Welcome back to the Healing Pain Podcast with Christine Robenalt, MPT
We’re discussing the power of massage and manual therapy, how it can be used to manage pain and discomfort in infants and children. Our expert guest is Christine Robenalt. Christine graduated from Marquette University in 2001 with a Master’s degree in Physical Therapy. Although she’s worked in many different practice settings, Pediatrics is both her specialty as well as her passion. In addition to her degree in Physical Therapy, she’s also a certified infant massage instructor through Loving Touch International and has additional in-depth training in primitive reflex integration. Christine has also furthered her education by completing the Integrative Pain Science Institute’s Functional Nutrition for Chronic Pain practitioner certification program and implements evidence-based nutrition education for both children and their families. You’ll learn all about the research supporting the benefits of massage for infants and children, when you can start massaging your infant and if there are any conditions when you should not perform massage on your infant or child, what to do if your child is bothered by massage, doesn’t like to be touched or maybe wants to sit still.
Christine will provide a free video demonstration. Hopefully you can access this on the blog at the Integrated Pain Science Institute. She’ll teach you how to help an infant or child with pain from constipation. Christine has also provided you with a free PDF download all about massage for infants. After downloading and reading this handout, you’ll feel confident and excited to begin massage with your child and you’ll learn how massage and other sensory experiences directly impact your child’s growth, development and learning. To download this PDF, all you have to do is text the word 156Download to the number 44222. You can type in the URL, www.IntegrativePainScienceInstitute.com/156Download. Let’s begin and let’s meet my friend and colleague, Christine Robenalt.
Watch the episode here:
The Power Of Massage And Manual Therapy – How To Manage Pain And Discomfort In Infants And Children With Christine Robenalt, MPT
Christine, welcome to the show. I’m excited that you’re here.
I’m so excited to join you, Joe. Thank you for inviting me.
This is the first time we’re going to be talking about massage actually on the podcast. We’re going to dial down to a very specific part of massage. I know you’re an expert in which is infant and child and massage. Tell us who you are and what your practice looks like.
I am a pediatric physical therapist, but I’ve started getting into kids maybe about ten years. Prior to that I worked everywhere. I worked in the skilled nursing facilities, acute care in the schools, the VA, I did Telehealth. I was pretty much like a jack of all trades and I was feeling after being a therapist for ten years or so, that it was time to get a little more specialty. I always wanted to work in pediatrics. I love children. At the time, I was pregnant with my first child. I started to work for pediatric home care, which was a completely different animal than adult home care. I enjoyed it immensely and that’s what I’ve stuck with. I’ve done some other things since then, but I always have come back to pediatric home care.
Now you see children and as well as their parents because you’re working closely with parents and all of that is done from home?
Yes. I go into their homes in Colorado. In the United States, we have early intervention for 0 to 3, so that’s a lot of the children I work with. Not only do I see them in their homes, but I can see them in their natural environment. I can see them at the park, at the pool. That’s great to get out and work with them at the library. Anywhere that they would naturally be, I can go.
It sounds like fun, PT in the park. We need that with more adults too.
I would love to.
Create a context of play for people, which is so important when it comes to movement. When we think about massage, the first thing that comes to mind, especially for most adults is, “I’m on vacation and I go and I get a massage at the spa after the time at the pool or I go with my friends on the weekend, we have lunch and then you go for a massage.” Why is massage important for children and infants? What are the benefits?
All of the benefits that we realize as adults are also true for children like relaxation, stress management. When you think about infants and children, we might think, what stress do those little guys have? They have a lot of stress in growing and trying to get a sleep schedule, trying to accommodate other people’s demands on them and tons of things. Then we can talk about preterm infants. The research in the area of touch and massage has exploded since the early ’90s. Preterm infants can get out of the hospitals up to six days sooner. Being in the NICU, the study showed they could gain 42% more weight than the infants that weren’t receiving massage. They estimated the cost savings. If we were talking about across the United States in the billions of dollars, if we could get massage into all of the NICU to get these kids gaining weight faster. Even though it doesn’t work that way for adults, we don’t gain weight because we get massage and help regulate their bodies. They think maybe through insulin. That’s for infants a great bonding for infant and mother. There’s research that supports that.
