Updates on COVID-19

As many of you are seeing from our local news, we have had several positive cases of the new virus confirmed in Wake County. So far all individuals have been self-quarantined at home and are doing well. 

I take cleanliness and sanitation seriously. Below you will find a list of actions I already take regularly to ensure a sanitary and safe space for my clients. 

  • I wash and sanitize my hands before and after working with each client.

  • All sheets, blankets, pillowcases, and fabrics that are used during a session are only used for that session. Dirty linens are stored in a trash bag and removed for laundering.

  • I sanitize the table, stool, oil dispenser, hand sanitizer bottle, and yoga mats between clients using hospital-grade disinfectant. The table is covered with a waterproof covering that keeps the cushioning from coming into contact with clients.

  • All toys used during a session are set aside for cleaning in a bleach solution. No dirty toys on my watch! The ball is sprayed and wiped down with the hospital-grade disinfectant and allowed to dry. (I make sure to rinse them all so that your child isn’t coming into contact with bleach.)

  • My payment processing equipment is sanitized between clients.

  • If you or your child is ill, please reschedule your appointment. If I am ill, I will reschedule all appointments.

I am now scheduling clients further apart so I can clean doorknobs and other public fixtures between each session.

I have been mindful of my health and exposure to illness for the past several months and will continue to adjust my lifestyle accordingly so I minimize my risk of exposure.

The office is shared with another provider. If you all have a preference for coming in at times when the waiting room will be empty so you can practice social distancing, please let me know and I’ll give you those options.

If your child or anyone in your family is immunocompromised, I recommend either delaying massage therapy or speaking with me about in-home massage therapy options.

If you are sick or feeling sick, please reschedule your appointment! If anyone in your family is ill or if you all have traveled recently, please consider rescheduling if we determine that is in everyone’s best interest. I typically waive late cancellation fees for illness and will continue to do so for the remainder of flu season.

Let’s keep washing our hands, reducing our susceptibility to infections through good lifestyle choices, and caring well for the people around us.

Importance of Tactile Input

Williams & Shellenberger Pyramid of Learning

In my training last summer with Tina Allen, she presented our class with the Williams & Shellenberger Pyramid of Learning, developed by Mary Sue Williams and Sherry Shellenberger.

What I love about the diagram is it helps give a framework for how the nervous system develops and expands from the early stages of receiving sensory input from the seven senses to eventually leading to academic learning. If you are reading this, you likely have most of the skills presented in the diagram. 😉

I want to draw your attention to the three senses listed at the bottom of the diagram right above the Central Nervous System base.

Tactile – This is fairly straightforward as most of us think of touch. Tactile input can range in a variety of ways, including pressure, temperature, vibration, texture, and pain. Tactile input is transmitted to the nervous system by specialized nerve endings.

Vestibular – This sensory system provides the brain with information about motion, head position, and spatial orientation. The inner ear is a part of this system! This system is important in balance and movement. 

Proprioception – This sensory system provides us with awareness of where our body is in space. There are specialized nerve endings located in our muscles and joints (connective tissue!) that relay this information. Interestingly, research has found that some individuals with a trauma history and/or mental illness also have poor proprioception. 

Massage provides an array of sensory information for the tactile and proprioceptive systems, as well as the vestibular system in lesser amounts. 

We can vary tactile input by changing pressure, location, texture, and vibration, all of which stimulate different nerve endings and send a wide variety of information to the nervous system. 

Some of these nerve endings, like mechanoreceptors, communicate with specific structures in the nervous system. Certain mechanoreceptors send input about pressure that can increase vagal activity, potentially releasing oxytocin and moving the body into a parasympathetic state. This is much of the reason why many people feel relaxed and sleepy after receiving a massage. 

Vibration stimulates other mechanoreceptors that can send excitatory signals to the nervous system. Vibration is a helpful tool when working with scar tissue as well as for stimulating a hypotonic (low tone) muscle.

Stay tuned for more information about the importance of the tactile sense, as well as ways to incorporate it more into your daily routine for yourself and for your child.

Respecting Physical Boundaries

The topic of boundaries seems to be popping up everywhere! What exactly are boundaries and how do we work with them in massage therapy?

Physical boundaries are essentially the way in which we define how others interact with us. It includes our personal space, privacy, and our bodies.

When working with children it is important to teach and model what physical boundaries are and respect the child as they begin to build their boundaries. As a massage therapist, I request permission from my pediatric clients before beginning the massage. This is because children are still learning how to understand and process their bodies, and respecting a child’s independence is crucial to helping them build a good relationship with their body. Teaching healthy physical boundaries helps to build bodily autonomy, self-esteem, and body awareness!

