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Massage for growth and development of pre-term infants

Clinical bottom line:

There is no convincing evidence to demonstrate significant benefits of massage or gentle, still touch on growth and development of pre-term or low birth-weight infants. Studies were small.

Pre-term and low birth-weight infants can be under considerable stress in busy neonatal intensive care units and may not receive the tactile attention they need. Massage may relieve stress and aid relaxation and has been promoted as a means of providing tactile stimulation in order to encourage the growth and development of infants. A number of reviews support the use of massage in these infants.

Systematic review

Vickers A, Ohlsson A, Lacy JB, Horsley A. Massage for promoting growth and development in low birth-weight infants (Cochrane review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.

Date review completed : Last search conducted 1999

Number of trials included : 14

Number of patients : 230 active / 186 control

Control group : Routine care

Main outcomes : Weight gain, length of hospital stay, behaviour and development.

Inclusion criteria were randomised controlled trial which assessed the effects of massage on growth and development of pre-term or low birth-weight infants. Gestational age at birth had to be less than 37 weeks or infants had to weight less than 2.5 Kg. Massage was defined as tactile stimulation by human hands. Studies with multiple interventions which included massage were included.

MEDLINE, EMBASE, CINAHL, PsychLit, the Cochrane trials register and the registries of the Cochrane Neonatal Collaborative Review Group, the Complimentary Medicine Field and Dissertation Abstracts were searched, along with checking of reference lists and correspondence with authors. Study quality was assessed.


Treatment sessions were administered for about 15 minutes and repeated 3-4 times daily over a period of mainly 5-10 days. Treatment consisted mainly of gentle rubbing and stroking, sometimes including kinaesthetic movements. In two trials no motion of the hands was conducted and nurses simply rested their hands (still, gentle touch) on the infants for about 15 minutes. One trial attempted to blind assessors who were responsible for discharge of infants from hospital, though it was unclear how blinding was achieved; no other study attempted to blind treatment assignment.


Information from six trials (274 patients) showed that infants randomised to massage (rubbing, stroking or kinaesthetic movements) gained significantly more weight than those randomised to control interventions; weighted mean difference 5.1 g (95% confidence interval 3.5 to 6.7). This difference was reported as of low clinical significance.

Information from seven trials (206 patients) showed that length of stay was decreased by 4.6 days (95% confidence interval 2.6 to 6.6) with massage compared with control.

Improvements in performance on the Brazelton scales for habituation or motor maturity were not significantly different between massage and control and were unconvincingly significant for range of state (weighted mean difference 0.6 (95% confidence interval 0.2 to 0.9) using a fixed effects model, but no significant difference with a random effects model). There was no effect on autonomic stability, performance on orientation or state regulation, or on number of abnormal reflexes. It was unclear whether postnatal complications were improved.

Gentle, still touch

Two trials assessed gentle, still touch (50 patients). There was no significant advantage of using gentle, still touch on length of stay, weight gain, neonatal morbidity, days on supplemental oxygen, activity or behavioural distress, or blood transfusions.

Adverse effects

Not mentioned in any trial.


This review showed little benefit of massage and no benefit of gentle, still touch on the growth and development of pre-term or low birth-weight infants. The included studies were small and mostly unblinded. Attempts in one trial to blind the assessors were of doubtful success. The reviewers' commented that there is insufficient beneficial effect to warrant wider use of massage interventions in these infants.