When a mother gives the child a massage, they have a decreased rate of postpartum depression. Teen moms, have better nurturing and self-coping skills when they’re providing massage to their babies. It’s another way for dads to be involved or for the other partner to be involved in care. There’s that type of bonding. It helps with digestion. It helps for overall circulation. It can improve sleep. It also helps motor development. That’s a humongous one for me as a physical therapist and probably the one that I focus on the most but all the other benefits I can’t get rid of.
You mentioned premature infants and you mentioned you’re working in-home care. You’re seeing children either in their home or in other places where they’re spending a lot of time. What kind of diagnoses do you see in your practice?
I have a variety of diagnoses from children who have absolutely no diagnosis to cerebral palsy, Down Syndrome, Spinal Bifida, autism. A lot of the children don’t have a diagnosis, especially in early intervention. They just have to have a percentage of delay in their peer group. They don’t have to have a diagnosis.
The development is delayed or they have a failure to thrive. That’s typically the blanket net term that they’re providing for diagnosis.
It helps everyone. I do it myself in the sessions, but the theory behind it is that the caregivers are doing it. You’re not taking your child to a practitioner once you learn these massage techniques. No matter who you are, no matter what your child is, you can be offering this gift of massage to your child. Especially for the parents that I work with who have so many medical concerns for their child, who everything is about, “When are we going to do the next two feet or when do we need to do the next medication?” This is the time for them to offer something very therapeutic in a non-clinical way.
I’d imagine it’s so important because there’s that bonding period. I don’t necessarily know the time of that bonding period between the parent and the child. I’d imagine it’s between 0 to 1.5. That’s important as people or as children are working through the developmental stages. I don’t have children so I don’t know, but I would imagine that when a child is born that has challenges and has health challenges, a parent may be a little bit apprehensive or having anxiety about working with or touching their child. At what age can a parent start this type of massage for their infant?
We can start it on day one. You could technically start in utero by massaging your belly. By day one even for babies who are in the NICU, if the doctor clears them and can be allowed to touch kangaroo care, getting them to your chest, having that contact. I’ll take a step back. We have massage and these massage sequences and then we have touch and that is what you’re talking about too. Let alone doing any particular sequence of strokes or movements. We want to be able to feel comfortable to pick up our babies and it’s good to pick up our babies and we cannot spoil them. In that first 12 to 15 months, absolutely there’s no spoiling going on. They need that attachment.
Kangaroo care, tell us what that is.
That’s basically like chest to chest and getting that baby right upon you to feel your skin. It’s wonderful if you can do it immediately after birth, after the baby’s delivered to get up onto the mom’s chest. Even all throughout the first weeks to months, to be able to have a lot of skin to skin time. Babies learn so much. The baby gains healthy bacteria by nuzzling in space against your chest. There are so many things besides, “It feels nice.” That’s part of it too. All of these things, when we talk about what it can do for us for relaxation, massage and touch, it releases endorphins. It releases serotonin and dopamine in our body’s oxytocin, the love hormone. Not only does it release it in the child or infant that we’re providing massage to, but many of those same chemicals are released in the caregiver’s body as well. That’s a bonus.
That oxytocin is so important when you look at the attachment between child and mother or father and child. It’s important. If you look at the whole theory of attachment, a lot of it’s based on, how do we work on the release of oxytocin through our interactions with other human beings? It’s so interesting. If you look at some of that nature, is there any concern, precaution or contraindication that a parent should have with regard to touch and massage for let’s say an infant who may have some health challenges?
As with anything as a healthcare provider, I must say talk with your doctor first. Apart from that, if there is an infection going on the skin, I wouldn’t want you spreading that infection someplace else with the massage. Avoid that area that has an infection completely particularly the face of the eyes. If the child has some pink eye or an infection, the eye, we’re not going to be wanting to wipe it across the face. Any broken bones, we wouldn’t be providing massage over that. Even with cancer, it’s not contraindicated to do that with a child who has cancer, that would not be something that would be contraindicated. Those are the big ones. Even for a child who has like a tracheostomy or a G-tube, all of those things are okay to work around. Thinking about the developmental process, I work with a lot of families who are afraid to put their babies on their bellies because they have a G-tube or because they have a Trache. We might have to prop them up a little bit or change the positioning, but absolutely, we want to be doing those positions. We want them to receive the touch like every other child. They’re not different in that way. I would argue they need that more.