This concept of respecting physical boundaries when working with children is still a newer topic. As a general rule, I only ask permission from a child when they have a choice. In massage therapy, they always have the option to consent to the treatment or not. I design sessions to allow for time for the child and I to interact before introducing touch, which also means initial sessions often last longer than the 30 minutes their scheduled for (sometimes up to 50 minutes!).

So, if there are times that a child has a choice in being massaged or touched, when is there not a choice? If there is a medical or safety need for physical handling, say a dirty diaper or grabbing at a hot object, I won’t ask permission because there is not an option. I have found it helpful to talk children and babies through the process when there isn’t an option as the sound of a calm, soothing voice can help them regulate their nervous system. (For these particular examples I’m thinking of my experiences of spending time with children of friends.)

In my next blog post, I’ll explore the concept of consent and how to look for permission!

Potential Benefits from Massage and Touch Therapy

There are many potential benefits from massage and touch therapy!

What do you think of as reasons to get a massage? Is it for muscle tension, anxiety, a headache that won’t quit, or relaxation? Children and teenagers receive the same benefits from massage therapy, though we often don’t think of them needing massage or finding it useful in the same way.

The reasons for pursuing massage vary from child to child. I work with parents and families, other medical providers and members of the care team, and the client themselves to craft a plan that will address the needs of the client. For example, goals will look very different for a child who is four and navigating life with developmental delays and an adolescent who plays multiple sports. Both clients will receive excellent sessions, but they have very different needs.

Below you will find a list of benefits of massage and touch therapy. There are research citations at the end for continued reading if you are curious to know more. We learn more about how the body works every day, so new research is always coming out about the importance of touch and the dynamic nature of the human body.

·     Improved attention span and on-task behaviors demonstrated in children and adolescents diagnosed with ADHD and Autism spectrum disorders (ASD) that received massage. 

·     Improved behavioral symptoms like aggression, anxiety, and hostility in teenagers.

·     Improvement in markers of anxiety and depression shown in children and adolescents diagnosed with anorexia, bulimia, and PTSD. Additionally, adolescents showed more compliance with eating disorder treatment protocols and improved body image.

·     Reduction in stress and anxiety measured in children undergoing hospitalization.

·     Children with chronic constipation showed marked improvements in reduced constipation symptoms, less laxative use, and increased diet intake.

·     Symptoms of acute diarrhea were reduced and studies indicate that massage therapy was more effective than standard pharmacological interventions. 

·     Significant reduction in hypertonicity and spasticity for children with cerebral palsy. 

·     Improvement in muscle tone for children with Down syndrome who received massage.

·     Improvement in gross motor and sensory sensitivity scores for children with motor developmental delays who received massage twice a week for a 12 week period.

·       Reduction in pain, nausea, and sleep disturbances for patients who received massage after hematopoetic cell transportation.

·       Lower anxiety scores and less benzodiazepine exposure for children receiving massage following cardiovascular surgery.

·     Burn victims who received massage therapy had higher pain thresholds, less post-burn pain, less itching, decreased amounts of crying, and increased range of motion.

·     Lower levels of pain, anxiety, and depression have been reported in children with sickle cell disease, juvenile rheumatoid arthritis, fibromyalgia, and chronic pain of unknown etiology.

·     Marked improvement in pulmonary measures for children with asthma and lower cortisol levels.

·     Decreased glucose levels and improved compliance with insulin and food regulation for children with diabetes who received regular massage.

·     Lower anxiety and pain, significantly less post-chemotherapy nausea and vomiting, and increased nighttime sleep have been observed with children and adolescents with cancer.

Research citations are included below.

ASD and ADHD

Field, T.; Lasko, D.; Mundy, P.; Henteleff, T.; Kabot, S.; Talpins, S.; Dowling, M. Brief report: Autistic children’s attentiveness and responsivity improved after touch therapy. J. Autism Dev. Disord. 199727, 333–338.

Escalona, A.; Field, T.; Singer-Strunk, R.; Cullen, C.; Hartshorn, K. Brief report: Improvements in the behavior of children with autism following massage therapy. J. Autism Dev. Disord. 200131, 513–516.

Aggression, Anxiety, Bulimia, Anorexia

Diego, M.A.; Field, T.; Hernandez-Reif, M.; Shaw, J.; Castellanos, D.; Rothe, E. Aggressive adolescents benefit from massage therapy. Adolescence 200237, 597–608.

