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Pediatric Therapy Corner: Pediatric Massage for Down Syndrome, Cerebral Palsy and Autism

by Tina Allen | Liddle Kidz Foundation

Nurturing touch is beneficial to almost anyone, but children in particular have an essential need for a regular routine of healthy touch.   Receiving professional pediatric massage therapy can be a vital contribution to their growth and development.   As much as pediatric massage therapy is considered to be a gentle, noninvasive intervention, care and caution should always be practiced in following all known contraindications, precautions and healthcare provider recommendations. Each child requires a unique approach and not all techniques and adaptations are safe for every pediatric client.  Massage therapy is not designed to replace medical advice, and no information contained within this article should be used without guidance.
Many children have different healthcare treatment, medical equipment and are on a variety of medications.  When considering a massage therapy approach, you must first assess each situation and receive any clarification on known precautions in relation to the child’s current care.
In this article we will take a special look at the benefits of using pediatric massage therapy with children diagnosed with Down Syndrome, Cerebral Palsy and Autism.
Pediatric Massage for Down Syndrome
Children diagnosed with Down Syndrome often present with some impairment of cognitive ability and physical growth. As well as, they may have further complications that include hearing loss, congenital heart disease, seizure disorders, cataracts, hypotonia & hypertonia, protruding tongue, constipation and spinal cord compression.  All of which are considerations when we think of safely and effectively applying pediatric massage therapy.
Some Potential Benefits of Pediatric Massage Benefits for Children with Down Syndrome
Every child feels the effects of touch therapy differently and may benefit from different gentle techniques, varied length of sessions and gentle application.  Evidence suggests that pediatric massage may improve muscle tone, increase performance on motor tasks and provide much needed relief from constipation by improving motility.
Suggested Massage Adaptations | Down Syndrome
In order to ease constipation, abdominal massage may improve gastrointestinal function and increase motility. It is important that all strokes follow the direction of the intestinal tract, and are provided at least thirty minutes following eating.
Specific caution should be practiced in relation to any pre-existing cardiac conditions, hypotonicity or hypertonicity due to affected muscles and joints, as well as atlanto-axial instability.   Always watch nonverbal cues closely, as there may be a delayed response to discomfort and/or pain due to higher sensory threshold.
Pediatric Massage for Cerebral Palsy
When you work with children diagnosed with Cerebral Palsy, there are no absolute assumptions.  Each child may present quite differently from another.  The brain’s motor areas have been disrupted which affects the ability to control movement and posture.  The child may present with joint and bone deformities and contractures (permanently fixed, tight muscles and joints). Classical symptoms include spasticity, spasms, other involuntary movements, difficulty with fine motor tasks, difficulty maintaining balance and walking and may be slower in reaching developmental milestones.
Some Potential Benefits of Pediatric Massage Benefits for Children with Cerebral Palsy
Massage may be an effective intervention used to reduce spasticity, encourage muscle flexibility and increase range of motion.  Depending on how you apply techniques, you may be able to use this gentle modality to increase or reduce muscle tone, encourage motor function and promote positive social interaction.  Published studies indicate that touch therapies can aid sleep, improve social interaction and communication.  Massage has also been found to improve digestion and aid in the absorption of nutrients.
Suggested Massage Adaptations | Cerebral Palsy
Application is designed on a case by case basis.  Some of your clients may have a combination of both “high tone” and “low tone” in their muscles.  Appropriate support should be practiced in positioning to support joints and the provider should not practice any rolling strokes near, or on joints.
For children who are predisposed to having seizures, use extra caution on areas close to the base of skull, the spine and do not practice any gliding strokes from proximal to distal on fingers or toes.
Abdominal massage is often indicated for children with decreased mobility.  So, this may be an effective approach that can be provided by healthcare providers, and parents when provided with education on safe and effective techniques.
Pediatric Massage for Autism
Autism is classified within the scope of Autism Spectrum Disorders (ASD).  Each diagnosis within this spectrum presents quite differently.  In this section we are approaching classical Autism, and not all diagnoses that fit under the auspice of ASDAutism is distinguished by a pattern of symptoms rather than one single symptom. The main characteristics are impairments in social interaction, impairments in communication (both verbal and non-verbal), restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis
Some Potential Benefits of Pediatric Massage Benefits for Children with Autism
In published studies, researchers have found pediatric massage to be an effective intervention to aid in providing relaxation and help the child to adapt to become more accustom to tactile stimulation.  Over time, children become more spatially aware and have better body awareness. After receiving massage, children are observed to have more on-task and social relatedness behavior during play observations.   Sleeping is also improved, as the length of time to fall asleep is decreased.
Suggested Massage Adaptations | Autism
Whenever we use massage, we must first have communication and ask permission.  So, with each pediatric client, we must take our time and use our skills to observe cues which indicate permission to touch.   Children may not always provide direct eye-to-eye contact or a verbal “Yes”.  So, establishing non verbal communication is important.
First, start with one touch at a time recognizing the child’s needs, vary your pressure and pace.  Try providing touch over clothing or cloth.  Gentle, deep pressure is often better received by many children who have been diagnosed with Autism.
A diagnosis is simply one factor determining how a child will find their fit within the world.  When it comes to the use of therapies, such as pediatric massage therapy, just knowing a diagnosis does not give you the full picture.  It is imperative that we meet each client and learn what they need to best succeed.
Featured Contributor Tina Allen of Liddle Kidz Foundation
With over a decade of service to children and families, Tina Allen, LMT, CPMMT, CPMT, CIMT, founder of leading children’s health and nurturing touch organization Liddle Kidz™ Foundation, has become a respected international lecturer, author and authority on infant and pediatric massage.
She is a Pediatric Massage Master Teacher, Developmental Baby Massage Teacher and a Licensed Massage Therapist with specialized training in providing massage therapy for infants and children with special healthcare needs. Ms. Allen managed the United States first comprehensive pediatric massage program at Children’s Hospital Los Angeles (CHLA), where she trained volunteer massage therapists and medical professionals to work with hospitalized Rehabilitation patients, medically complex infants in the Center for Newborn and Infant Critical Care (CNICC), Neonatal Intensive Care Unit (NICU), Children with Retinoblastoma, Spina Bifida and Cerebral Palsy. She developed pediatric massage programs at Mattel Children’s Hospital at UCLA and Cedars-Sinai Medical Center, as well as developed a program focusing on introducing gentle compassionate touch to women and children who have survived domestic abuse. She is currently consulting on the development of comprehensive pediatric massage programs for The Mayo Clinic, Nemours/Alfred I. duPont Hospital for Children and Connecticut Children’s Medical Center.
Ms. Allen has received recognition as First 5 California’s Champion for Children, was honored with the Richard Ryder Award for her dedicated and passionate service, is a 2009 Massage Therapy Hall of Fame Inductee,  2011 International Massage Therapist of the year and 2012 Massage Therapy Foundation Humanitarian of the year.
Her innovative approach to children’s health has allowed her the unique opportunity to educate families and professionals throughout the world in the many benefits of nurturing touch.
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