orphanage children before actually starting her study. Those first 14 days, however, were mostly spent winning the trust of the orphanage nuns who were gatekeepers to anything Jump would have access to, even though all arrangements had been approved in advance. Between uncertain questioning and notes of mistrust, Jump worked hard trying to prove herself. She was met with a "show me" mentality.

"If massage was such a good thing, then fantastic," Jump explained of the nuns' mindset. "But you can only try it on one child first and let's give you one of the most difficult."

Her "test" was administered to 18-month-old Vicente, a hyperactive, violent and aggressive child. Jump's mission was to convince all the other nuns, as well as Sister Catalina (the head nun), that massage could have positive effects on this boy, as well as explaining the scientifically proven benefits and the physiology of touch. The other nuns brought the troubled Vicente in and Jump explained to him what she was going to do in the simplest of terms. In preparing the boy for massage, she applied lotion to his small body and began the work. He immediately responded in kind: "Mas, mas." English translation: "More, more." The mood in the room of observers immediately warmed. "That moment broke down all the barriers," Jump said. "After that, I was given permission to start the study."


The Orphanage Environment
In the Catholic orphanage, three rooms housed the babies and toddlers up to 18 months old. The first room held the infants (birth to 6 months) who had almost no human stimulation throughout the course of the day. A radio played constantly in this room, offering little comfort and no moments of silence. When feeding the babies, volunteers would prop bottles on pillows allowing the supine babies to "feed themselves" while the adult moved on to the next task.

"The thing that amazed me most was there was no cooing or babbling, ever, from those babies," said Jump. "It was surprising, because all babies under 6 months of age, even deaf babies, will coo and babble. They will stop, if there is no reinforcement over time. But in this room, you only heard crying or silence -- and nothing between."

The second room held the more "fortunate" children, those 6 to 11 months old. "In the morning they would get their bottle and no one would hold them, but they would have someone hold them for dinner," said Jump. The final room housed the children up to 18 months old. This group drank milk blended with fruit for breakfast and lunch, but also had a vegetable puree during the latter. While the nourishment seemed better than might be expected, Jump points out these children had little sensory stimulation eating the same flavors and experiencing the same textures each day. They did, however, have more interaction with staff during the feeding process.

Lack of compassion was the not the reason for lack of care with these children, Jump said. It mimicked most underfunded, highly crucial social programs -- try to work with limited resources in the best way possible. It was one reason why the nuns would "shovel the food" into the toddlers mouths even when the child showed they were finished. Jump said they didn't have time to determine the individual needs of these children. The nuns had a predetermined amount of food they wanted each child to consume daily, and they made sure that happened, regardless of circumstance.

The babies, 6 to 18 months old, had the privilege of interacting with four volunteers after breakfast. The routine included a change of all the diapers, then play time until 11:15 a.m. "It would range between 17 to 25 babies in the room at one time, supervised by the four volunteers," Jump said. "On good days, the volunteers might be singing to the babies and even going to different areas of the room to interact with different babies, but there was very little one-on-one interaction. On bad days, they might only have two volunteers. Those days were really chaotic with lots and lots of crying."

Jump said mostly what she saw from the caregivers was reactionary response. "Volunteers would go from one crisis to another. They really had no other choice." Jump surmised that sort of care might be one reason for the childrens' delayed motor skills, as no one ever had the chance to offer the babies "tummy time" or any sort of individual interaction.

It's important to note that while the Ecuadorian orphanages were quite clean -- bed sheets and clothes cleaned daily, floors mopped daily, etc. -- the children's shared toys from the playroom were only cleaned once a month. Also, during distribution of particular medications, the children were all doctored using the same spoon.


The Research
The 11-week study officially began on week three. A total of 37 infants from both orphanages were randomly assigned to either an experimental or control group. Final data appears only for 30 infants; seven were no longer part of the study as the result of either adoption, death, being returned to family or having moved to another part of the orphanage.

Children in the experimental group received a daily 15-minute massage from either staff or volunteers trained by Jump. As her protocol, she used the infant massage techniques endorsed by the American Association of Infant Massage. By training volunteers, Jump also hoped an ancillary benefit would be for intervention to continue even after she was gone. As for the control group, instead of massage, the participants were given 15 minutes of individual, interactive playtime with a volunteer.

Orphanage volunteers were asked to record visible signs of illness exhibited daily by the children. Those signs were usually upper respiratory symptoms, including runny nose, congestion and cough; symptoms of infection, including vomiting and diarrhea; and general symptoms of illness, including whininess and fussiness.

At the end of the study, Jump perceived anecdotal results, but called for a complete analysis from Duke University. She's recently received the data, but is still extrapolating its meaning. What she did confirm was this:

- Babies in the massage group had more days of wellness than those in the control group, although both experienced similar conditions of cleanliness and nutrition on a daily basis.

- Babies in the massage group had diarrhea less often than those in the control group -- four days versus eight days.

Jump pointed out that nearly 2 million children under the age of 5 die each year from dehydration resulting from diarrhea. "Massage could be a cost-effective intervention to prevent it," she said hopefully.