Field, T.; Morrow, C.; Valdeon, C.; Larson, S.; Kuhn, C.; Schanberg, S. Massage reduces anxiety in child and adolescent psychiatric patients. J. Am. Acad. Child Adolesc. Psychiatry 199231, 125–131.

Jalalodini, A.; Nourian, M.; Saatchi, K.; Kavousi, A.; Ghaljeh, M. The effectiveness of slow-stroke back massage on hospitalization anxiety and physiological parameters in school-age children: A randomized clinical trial study. Iran. Red Cresent Med. J. 201618, e36567.

Hart, T.S.; Field, T.; Hernandez-Reif, M.; Nearing, G.; Shaw, S.; Schanberg, S.; Kuhn, C. Anorexia nervosa symptoms are reduced by massage therapy. Eating Disord.20019, 289–299.

Field, T.; Schanberg, S.; Kuhn, C.; Fierro, K.; Henteleff, T.; Mueller, C.; Yando, R.; Burman, I. Bulimic adolescents benefit from massage therapy. Adolescence 199833, 555–563.

Gastrointestinal Functions

Bromley, D. Abdominal massage in the management of chronic constipation for children with disability. Community Pract. 201487, 25–29.

Gao, L.; Jia, C.; Huang, H. Pediatric massage for treatment of acute diarrhea in children: A meta-analysis. BMC Complement. Altern. Med. 201818, 257.

Cerebral Palsy, Down syndrome, Developmental Delays

Rasool, F.; Memon, A.R.; Kiyani, M.M.; Sajjad, A.G. The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomized controlled trial. J. Pak. Med. Assoc. 201767, 87–91.

Glew, G.M.; Fan, M.Y.; Hagland, S.; Bjornson, K.; Beider, S.; McLaughlin, J.F. Survey of the use of massage for children with cerebral palsy. Int. J. Ther. Mass. Bodyw.20103, 10–15.

Silva, L.M.; Schalock, M.; Garberg, J.; Smith, C.L. Qigong massage for motor skills in young children with cerebral palsy and Down syndrome. Am. J. Occup. Ther. 201266, 348–355. 

Lu, W.P.; Tsai, W.H.; Lin, L.Y.; Hong, R.B.; Hwang, Y.S. The beneficial effects of massage on motor development and sensory processing in young children with developmental delay: A randomized control trial study. Dev. Neuro Rehabil. 201830, 1–9.

Burns, Chronic Pain, Post-hospitalization Pain

Ackerman, S.L.; Lown, E.A.; Dvorak, C.C.; Dunn, E.A.; Abrams, D.I.; Horn, B.N.; Degelman, M.; Cowan, M.J.; Mehling, W.E. Massage for children undergoing hematopoitic cell transplantation: A qualitative report. Evid. Based Compl. Alternat. Med. 20122012, 792042.

Staveski, S.L.; Boulanger, K.; Erman, L.; Lin, L.; Almgren, C.; Journel, C.; Roth, S.J.; Golianu, B. The impact of massage and reading on children’s pain and anxiety after cardiovascular surgery: A pilot study. Pediatr. Crit. Care Med. 201819, 725–732.

Morien, A.; Garrison, D.; Smith, N. Range of motion improves after massage in children with burns: A pilot study. J. Bodyw. Mov. Ther. 200812, 67–71.

Parlak Gurol, A.; Polat, S.; Akcay, M.N. Itching, pain, and anxiety levels are reduced with massage therapy in burned adolescents. J. Burn Care Res. 201031, 429–432.

Lemanek, K.L.; Ranalli, K.L.; Lukens, C. A randomized controlled trial of massage therapy in children with sickle cell disease. J. Pediatr. Psychol. 200934, 1091–1096. 

Field, T.; Hernandez-Reif, M.; Seligman, S.; Krasnegor, J.; Sunshine, W.; Rivas-Chacon, R.; Schanberg, S.; Kuhn, C. Juvenile rheumatoid arthritis: Benefits from massage therapy. J. Pediatr. Psychol. 199722, 607–61

Field, T.; Delage, J.; Hernandez-Reif, M. Movement and massage therapy reduce fibromyalgia pain. J. Bodyw. Mov. Ther. 20037, 49–52.

Asthma, Cystic Fibrosis, Diabetes

Field, T.; Henteleff, T.; Hernandez-Reif, M.; Martinez, E.; Mavunda, K.; Kuhn, C.; Schanberg, S. Children with asthma have improved pulmonary function after massage therapy. J. Pediatr. 1998132, 854–858.

