Massage therapists strive to ensure that their clients and patients understand the benefits of massage so they can provide informed consent, and this practice is particularly important when working with pediatric clients.

Pediatric clients, however, are not always going to communicate in the same way as some of your adult clients ─ and massage therapists need to be prepared to work alongside family members and other health care providers to understand how best to communicate with the child.

Following, you’ll find helpful tips for communicating with pediatric clients so you can be sure you are practicing safely.

Getting Started: Communicating and Informed Consent

Some children will be verbal and others will not, and this may be dependent on their developmental age or cognitive ability. In some cases, the child may combine various forms of communication, such as American Sign Language (ASL), picture boards, some spoken language, computer/tablet, augmentative communication device and/or written language. 

Working closely with a pediatric client’s parents and health care providers will ensure a child understands what you are saying and you understand what the child is saying—which is absolutely essential before you begin a massage therapy session and during the session as well.

Massage therapists should speak to their pediatric clients before every session so they can be aware of anything that has changed and re-assess.  This will help you to understand how they communicate and if you need assistance in understanding their responses.

Autism Spectrum Disorders & Neurological Considerations: Communicating with Clarity

There are many children who do not verbally respond to questions or hold conversations with others. These children may have a developmental difference or may simply not be verbal yet.

Neurological and developmental disorders occur across a spectrum and affect individuals differently. Some children lose the ability to speak, for example, and some might have motor impairment. Many children with neurological and developmental disorders have difficulty with social and emotional awareness.

Autism spectrum disorders. One group of children often categorized as being nonverbal in their symptomology are those with Autism spectrum disorders (ASDs). ASDs can interfere with the neurotypical development of the brain in the areas that influence reasoning, social interaction, motor skills, communication skills and attention.

Children with ASDs may appear deficient in verbal and nonverbal communication, social interaction and play activities, and these characteristics are often observed in the child’s social relationships, communicative competence, pattern/ range of interests, and sensory responsiveness. 

Cerebral palsy and traumatic brain injury. Approximately two-thirds of people with cerebral palsy have some developmental or processing delay. Others may not be able to hear well or have difficulty controlling mouth and jaw movements. With both cerebral palsy and traumatic brain injury, damage to one or more areas of the brain affects how the brain and nervous system communication. For massage therapists, working with children with these conditions will most often mean finding unique ways to communicate.  

Some pediatric clients with cerebral palsy or a traumatic brain injury will be able to communicate at peer-level. For others, communication might be challenging. Working with children with neurological considerations will almost always mean communication is largely dependent on the individual child, so massage therapists need to be flexible and able to adapt.

If the child has a different form or style of communication, you should not assume they lack intellectual ability. Many children process input at a different rate and respond in a variety of ways, which requires the pediatric massage therapist, parents, and health care providers learn to understand the child's form of communication and respond appropriately.

Non Verbal Communication: Helping Pediatric Clients Get the Most Benefit

After you have performed a thorough health care intake, or reviewed their electronic medical records (EMR if working in a health care setting), you will need to speak with the family to make sure you understand how best to approach communication with their child. The parents or a trusted health care provider should be present alongside you during the massage session to help in case you have difficulty communicating with the child.

Be prepared to take it slow. For example, your first session might not include massage at all, and that’s OK. Start out by trying to make the child feel comfortable and introduce tactile stimulation by allowing the child to choose various items to touch and feel. Know, too, that you will want to give the child the opportunity to participate in the pediatric massage session as much as possible.  

Some key points to remember:

-Always be present in the moment and give your individualized and focused attention.

-Remember, you may not receive direct eye-to-eye contact or a verbal “Yes,” so you need to be aware of a child’s nonverbal cues that indicate permission to touch.

-Vary your pace and pressure while recognizing the child’s needs.

-Be very aware of the child's response to receiving touch therapy.

-Children diagnosed with ASD and other neurological differences often prefer deeper pressure. (Note: Deeper pressure does not mean heavy pressure, and you must always observe safety in relation to pediatric development. For children, deeper pressure often indicates slow movements and gentle, sustained contact).

-Skin-to-skin contact may not be immediately well-received by children with sensory differences, so consider providing touch over clothing or cloth. Starting with the hands and feet may be more comfortable.

-Ask questions and wait quietly for the child's verbal or nonverbal reply.

-Give choices and ask the child if they would like a change in pressure.

-Before moving onto a different part of the body, be sure to ask for—and receive—the child’s permission.

-Give the power of choice to the child.

-Use the child’s method of communication.

With all of our clients and patients, regardless of age, communication is the key to making sure the client experiences the full benefits of massage therapy. When you invest the time in learning how best to communicate with your pediatric client, you will find that your sessions are much more beneficial.