Children with chronic conditions and complex medical needs often develop fear and anxiety surrounding their medical care—and they must cope with a variety of stressors, symptoms and side effects related to their illness and treatment. Facilitating healthy touch experiences within the medical system can help restore trust and teach children how to effectively express their needs, while improving the quality of life of pediatric patients.
Pediatric massage therapists typically provide touch therapy to patients ranging in age and medical background, from infants born prematurely in the neonatal intensive care unit (NICU), and expanding care to various medical departments. Many hospitals provide placement for therapists throughout the health care setting; however, specific departments using pediatric massage may range from pain management, cardiac, pulmonary, pediatric intensive care units (PICU) and post-op, to orthopedics, rehabilitation, hematology/oncology and palliative care.
“On a daily basis, the [integrative medicine] team is called to care for patients in the NICU, pediatric intensive care unit (PICU), and for our general pediatric populations,” said Center for Integrative Medicine Team Lead Donna Audia, R.N., H.N.-B.C., who is also an integrative care nurse at the University of Maryland Medical Center in Baltimore, Maryland.
“We work with kids with breathing disorders or cancer, [as well as] surgical patients, and [patients with] sickle cell anemia, seizures and anxiety,” she said. “They benefit from the nurturing touch that provides a caring support during times of crisis. It enforces for the family the importance of touch.”
Health care staff and pediatric massage therapists report observed stress-and-pain reduction with healthy touch. Allison Fernandez, M.D., director of Pediatric Pain Service for All Children’s Hospital in St. Petersburg, Florida, uses pediatric massage therapy as part of her pain management intervention approach. “We have provided massage therapy to patients suffering from opioid-induced constipation, cerebral palsy, hypotonia, extremity muscle pain and back pain,” she said. “The patients feel improvement from the muscle stiffness they experience due to lack of movement. It also has decreased the abdominal pain from abdominal distension secondary to constipation.”
Recognizing that children are not just small adults helps us understand their unique needs and adjust applications to be developmentally appropriate. Corrie Frey, L.M.T., C.P.M.T., at Nationwide Children’s Hospital in Columbus, Ohio, shared her experience working with a young child enduring an excruciating hospital stay while waiting for a heart transplant.
“One day, rather than offering massage, I offered to read him the book Pete’s a Pizza. This kiddo loved the ‘pizza massage,’ as I gently kneaded the dough (his back), spread on the pizza sauce (hospital-approved lotion), and sprinkled on all of the pretend pizza toppings and cheese. From that day on, this kiddo was hooked on massage, and I learned a very valuable lesson.”
When Kerri Padgett’s 2-year-old son was in the hospital undergoing treatment for an inoperable brain tumor, he received many integrative, or complementary, therapies to manage symptoms and side effects, with great success, she said.
“In addition to the physical effects, these therapies broadened our care community, reducing isolation and empowering me as a mom to take a more proactive and informed role in his overall health care plans,” Padgett said. “Having this experience with my own son inspired me to want to help other families access these benefits of nurturing touch.”
Two months after losing her son, Padgett enrolled in massage therapy school. Today, she is the director of the Inpatient Integrative Therapies Program at Hasbro Children’s Hospital in Providence, Rhode Island. She is licensed as a massage therapist and certified as a pediatric and infant massage therapist.
Healthy children receive the benefits of touch from a variety of sources; however, the symptoms of physical and emotional stress in the health care setting can often be alleviated by massage therapy safely provided by trained health care practitioners.
“The day I graduated [from massage school], I boarded a plane to attend my first Liddle Kidz Foundation hospital training at Children’s Hospital Orange County, and now hold certification in pediatric massage, infant massage and autism spectrum disorders,” said Padgett.
“The education and cue-based approach I learned in these courses prepared me for working with children and families in a clinical setting,” she added. (Editor’s note: The author of this article is the founder and director of the Liddle Kidz Foundation.)
Pediatric massage therapists are extremely important for providing a supportive health care environment with the greatest care of the patient in mind. Having specialized staff dedicated to pediatric massage allows a patient and family to feel supported emotionally and physically during hospitalization and outpatient visits.