Fattah, M.A.; Hamdy, B. Pulmonary functions of children with asthma improve following massage therapy. J. Altern. Complement. Med. 201117, 1065–1068.

Hernandez-Reif, M.; Field, T.; Krasnegor, J.; Martinez, E.; Mavunda, K.; Schwartzman, M. Cystic fibrosis symptoms are reduced with massage therapy intervention. J. Pediatr. Psychol. 199924, 183–189. 

Huth, M.; Zink, K.; VanHorn, N. The effects of massage therapy in improving outcomes for youth with cystic fibrosis: An evidence review. Pediatr. Nurs. 200531, 328–332.]

Field, T.; Hernandez-Reif, M.; LaGreca, A.; Shaw, K.; Schanberg, S.; Kuhn, C. Massage therapy lowers blood glucose levels in children with diabetes. Diabetes Spect. 199710, 237–239.

Sajedi, F.; Kashaninia, Z.; Hoseeinzadeh, S.; Abedinipoor, A. How effective is Swedish massage on blood glucose level in children with diabetes mellitus? Acta Med. Iran. 201149, 592–597.

Cancer

Field, T.; Cullen, C.; Diego, M.; Hernandez-Reif, M.; Sprinz, P.; Beebe, K.; Kissel, B.; Bango-Sanchez, V. Leukemia immune changes following massage therapy. J. Bodyw. Mov. Ther. 20013, 1–5. 

Post-White, J.; Fitzgerald, M.; Savik, K.; Hooke, M.C.; Hannahan, A.B.; Sencer, S.F. Massage therapy for children with cancer. J. Pediatr. Oncol. Nurs. 200926, 16–28. 

Haun, J.N.; Graham-Pole, J.; Shortley, B. Children with cancer and blood diseases experience positive physical and psychological effects from massage therapy. Int. J. Ther. Massage Bodyw. 20092, 7–14.

Batalha, L.M.; Mota, A.A. Massage in children with cancer: Effectiveness of a protocol. J. Pediatr. 201389, 595–600.

Celebioglu, A.; Gurol, A.; Yildirim, Z.K.; Buyukavci, M. Effects of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer. Int. J. Nurs. Pract. 201521, 797–804. 

Mazlum, S.; Chaharsoughi, N.T.; Banihashem, A.; Vashani, H.B. The effect of massage therapy on chemotherapy-induced nausea and vomiting in pediatric children. Iran J. Nurs. Midwifery Res. 201318, 280–284.

Jacobs, S.; Mowbray, C.; Cates, L.M.; Baylor, A.; Gable, C.; Skora, E.; Estrada, M.; Cheng, Y.; Wang, J.; Lewin, D.; et al. Pilot study of massage to improve sleep and fatigue in hospitalized adolescents with cancer. Pediatr. Blood Cancer 201663, 880–886.

Rodriguez-Mansilla, J.; Gonzalez-Sanchez, B.; Torres-Piles, S.; Martin, J.G.; Jimenez-Palomares, M.; Bellino, M.N. Effects of the application of therapeutic massage in children with cancer: A systematic review. Rev. Lat. Am. Enferm. 201725, e2903.

What is Pediatric Massage?

What comes to mind when you think about pediatric massage? 

Is it spa day for kids? Maybe a child receiving deep work between the shoulder blades? Do you picture a relaxing space with a massage table and salt lamp glowing where you undress and lie down?

While these are all scenarios you may have experienced or seen in the media, none of them are quite accurate for pediatric massage.

Pediatric massage is massage therapy that is adapted for children and teenagers. Adaptations are made to take the age and developmental stage into account, include the family in the session planning process, and provide a safe, nurturing, kid-friendly environment. 

There are several differences between a “normal” massage experience you may have had and a pediatric massage session.

1.    Clients stay clothed in pediatric massage sessions.

All the massage I do can be done over clothing. Additionally, a child may not lie still for 30 minutes, which is normal and expected. Staying clothed means we can seamlessly transition from massage to a stretch break to dancing to education and beyond! It’s also more comfortable and appropriate for a child who may not know or understand what massage therapy is to stay clothed.

Older clients, like teenagers, may choose to wear a bathing suit or sports attire during their session. If so, we will also use appropriate draping (covering the client with a sheet and blanket) to ensure they are comfortable.

