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A Question of Ethics
Recently, after I had finished teaching a class on ethics, I  read a blog post on the AAAOM
website regarding "gainful employment." The published information made me reflect on what I had just discussed with the students — the acupuncturists' ethical responsibility to the patient, the profession and the public.

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Pediatric Massage

By Tina Allen, LMT, CPMMT, CPMT, CIMT

About the Columnist
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Build Muscle With Infant Massage

From the time a baby is born, they are reaching major developmental changes on a regular basis. Some of these come through self-exploration, while others are encouraged by outside stimuli.

One of the first major infant development milestones is around four months of age with the ability to control head movement. Motor control develops in a "cephalocaudal" fashion, meaning baby first gains control of her head, then her shoulders and then her abdomen and so on down to her feet.

Building Upper Back Strength

Due to baby gaining control of her head first, it is imperative to build muscular strength in the upper back to support the head, which in turn will aid in development of motor control down the body. Keep in mind that an infant/toddler's head is heavier and larger in proportion as compared to the rest of their body size.

Since the concern of Sudden Infant Death Syndrome (SIDS) we have moved away from letting our babies sleep on their stomachs; coupling this with swings and child seats, modern infants are not developing those vital upper back muscles as early as needed.

Exercise for Baby

infant massage - Copyright – Stock Photo / Register Mark Providing exercises and gentle massage for infants that center around building upper back strength is imperative. Not only will it strengthen baby's neck, back and trunk muscles, it can help with cognitive and visual development, and prevent both flathead syndrome and torticollis.

Typically, infant massage is performed by parents who have been trained by a certified infant massage teacher. In some cases, a parent can be trained to perform massage that is useful to encourage this type of growth and development, while other times certified pediatric massage therapist provide the therapeutic massage treatment.

Prior to beginning any treatment, a full health history and thorough assessment should be performed. Always take into consider any known precautions and contraindications, and when necessary seek advice from the child's health care provider.

Tummy Time

Always practice precaution to the umbilical cord stump, and recognize that as long as baby is comfortable, she can safely play on her stomach. It can be important to incorporate tummy time exercises.

Tummy time exercises are performed by placing baby on her stomach while awake and supervised. This exercise can help develop strong head, neck and shoulder muscles, while at the same time promote motor skills. Tummy time can also help in preventing flathead (positional plagiocephaly).

These exercises are essential in building the strength and coordination needed for rolling over, crawling, reaching, and playing. By starting to train these muscles early, it will enable baby to feel more confident on her stomach as she grows.

Don't just focus on tummy time but use this opportunity to increase their ability to reach and play as well. Arranging toys in a circle around her will promote reaching in different directions and singing or cooing to baby will encourage engagement.

Comfort for Baby

If baby is uncomfortable or cannot support herself on her forearms use a rolled up towel or blanket as a bolster under baby's chest, position her arms over the roll with hands stretching out. Always make sure to have baby's chin in front of the bolster to prevent any airway blockage and always supervise baby during bolstering. Changing the texture and color of the bolster or blanket that baby is lying on will help engage babies senses.

Similar to pediatric massage, it is important to watch for non-verbal cues and pay attention to baby's requests to be done or change positions. Short but frequent bouts of play will prevent tiring and enable the baby to build strength confidently.

Introducing Baby to Therapy

When it is time to introduce massage therapy, we typically begin by positioning baby on their abdomen, or while holding them securely, so they may support their own head. With the baby safely positioned, apply gentle, still touch to begin to warm soft tissues, followed by small, circular massage strokes on both sides of the back.

Practice caution, while at the same time using very gentle pressure. Do not provide touch therapy techniques directly, or within short distance, to the baby's spine. After applying gentle circular massage, follow by stroking from shoulders to lower-back with a gentle pressure. Alternate stroking with closed fingers three times, followed by stroking with open fingers three times.

If the baby is receiving the massage well, continue this alternating stroking for three repetitions of each style of stroke. After these stroking motions, repeat the gentle circular strokes down the back from shoulder towards low back, and finish with a still, calming touch.

Improving upper back muscles is such an important part of infant development and can be incorporated easily into other everyday activities such as diaper changes, towel drying or during infant massage. Try adding in the "tummy time" position when massaging an infant.

Teaching the Parents

When teaching parents, encourage them to start with several minutes a day until baby is able to do 20 minutes a day, even if it is broken up into intervals. Remind parents to take precautions with all exercises especially if the child is elevated (on a bed or changing table.)

Above all, for the therapy and exercises to achieve best results and received in the most relaxed fashion by the child, it is imperative that we listen to and respect the infant's cues. An infant will know when they are done with a certain activity or exercise.

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