“We wanted to add massage therapy to our practice, since there are so many benefits,” said Fernandez. “It also is a way for parents to participate in the care of their child at a time when they have a difficult time contributing [to] their care. I think that massage therapy is a modality that can be taught to families. It’s a practice that families can learn and do at home as well.”
With a focus on family-centered care, it is equally important to provide caregiver and sibling support through hands-on therapy and education. Including siblings in treatments and providing take-home skills for families allows each member to have a contributing role in the care of the child.
“Pediatric massage therapists are not just a nice thing to provide,” said Audia. “Pediatric massage therapists are a necessary part of a comprehensive medical team. Providing non-pharmacological strategies to manage pain, stress and anxiety leads to healthy, happier patients and families.”
Massage therapists practice hands-on therapeutic techniques to address a variety of medical and non-medical concerns for patients. As with all massage specialties, advanced training matters. Special precautions should be taken due to the patient’s vulnerability, both physically and emotionally, and to minimize risk and discomfort to the patient. Children may have apprehension relating to touch due to their medical treatments.
“Keep in mind that working in a hospital will expose you to things that we were never prepared for in massage therapy school,” said Frey. “Working with a child in ICU following a motor vehicle crash can be emotionally gripping to say the least, so it’s important to prepare yourself, and know what you are walking into when entering a patient’s room.”
The pediatric massage therapist should minimally have a basic medical understanding in order to effectively communicate with other members of the medical team. Being able to read a hospital chart and navigate the documentation system is extremely important. You must be willing to look up any diagnoses, procedures, medications or medical terms you are unfamiliar with, so that you have a complete understanding of the patient’s medical history and current status. The pediatric hospital is not the place to “fake it until you make it.”
The type of work you provide to patients will depend on the scope of your background and the job description associated with your position. Some pediatric massage therapists are categorized under the auspice of providing emotional and nurturing support, while others are focused on specific therapeutic plans, including pain relief or rehabilitation goals.
Hospitalization for children is stressful, as they may not completely understand their treatment and prognosis. Pediatric massage requires extra communication to alleviate everyone’s concerns, and address the opportunity for education and increased awareness.
“Because I am called to care for very sick babies and children, I wanted a modality that enables the involvement of the patients,” Audia said. “Touch is essential to the growth and development of our children, and it is so easily overlooked during the hospital course.”
The Health Care Team
In some health care settings, there is still a tendency to minimize the role of massage in the hospital setting, pointing to stereotypes of massage purely as a luxury. To best integrate into the health care system, massage therapists should look at their work as a team-based approach to integrative health care and scope of practice, establish therapeutic relationships and work with the team to develop comprehensive treatment plans.
“Be willing to start small and don’t get discouraged,” said Padgett. “Find a physician champion willing to back you, and go from there.
“Programs don’t start in a day, so it’s important to remember that when approaching a hospital environment,” she added.
Your success in the hospital can be attributed to understanding your role and boundaries. Having knowledge and understanding of hospital-based policies relating to safety and infection control are essential skills required by every medical professional.
“I will never forget the first time a physician, outside my immediate team, went out of his way to thank me for helping his patient,” said Frey. “Through provider education and patient and family feedback, our massage program is slowly becoming imbedded as an important part of the interdisciplinary team.”
Physical and Emotional Benefits
Pediatric massage therapy is a valuable asset to the medical team, and pediatric massage therapists provide specialized, safe and effective care. This gentle modality can be adapted for young patients even when they are medically fragile, and contribute to both physical and emotional benefits, providing essential positive touch to their hospital experience.
Medical practitioners touch with purpose and procedures, and medical touch can become overwhelming and elicit a negative response within our children, Audia said. “We are aware that we can create trauma for the kids with medical care, so providing massage to our kids allows them to become active participants in their healing journey.”
Tina Allen, L.M.T., C.P.M.M.T., C.P.M.T., C.I.M.T, is the founder and director of the Liddle Kidz Foundation, and an authority on infant and pediatric massage therapy. She has written for MASSAGE Magazine on topics including “Father-Baby Bonding: Infant Massage Builds Bridges That Last a Lifetime” (February 2014) and “In Pediatric Massage, Advanced Training Matters” (Aug. 1, 2015).