2.    A parent or caregiver is required to be present.

I require a parent and/or caregiver to be present for the entire session. If the client is 13 or younger (including functioning at a younger age), I require you to stay in the room. I have a comfortable chair and side table in the room, and you are welcome and invited to be involved in the session so that you can learn how to massage your child! For clients 14-17, there is a comfortable waiting area you are welcome to relax in if you prefer to be outside of the room during the session. 

3.    The sessions are shorter.

With the exception being for older teenagers who desire a longer session, I keep pediatric sessions 30 minutes long.  The sessions include up to 30 minutes of hands-on time and may also include dancing, moving, stories, music, parent education, and more!

Sometimes clients may need more time to get comfortable with the idea of receiving massage, or they may want short bursts of massage with breaks in-between. Time not spent massaging is where I incorporate other activities that are beneficial to the musculoskeletal and nervous systems, like movement or dancing, and that will promote a sense of comfort in the space. 

I also will take time to educate the parents and/or caregivers about techniques that can be used at home to massage their child. You may receive a short massage from me (and your child!). It happens more often than you might think. Most kids are curious about massage and want to learn and get involved.

4.    The type and style of massage is different than what you may imagine.

I’m not sure what your past experiences with massage may be, but I can assure you this isn’t spa day for kids, nor will I be elbowing your child in the back!

Pediatric massage uses touch to impact the musculoskeletal and nervous systems. I practice what is known as “deep touch,” which applies full-handed, firm, gentle pressure that will stimulate mechanoreceptors in the skin and fascia that send a signal to the nervous system resulting in increased vagal nerve activity.Increased vagal activity has been associated with lower amounts of cortisol in the body.

In short, specific kinds of touch will tell the nervous system to relax and rest. The vagus nerve is related to parasympathetic, or “rest and digest,” side of the nervous system. This calm side of the nervous system promotes restorative functions of the body, like digestion, sleep, and wound healing. When the nervous system is in this parasympathetic state, research has indicated that stress hormones like cortisol are reduced and others like oxytocin are boosted. Win-win!

Just to reiterate, deep touch is not the same thing as deep tissue. Your child will never receive pressure that is hard, painful, or damaging to their growing bodies in a session with me.

I hope that this has answered some questions you may have! Please check my FAQ section here to see more answers to common questions.


Contact me at 919-228-8663 or sydney@trianglepediatricmassage.com for other questions or for a consultation call to see if pediatric massage will benefit your child!

Diego, M.; Field, T. Moderate pressure massage elicits a parasympathetic nervous system response, 119, 630–638. https://www.tandfonline.com/doi/abs/10.1080/00207450802329605

When and Why To Consider Massage for Kids

Pediatric massage is massage and touch therapy that is specifically created and adapted for children and adolescents. Pediatric massage therapists have additional training that prepares us to work with kids and teens in a skillful manner that takes into account age, developmental stage, and the specific needs and goals of the child, family, and broader healthcare team.

There are many times when massage may be beneficial. Physical complaints and conditions like headaches, muscle hypertonicity and contractures, low muscle tone, injuries, and chronic pain can be responsive to massage. 

Research1 also supports the use of massage for conditions like ADHD, Autism spectrum disorders, sensory processing disorders, anxiety, and depression. Several studies showed outcomes including lower levels of anxiety, increased attentive and on-task behaviors, a reduction in touch aversive and aggressive behaviors, and the promotion of healthy sleep patterns.

Many of these benefits arise from the impact that touch has on the nervous system. Touch using moderate pressure stimulates nerve endings called mechanoreceptors in the skin. These nerve endings communicate with the vagus nerve and increase vagal activity. Increased vagal activity is associated with a parasympathetic (relaxed) nervous system state. When the body is in this state, helpful hormones like oxytocin, serotonin, and dopamine are released and the amount of cortisol in the body decreases.2

In addition to these potential benefits, massage therapy is noninvasive and has no side effects. Education is provided during sessions to teach parents and/or caregivers on ways to utilize techniques at home, as well as to empower the child to establish healthy body awareness and autonomy.

If you have questions about your child’s health and ability to receive massage therapy, please consult with your child’s healthcare practitioner.

Field, T. Pediatric massage therapy research: A narrative review. Children.2019. 6(6), 78. https://doi.org/10.3390/children6060078

2  Diego, M.; Field, T. Moderate pressure massage elicits a parasympathetic nervous system response. International Journal of Neuroscience. 119(5), 630–638. https://www.tandfonline.com/doi/abs/10.1080/00207450802329605