This study opened up other avenues of pursuit as well. "A researcher in Colorado has done work with Rhesus monkeys that indicates for non-human primates, separation from the mother negatively impacts the infant's immune system," said Jump. If massage can affect the immune system, then obviously this would have huge implications on the unwanted children around the world being housed in these orphanages, as well as children in need everywhere.

In previous field studies with HIV babies, Jump said natural killer cell production is increased with massage, thereby helping the body fight off the disease. "I wonder if that same mechanism could be working here?" she asked.

Anecdotally, Jump said the infants seemed to especially enjoy having their chests massaged. Could it be relative to the principle that our core is the center of our physicality? Could it be because someone is closer to their face during chest massage and they might be more attentive then? Jump wasn't sure. "It just seemed like a calming thing."

Also, the babies being massaged were more capable of engaging with people. "They smiled more and looked at you more," said Jump. "It's something that's completely my bias, but it's I want to look at in other studies to see if that's what happens. Yes, I'm subjective, but it's one of the biggest things I witnessed."

Self-admitted limitations of her work include a small sample size, potentially biased volunteers and an imprecise design of the control group.


What's Left Behind?
I hope I left several things different than when I arrived," Jump said of her experience in Ecuador. "Just the knowledge about massage and establishing the habit of doing massage with babies was big. All the infants are still being massaged once a week." She said the nuns were excited about what they had seen and decided to keep it as part of the childrens' care.

Outside of the research study itself, Jump tried to leave knowledge with the nuns and staff that would benefit the babies she had watched so closely. "After I realized there wasn't a lot of language going on, I asked the volunteers to sing to the babies and to talk to them while changing their diapers." Jump said with the pressures of the job, the volunteers were becoming more mechanical in their duties. She encouraged them to interact with the babies every chance they could get and look at each child as an individual.

Jump also had an impact on the babies' incidence of pneumonia. "When you go into a developing country, there are so many things you can offer an orphanage staff. Here, the babies were on their backs with their bottles propped up for feeding. There were quite a few babies with pneumonia when I came. In fact, a baby died from pneumonia three weeks after I arrived." Jump said in talking with one of the co-directors of the volunteer staff, she explained how feeding the babies this way could be the reason they were always getting so sick, swallowing their spit-up back into their lungs. "I talked to the nurse about changing their practices and feeding them on their sides." Jump suggested using stuffed animals to prop up the babies from behind. They incorporated the new practice and there were no more cases of pneumonia in the baby room. "It's neat to see you can just change one small aspect and really make a difference."


What Next?
Jump knows being in Ecuador changed her. "It totally increased my interest in this area," she said. Her goal is to apply her research design to a new location.

Since leaving Ecuador, Jump said she has been corresponding with other orphanages trying to determine where to take her research efforts next. What she's found is that the orphans of Ecuador "have it pretty good." In talking with resources in Haiti, Jump learned the babies housed in orphanages there are malnourished and wasting away. "In one orphanage they had 180 babies, and the volunteers told me the babies and children were devouring dry flour, because that's all they had that day."

Because of the malnourished nature of the Haitian babies, combined with their living conditions, Jump is anxious to see whether they would be sick less often with massage and whether it could make a difference in the incidence of diarrhea. "Tiffany Field found that premature infants being massaged had a 47% greater weight gain than those who didn't receive massage," said Jump. "It appears through massage the body is working more efficiently. If babies could process the food they do get more effectively, that could be a great thing."

In addition to a change in locale, Jump is wanting to ask additional questions, especially about the babies' ability for social engagement. "Usually we mentor our babies over that first year, but these babies don't get that lesson time." Could massage improve their ability to interact with others?

So, even with all the hurdles presented Jump and the to-date inconclusive data, what makes her want to continue? She remembers words of wisdom spoken by her daughter, who was 8 at the time. "I was invited to do a presentation on massage," said Jump, "and I had never asked Bianca what she thought about it. She wrote 'I think everybody should be massaged because it makes a difference. It makes me warm on the inside and happy on the outside. It makes all my problems go away, and I feel closer to my mom when she's massaging me.' " The words resonated for Jump and have inspired her to continue on her journey ever since.

Karrie Osborn is the former editor and current contributing editor to Massage Bodywork magazine.

Vonda Jump can be contacted at 435/797-3579 or vonda@cpd2.usu.edu.


References
1. Field, T., Schanberg, S.M., Scafidi, F., Bauer, C.R., Vega-Lahr, N. Garcia, R., Nystrom, J., Kuhn, C.M. (1986). "Tactile/kinesthetic stimulation effects on pre-term neonates," Pediatrics, 77, 654-658.

2. Field, T., (1995). "Infant massage therapy," In T. Field, Touch in Early Development (pp. 105-114). Hillsdale, NJ: Erlbaum.

3. Field. T., Henteleff, T., Hernandez-Reif, M., Martinez, E., Mavunda, K., Kuhn, C, Schanberg, S. (1998). "Children with asthma have improved pulmonary function after massage therapy." Journal of Pediatrics, 132, 854-858.






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