Babies cry. I’ve worked with pediatric therapists before and younger siblings and cousins, things like that. Babies are going to cry. What if someone’s reading this episode and they’re excited to do this and they start working with their child or their infant and they start to cry or they’re a little finicky and then it looks like they’re not liking what’s happening?
Great for you to be noticing that something is not right with the baby. Is it the fact that you’re giving the massage? Maybe they’re cold, maybe they’re hungry. As adults, we have to decipher or interpret the signals that our baby and children are telling us. They do that with nonverbal language because they’re not using language or at least not the young ones are. Even when a child does get older enough to have words to say how they’re feeling, they still may not be able to express themselves completely. I would assess the situation and take care of those things. “That light above my head is bright. I better turn that down. It is chilly in this room.” Basically, we want to always have at least one layer more than what we’re wearing if we’re dealing with a newborn or a couple months old, but that baby in the first two months of life is still working on state regulation, controlling their body temperature. Always put on one extra layer for them. For doing the massage and they don’t like the particular touch that we’re doing, you can change the touch. Maybe make it a little firmer or a little softer because we are all sensory beings, you and I, included and we all get information in from our environment. Joe, do you have a particular food that you don’t like?
Which food don’t you like?
I try not to eat foods I don’t like.
You avoid doing something you don’t like?
Our children do the same. Whether it is mustard, if you don’t like the flavor of mustard, that’s not good or bad that you don’t like the flavor of mustard. For a child who doesn’t like to be touched, that’s another sensory stimulus that they’re not accepting. I want to find that right balance. My suggestion to a parent who is trying to give a massage and the kid is squirmy is try to take a look at your environmental factors and get those taken care of. If the child’s not in a calm and alert state right now, no matter what you do, they’re not going to accept the massage. Whether you’re 0 or 100, we need to be in a calm and alert state for new learning and for listening.
We see this with our kids all the time. We probably see this with our partners. If you’re watching TV and someone’s talking to you, you’re attending to the TV, you’re not attending to this other auditory stimulus that’s coming in. You might be calm, but you’re not alert. It’s the same thing with our kids. If our baby’s crying or fussy and we can’t sooth them by talking or some soft touch, it’s probably best to choose a different time, different stroke type, “Tomorrow or later in the afternoon, if I do this again, do they give me the same reaction?” Be a little bit curious about what that might mean. The fact that they don’t like it is a big sign that this is actually what they need, but we have to pull it back a little bit.
When we deal with infants or with children who have special medical challenges or any child for that matter, in our mind we might think, “I’ll take it back to this step. I’ll only do it this much.” It still may not be enough. I feel like I have to stick a sticky note pad in my head and maybe take off the whole layer of sticky notes. Is it going to be too much or do I have to peel off the layer one at a time and figure out what that right layer is and start there? Be curious, try some different things and see what happens on the other side of their body. Do they respond the same? You’ll start to cue into the things that your child is becoming more comfortable with and looking at their facial expressions, how their body is? If they’re tight or tense, that’s a sign that they’re not enjoying this. If they’re able to be more relaxed or they’re able to make some gentle eye contact with you, if they’re completely looking away. They’re a little bit overwhelmed with the situations where it may not be crying. Crying may not mean that they aren’t enjoying the massage. There might be something else that’s going on.
First is check your environment, make sure they have at least one layer of clothing on. The baby would have one layer of clothing on. It sounds like what you’re saying is to titrate the amount of time you’re providing the intervention or the type of touch, whether it’s too light or too soft or too pokey or too firm. All those can be a factor. What you’re saying is that as children, as infants, babies of learning about their environment. They’re taking in all of the sounds, smells and touches and some of those things can be a little concerning for be able to do it over time they get used to it. Us as adults sometimes get used to certain things that are noxious in our environment that as adults we have to put up with because it’s part of life.
There’s a difference between something that is harmful and a noxious stimulus and something that we prefer or don’t prefer right now. If the amount of pressure you are providing is causing a lot of immediate redness or something, then back off. Maybe that is hurting them. For the most part, it is adjusting to this new sensory stimulus. Babies, because they don’t have any experience before this, all of our thoughts or emotions or feelings are stemming from sensory experiences. They’re working from the bottom up. As adults or older children, we’ve done things before. We have something to draw from. Our hippocampus can pull back some memories of, “I did this before.” We can use more of that top-down approach to even like say, “I did this before. I didn’t like it but I’m going to be okay with it right now.” A baby doesn’t have the ability to consciously process that or the experiences to go from.
