Pediatric Massage
Feature Article in Massage Therapy Canada, Winter 2002
Forget the quiet, babbling brook music, scented flickering candles and a peaceful calm descending in the room and bring in the children!
Touch, along its full spectrum is a universal communication of attention and nurturing care. The new parent’s loving caress as they get to know their baby, mothers rubbing the backs of her troubled children, to the therapist’s focused attention to treating an injured athlete’s knee, all lie along the continuum. The intention is always to be nurturing, be it the person, the nervous system or the tissues.
For the therapist considering pediatric massage, there is also a full spectrum of avenues to explore.
Toddler Years
Attempting to work in traditional ways with toddlers will be challenging. It is the developmental task of this wonderful age group to move away, using their new motor skills to explore the world with the parent as a safe harbor to return to for reassurance and support. Touch can be given when they initiate and for only as long as they determine, which is not always ideal with the constraints of a clinical setting.
Developing a range of resources like interesting hand toys, movement games and music may help momentarily, but it is more likely that we would be using a doll to demonstrate technique for the parents to try to integrate into their child’s daily routines. It is helpful if your teaching doll for this age group is size and appearance appropriate, i.e. a “big” boy or girl. In this way you may be able to engage a child in playing with you and be able to access brief hands-on moments to assess and then instruct the parents who will likely always be more successful in their massage than you.
Childhood Years
Once a child has mastered the full range of motor and exploration skills and has developed the language they need for satisfying communication of their needs, they transform into the massage therapist’s dream. Attention and focus is primarily to voice, making creative and elaborate story telling the therapist’s greatest tool for her accompanying hands.
Acting out on the child’s body imaginary dragons, unicorns or even a variety of weather patterns – whatever engages the child’s imagination and attention- becomes the backdrop for the massage. With this age group we can be true to our primary focus of facilitating parents’ comfort and skills with massage and work directly with children, giving them the benefit of our direct attention simultaneously.
Last spring one of my regular clients approached me with concern of her five-year-old son’s over-activity and tendency to anxiety. She hoped massage might calm him, but she needed help with figuring out what and how to do this at home.
While his mother watched quietly from the sidelines, I perched up on the table with John. Over the course of four half-our sessions, we created an ongoing narrative of the adventures of Pete and Pot, two prehistoric stegosaurus creatures and their good friend Sam, the saber-toothed tiger. John enthusiastically helped me tell the story. He kept the names straight, while my hands acted out on his truck and legs, the actions of stomping across the tundra and moving quietly towards the prey.
In the moments that we were discussing the finer details of what would happen next, my hands were busily yet quietly engaged in calming, centering, deep-breath encouraging strokes that his mother would mentally note and imitate at home. In this family, the continuing saga has become the framework for some calm and centering time as needed throughout the day and before bed.
Integrating instructions for parents with treatment requires some practice. It is not unlike that childhood game of patting your head and rubbing your tummy at the same time.
HINTS TO ASSIST IN YOUR PRACTICE
Adapt your positioning: Become comfortable working in a variety of positions. Supported side lying, supine, and semi-reclined work best with children to facilitate communication with words and eye contact. Do not rule out massaging in any other position of sitting, standing, in your lap on the table or under the table. The trick is to get your hands on wherever the child feels comfortable and gradually work toward a more traditional table position.
Adapt your time: More frequent, shorter treatments work best. Thirty minutes is usually more than enough time to be in a focused session with a child and their attention span.
Adapt your pressure: Create a couple of feedback strategies, geared to age, for your young client to use in reporting what feels right for them. Most children after three years or so will be able to use the stoplight words: green means go ahead, it feels great; yellow means caution, it feels like it might change suddenly; and red always means STOP. Another strategy may be more simply describe “light as a butterfly, heavy as an elephant or Just Right,” a variation of the Three Bears story that most children know. Be prepared for children to test out the control they have in directing the pressure of their massage. They need to know that they can trust you to listen, and then they can focus in on the experience of the massage. Know that the amount of pressure will always be right therapeutically for the moment, for the tissues themselves and for the child’s personal sense of body and experience ownership and control.
The experience of controlling what is done to their bodies becomes particularly important in working with children who are chronically ill or disabled. For children whose life experience is filled with occasions of adults doing things to them, sometimes painfully, without their permission or in spite of their protests, imagine what an affirming experience massage could be for them when our hands not only feel good, but we work WITH them rather than doing TO them.
Work with parents: Working with the parents in the room watching requires some preparation. Be clear in your communication with parents that your attention will be with the child for the time that you are together. Ask parents to observe quietly until the end of the session at which time you can discuss what you did, answer questions and give directions. It is difficult for a parent to not get involved, especially if their child appears to be uncooperative. If this is the case, assure the family that you are comfortable handling the situation and that you will request their support if you feel you need it. There may be times when children need more support from their parents in the treatment sessions and this too needs to be accommodated. I have worked successfully with families and children though I never touched the child.
I have a realistic child-sized rag doll, Annie, that becomes my child who has come for a massage and Annie and I interact as if she were real, acting out what it is I want the parent to do and the child to do.
There are endless, fun ways to bring massage to families and children. I have arranged special birthday packages when the child of a regular adult client comes for a massage, gets to choose, mix and take home their special massage oil blend with a birthday card. For special celebrations I have led Family Massage classes where children learn how to massage their parents’ feet and backs, always a popular event!
There is yet another purpose of bridging the worlds of massage and children. Massage therapists in fact share an important common dream with families everywhere in that we too wish for a more nurturing, less violent world for future children. Our massage is the way in which we work toward that future.