Kangaroo Care and Infant Massage

In the old days, extensive parental contact was discouraged because of fears about injury or infection. Now, however, some hospitals are encouraging parents to spend up to several hours a day holding their preterm infants, preferably upright and skin-to-skin against their bare chest. This approach has been dubbed "kangaroo care" because of its resemblance to early-life marsupials, which are born prematurely but kept warm and nourished in the maternal pouch.

Studies have shown several advantages of kangaroo care. Babies are better able to maintain their body temperature, so they do not use any excess energy during kangaroo care with either the mother or father. They sleep better, cry less, breathe more regularly, breast-feed longer, gain weight faster, and are discharged from the hospital earlier than comparable preterms who do not have skin-to-skin contact with their parents. Equally important are the benefits to parents, who bond sooner and express greater confidence about parenting when they "kangaroo" their preterm baby. And the greatest advantage of kangaroo care is in promoting breast-feeding, which can be very difficult to establish when babies are born prematurely. Warm, safe, and comforted by the familiar maternal heartbeat, preterm babies nurse more and earlier when held for long stretches close to their mother's bare breasts.

Yet another approach for increasing preterm babies' touch experience is to add a massage to their daily routine. Infant massage has a long tradition in southern Asia, where gentle, systematic stroking and rubbing of the baby's entire body is considered an important part of daily infant care. Even in orphanages, Indian babies are treated to regular massages, and these children grow and develop remarkably well, especially considering their many other disadvantages. In the United States, several controlled studies have now shown that massage improves the health and development of babies compromised by various medical problems, including prematurity, prenatal cocaine exposure, and HIV infection.

For about an hour each day, nurses gently mb or stroke a preterm baby's entire body—face, shoulders, back, chest, arms, and legs—pausing between each region so the baby does not become overstimulated. (If the touch is too light, babies react aversively, as if they're being tickled, and do not experience the same health benefits.) This is often followed with gentle flexion and extension of all four limbs, providing proprioceptive stimulation. Preterm infants who receive these daily massages gain weight faster, perform better on neonatal behavioral tests, and, because of their more rapid progress, are able to leave the hospital earlier than comparable preterms who do not receive this stimulation. Such massaging also improves the development of touch itself; by the time they reached full-term age, preterms given the massages proved to be more responsive to touch than preterms who had not. (But both groups were less sensitive than normal full-term babies.) Most encouraging are later cognitive effects of this early massage therapy; in one study, preterms who had been given the massages performed better on tests of visual recognition at six months of age than comparable control preterms.

Preterm babies are not the only ones who can benefit from daily massage. In one recent study, full-term four-month-olds were given an eight-minute massage shortly before being assessed for "novelty preference," a procedure that tests early memory and sensory discrimination skills. Compared with control babies, who were simply entertained by the experimenters with a red toy for the eight minutes preceding the test, massaged babies were significantly better at detecting when one auditory-visual stimulus changed and a new one appeared. As we will see in Chapter 13, novelty preference actually predicts later IQ better than any other infant skill, suggesting that regular. early massage may have important cognitive benefits for babies of all gestational ages.

A technique for helping a preterm infant to regulate their body heat and a daily exercise for stimulating the infant to improve its cognition and responsiveness.