I want to backtrack to something you said earlier in the episode and if I remember this statistic correctly, you said infants who do not receive touching care or 42% more likely to put on weight.
Tiffany Field at the University of Miami has the Touch Research Institute. She’s got a wealth of information about this. She’s definitely the forerunner of touch and massage across the ages. Particularly for preterm infants, they’ve done a lot of research. What they did is they had a fifteen-minute protocol that they did three times a day, so 45 minutes total. For those infants that were in the NICU, they were able to leave the hospital six days sooner than the control group who didn’t receive a massage. They gained weight 42% faster than the control group. That’s a good thing.
In that case, children gaining weight is a good thing because these are babies who are born prematurely with low weight.
They gained 42% more weight than the control group.
Which is huge and very important.
That’s usually one of the indicators of when they can leave the hospitals, is that they can sustain their weights and that they are showing that they’re thriving and ready to leave the security of the hospital.
Thank you for clarifying that. I know you work with not only babies but children in adolescence. Thinking about the weight on the other side of that, how much is childhood obesity something that you see in your practice and something that you address?
That’s an interesting question and actually is one of the reasons I became so much interested in nutrition and looking for more information. It’s because I am seeing that in kids that I’m working with and their siblings and it is very concerning. I will say that there is no research to support that giving a child a massage who is a full term will increase weights. It is something that could be an adjunct to help support digestion, support overall well-being and encourage. Let’s say we do the massage and we know that it releases the serotonin and dopamine and that makes us feel good. This child who is more of a couch potato who doesn’t like to move, we can do these massages with them and help stimulate their body that can help them get more excited about getting up and moving and also having that interaction with our child. I’m a mom of three. If I give each of my kids a massage for fifteen minutes a night, that’s 45 minutes of my time. That’s good. I need to do that for that bonding to help them know that I’m there for them. We talk about the day and that connection.
I think that too, like taking time to show that I have an interest in my child can help that child feel better about themselves, want to move and want to play. This is where all our entire bodies are connected. We’re not just our muscles and our weights. Everything works together. Massage can be an easy, simple way to help unify all of that. I have not specifically used it in my practice to address obesity, but sure enough we do use it for the digestion and that bonding.
For the older kids, the kids who are obese, you notice that’s a bit of a problem for them. Have you started to fold some nutrition education into your practice?
Yes, for sure. Of both at the child level, if they’re old enough, as well as at the parent level. It’s trying to meet the parent where they’re at and understanding what’s working in their lives right now and what’s not. If they can come up with something that’s not working for them right now, then I have a great way in versus me coming and saying, “They’re not going to be very receptive.” I have had some parents, once I started talking about that, they ask me additional questions. “What would you recommend? What do you think about this?” I like that when the parent can take some of the information that I’ve started and then they have started going a little bit further. I also have parents who are on the opposite side of that. I’ll present the information, I’ll go to the doctor’s appointments with them and they still are resistant to making changes. It may be that they’re fearful of making the change. We have more work to do or maybe something that they’re not ready for yet, which I’ll continue on my other things and continue to provide the information to them.
It’s such an important position though because if you’re working with probably I would think in most cases the mom, but both parents that if you can help the parents change or educate them about their eating habits and their decisions, it’s going to help that your immediate patient, which is their infants or their child but the entire family actually. It can have a tremendous impact on their health.
Hands down. Our children first of all are going to be always mirroring us. If we are eating chips, they’re going to be wondering why they can’t eat chips out of the bag on the couch. It’s setting up a space where your pantry is full of foods that you want them to eat. As I said, I have three kids myself. I do speak a lot of personal experience of things, not to say that what I did is the right thing, but these are some options or these are some struggles that I had and this is how I overcome it. These are the researches I look to. It’s so that they don’t feel alone. Lots of times parents will say to me, “I’ve never thought of that. I didn’t realize that was connected.” My answer to them is, “You didn’t. You’re the parent working on so many other things. What I’m here for right now is to help you. Don’t feel bad that you didn’t know.” We only know so much at the time and when we gain more information, then we can make the changes from there.
A big part of what we do as practitioners is we are a massive resource to help people cope with what’s happening in their life or what’s happening in their infant or their child’s life. Can you describe for us a sequence of massage or people have an idea of like what this might look like?
