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Pediatric Massage

By Tina Allen, LMT, CPMMT, CPMT, CIMT

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Using Massage to Address Pediatric Digestive Issues

Massage therapists practice hands-on therapeutic techniques to address a variety of medical and non-medical concerns for clients and patients. While teaching therapists of all backgrounds, it is very common that I discover at some point in their professional career, they have learned to use abdominal massage to address digestive concerns, such as constipation. But frequently, they stop using these techniques, or even offering massage for abdominal massage to clients. Many educators present to therapists that this is a very vulnerable body zone/region for clients, and abdominal massage should not be offered unless a client requests it. However, a client may not even know they can request this, so we are essentially performing a disservice by not addressing this very valuable region of the body.

Frequency

An estimated 42 million people, or 15% of the population, suffers from constipation making it the most common gastrointestinal problem in the United States. In 2004, 6.3 million outpatient visits were due to constipation and 5.3 million prescriptions for constipation medications were written. The National Digestive Diseases Information Clearinghouse defines constipation as, "a condition in which a person has fewer than three bowel movements a week or has bowel movements with stools that are hard, dry and small, making them painful or difficult to pass." Essentially, constipation happens when stool spends too much time in the colon making it dry and compact. When the stool becomes hard, it is much more difficult for rectum muscles to push out of the body, thus creating constipation.

tummy ache - Copyright – Stock Photo / Register Mark Constipation is often uncomfortable or even painful, based on the length of time and presentation of the person affected by this condition. Roughly 8.9% of the general pediatric population suffers from it on an ongoing basis. Although documentation supports that less than 10% of the pediatric population suffers from constipation, within pediatric cancer patients that rate inflates to nearly 50% to 60%. While direct cancer treatments can cause constipation, it is normally found that opioid use is the number one reason for constipation in this population. In the community of children labeled as having "special healthcare" needs, a study done of group homes found that out of 16 care homes between 29% and 36% of the residents were taking laxatives on a daily basis.

Causes

For children who have lower muscle tone, neurological conditions, poor posture, are non ambulatory, confined to bed rest or taking medications, they may be subject to frequent bouts of constipation and slow motility. Stress, anxiety and sense of control are also culprits for children suffering from constipation. Lack of adequate sleep, exercise and balanced diet often contribute to repeat incidents of abdominal upset.

Medical providers and parents use a variety of resources to address pediatric constipation and slow motility. Some treatment plans for addressing pediatric constipation call for the use of laxatives, enemas, suppositories and when the fecal matter is too impacted, surgical procedures are utilized.

One reported problem of using laxatives as an intervention for constipation are side-effects such as increased rate of constipation, fecal impaction, cramping, diarrhea, even more discomfort and electrolyte imbalance. While there are several options in dealing with constipation, one such approach which has been met with great success is the use of gentle, noninvasive abdominal massage.

Benefits of Abdominal Massage

Participants of a Swedish study felt that abdominal massage "influences the whole person" and while initially skeptical, felt comfortable by the end of the study. This study was done with 60 patients all regularly using laxatives to ease bowel symptoms. Significant improvement in bowel movement and reduction in laxative use after eight weeks of weekly 15-minute massages while the control group saw minor improvement but no reduction in laxative use.

A related study took these results but quantified how massage intervention related to financial savings. This study found that 40% of the massaged group felt massage had a good effect. Both self-massage and professional massage interventions showed abdominal massage as cost-effective in the long term and "relevant to consider ... when managing constipation."

A British study found that using abdominal massage as a holistic intervention of people with "special needs" found reduced rates of constipation, reduced use of laxatives and an unexpected finding, interpersonal contact between caregiver and clients who have profound disabilities. This same bond facilitation happens between parent and child, making it especially important for a hospitalized child. Hospital stays and hospital treatments are stressful especially for children, using massage can not only ease stress, help the child sleep better and longer, but can also aid in digestion.

In the healthcare setting, once providers see the benefits of abdominal massage, it has rapidly become one of the most common referrals for pediatric massage amongst hospitalized patients in my practice.

A Pediatric Protocol

As with any massage therapy provided for children, we should always ensure there are no precautions or contraindications to the hands-on therapy prior to begin. In many cases, asking the parents to administer techniques can be quite beneficial when led by a Certified Pediatric Massage Therapist. Children who may express they feel "ticklish" when touch therapy is applied to the abdomen may benefit from having their own hand placed first on the belly, with the therapist or parent's hand placed on top of the child's hand. This method may decrease heightened tactile sensitivities. For children who communicate in a non-verbal fashion, careful observation of non-verbal cues is even more imperative.

Wait approximately 30 minutes after the child has eaten to provide massage therapy techniques on the abdomen and do not perform massage on this region if there is medial equipment present in the body area. With the child relaxing in a safe, properly supported, supine position, you may wish to begin by gently applying a still, nurturing touch to the abdominal area. Be mindful to notice any discomfort or distention.

When making circular strokes on the abdominal area, they should always follow the direction of the child's digestive tract. For the vast majority, this is a clockwise direction moving from the child's right side to left side. Provide massage techniques on the soft areas of the child's abdomen, from the bottom of their rib cage down. Do not put any pressure on the Xyphoid process, the cartilaginous section at the lower end of the sternum, which is not attached to any ribs and gradually hardens during adult life. Practice care and caution to not press too firmly or deeply. If the child asks you to stop, or shows sign of discomfort, stop providing massage. Pediatric massage is always best applied with the child's express permission and with gentle relaxation in mind.

As evidence continues to support the use of non invasive therapies such as pediatric massage, children, families and healthcare providers gain greater access to an integrative approach that can best our clients and patients needs.

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