As professional health care practitioners, massage therapists are bound by guidelines mandated by their country and state licensure requirements. It is the massage therapist’s responsibility to know the rules for maintaining a professional practice.

Ethics are part of the professional code each massage practitioner should follow. However, when it comes to providing therapeutic care to specific client populations, we need to follow special ethical guidelines for the most vulnerable—such as the pediatric palliative care client.

When working with pediatric populations, it is especially important to have a solid grasp of legal mandate, as well as ethical considerations. Clarity and consistency will help develop a professional understanding of nurturing touch as an important part of every child’s life. The pediatric massage therapist strives to provide family-centered care, and will face a number of unique ethical considerations.

Ethics of Pediatric Palliative Care

Traditionally, ethics is defined as a philosophy that seeks to address questions about morality and the concepts of what is right and wrong. Ethics includes principles that determine people’s behavior, their specific conduct and the moral duty of dealing with what is considered good and bad.

As health care providers, we are judged not only on our technical competence, but also by our ability to establish and build trust with our clients.

Each and every day we face numerous ethical decisions. During this decision-making process, you must always ask if the choice you have made is legal, ethical and fair.

Professional Boundaries for Pediatric Massage

When working with children, it is imperative we establish clear boundaries and follow guidelines to ensure we are consistent in our practice with each and every client. When working with children—as with any population, but especially with children—you must:

  • Abide by professional massage standards as mandated by your country, state or province, and city law.
  • Understand your scope of practice and always practice only within your scope.
  • Adhere to all rules, guidelines, policies and protocols of any facility, hospital or family home you are visiting.
  • Maintain the confidentiality of all clients and their families.

As you work with your pediatric clients, use your listening skills to recognize both verbal and nonverbal communication, which will help you understand your clients’ boundaries. Communicate promptly with health care staff or caregivers if changes arise which may affect your interaction with a client.

Also, ensure you understand and follow mandated reporting guidelines.

Are Children Able to Consent to Massage Therapy?

In some countries, states or geographic areas, there may be established, specific ages at which a child is able to consent to therapy. However, in all cases when a child is considered a minor, the parent or guardian must consent to the child’s massage therapy session.

Providing therapeutic care to pediatric clients can become additionally confusing if parents or guardians are present during the sessions. The parents often may have an opinion on their child’s care.

Within the guidelines of informed consent, a pediatric client must be fully informed of the care you wish to provide so he or she may make an educated choice in receiving hands-on care. It is clients’ legal and ethical right to direct what happens with their care plan and their bodies, and to consent to or refuse therapy. For children, this may involve their parents or health care provider’s request for you to provide massage therapy.

When the parent or guardian sets the massage therapy appointment for the child, the child has the right to receive or refuse any part of the massage session. The child’s decision is to be respected, whether the parent or guardian made the appointment, or the massage was medically ordered.

Often, children do not understand what massage therapy is, or its benefits. Taking your time and establishing developmentally appropriate language to explain massage therapy in terms they understand, along with why massage might be beneficial, will allow the child to have a good understanding prior to consenting to receiving therapy.

Respect Belief Systems

Always respect cultural, ethnic and religious beliefs of clients and their families; do not impose your own beliefs or values. All health care professionals should understand that a family’s cultural or religious beliefs often shape their understanding of illness and death.

Providing care to children in hospice and palliative care can be emotionally different from working with other pediatric clients. You are dealing with your own belief system, but can also find yourself faced with the child’s question, “What will happen when I die?” Children of all ages may pose this question.

First, recognize your beliefs may or may not mirror those of the child or the family, and it is not your place to correct what you consider wrong beliefs. Prior to beginning a child’s massage session, it is important to understand what the child understands about his or her prognosis. Asking the family if they have discussed the child’s prognosis with the child is important.

When faced with questions about death, you might try using a reflective response: “What do you think will happen?” Listen to their response without trying to advise. Do not judge, do not place your beliefs onto them, and do not try changing their mind to your beliefs.

You can always respond with an answer of, “That is definitely possible” or “That sounds lovely.” The reality is that whatever your beliefs may be, ultimately we do not know what will happen if the child dies—but your being present is essential for the child right here and now.

If a child has questions you are unable to answer, or if it is out of your scope to do so, the family may speak with the health care team about enlisting the support of a social worker, cultural interpreter, spiritual counselor or chaplain.

Massage Therapy as Part of Pediatric Palliative Care

Health professionals providing pediatric palliative care have an ethical responsibility to provide comfort and work diligently to minimize the child’s discomfort, suffering or pain. This means providing noninvasive interventions, such as massage, to ensure that pain is managed during end-of-life care.

About the Author:

Tina Allen, LMT, CPMMT, CPMT, CIMT, 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 many topics, including “Pediatric Massage in the Hopsital: Your Healthy Touch Can Make a Difference” and “Why Pediatric Massage Requires a Unique Approach.” View the photo essay of Indian children benefits from massage by Liddle Kidz ambassadors here. Allen also wrote ” Massage on the Pediatric Palliative Care Team” for the December 2018 print issue.