First of all, I’ll say that massage is instinctual. This has been going on across the world for centuries. Many different cultures incorporate massage. The sequences that I might recommend or that you could find on my website are menagerie of different sequences. I was trained through Loving Touch International and then I took those sequences in addition to some of the other reflex integration work that I do. I put it together in my own sequence. You as a mom, as a dad, as an aunt, grandparents intuitively know how to do this, so that’s one. Secondly, there have been some studies done where they had people stroke a wooden board and stroked something that was more like a skin or felt more like skin.
What they noticed was that when they went to stroke the wooden board, the strokes were random, were hard or no real rhythm to it. When you were stroking a soft piece of material, people were stroking it within a certain range of centimeters per second. That happens to correlate with the same rate of stimulation for our nerve fibers. Our nerve fibers help bring information from our skin to our brain. That is instinctual in us that we know to stroke the skin at a certain rate. Trust your instincts, go with your gut, use your right brain and do what feels right to you and your child. If you’re somebody who needs a little more direction, I’ve got your back.
Feet and hands are incredibly important to massage. There’s a whole study of reflexology, but apart from that, there are so many infant reflexes that begin in our hands and our feet. In order to gain active control of our body, we need to have those reflexes integrated. One way to do it is by stimulating them. You can use oil. You don’t have to use any oil, but especially for your infant or child, I would highly recommend a food-grade oil. Olive oil, coconut oil, almond oil, something that if they do put it in their mouth, it’s not going to be toxic. I caution against using any synthetic or baby oil because it can cause a lot of skin irritation and it is not a good thing for your child to be ingesting and no baby powders. Talks and baby powders can get into our lungs and cause breathing difficulties. Please stay away from that. You don’t have to use the oil though. In fact, for a child who is hypersensitive to touch, sometimes I’ll tell parents that put a sock over their hand or their foot or do it over their clothing if they’re hypersensitive.
Start off with the palm of their hand. The first thing you’ll do is you’ll take each of your thumbs and go up and out. You’ll go ahead after you’ve done that stroke 3 to 5 times, all of these strokes are about 3 to 5 times. You’re going to go ahead and roll each finger. While you’re doing this, because you’re talking with your infant or your child, you’re singing a song, you’re looking at them. You might be making some silly faces. Engage with your child. The next one that you will do is called circles in the center. You can do it with both of your thumbs at the same time making the circles. For a little baby, expect them to grip your hand. That’s normal. You can also massage a little bit into their lower part of their wrist and you shall watch their fingers extend. That’s a nice simple hand sequence and it can only take 2, 3 minutes to do that on both hands. It’s great to do during diaper changes. It’s great to do if you’re waiting in the line for whatever. You can add massage into three minutes throughout your day. It doesn’t have to be, “We’re going to have a massage now.”
Christine, it’s been great chatting with you about this important topic that we haven’t carved before. Tell everyone how they can learn more about you.
You can find me at Sweet Pea Pediatric Wellness. I have a website. You can email me directly and that email is SweetPeaInfantMassageClasses@Gmail.com. You can reach me there and I’d be happy to answer any of your questions. I did make a chatbot. If you use Facebook Messenger, you can go to my website or in the PDF that you guys can ask for. There’ll be a link to a chatbot through Facebook Messenger to get your own personalized massage sequence with some pictures and interact with me that way.
All those links will also be in the free gift. Make sure that you download this week’s free gift, which Christine created for all of you. It’s been a pleasure being with you. Make sure you share this podcast out with your friends and family, especially if you have friends and family who are helping manage pain and discomfort in their infants or children or a pediatric practitioner, whether it’s a physical therapist or an OT or perhaps a pediatric nurse or even a pediatric physician. This is great information for them. Stay tuned and we’ll see you.
- Christine Robenalt
- Loving Touch International
- Functional Nutrition for Chronic Pain
- Touch Research Institute
- Sweet Pea Pediatric Wellness
About Christine Robenalt, MPT
Christine graduated from Marquette University in 2001 with a Masters of Physical Therapy. Although she has worked in all practice settings, pediatrics is her passion. Christine has furthered her education by taking The Integrative Pain Institute’s Functional Nutrition For Chronic Pain course.
She is also a Certified Infant Massage Instructor through Loving Touch International. Soon she will begin additional training in primitive reflex integration.
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