The Use of Comforting Touch and Massage to Reduce Stress in Preterm Infants in the Neonatal Intensive Care Unit
Summary of research on the need for comforting touch for preemies in the NICU.
By Lynda Law Harrison, RN, PhD, FAAN
The findings from the studies suggest that preterm infants receive very little comforting, nonprocedural touch in the NICU. Gentle, still touch has immediate positive effects including reduced levels of motor activity and behavioral distress, which suggests that this type of touch might reduce energy expenditure and promote comfort. Gentle touch has no clinically significant effects on levels of heart rate or oxygen saturation, which suggests that this type of touch is safe for physiologically fragile infants. Findings from studies of supplemental stroking/massage, either alone or combined with kinesthetic or vestibular stimulation, suggest that this type of touch may have positive immediate and longer term effects on infants who are physiologically stable, including reduced apnea, improved TcPO2 levels, improved weight gain, and enhanced developmental outcomes. However, some infants may react to such stimulation with decreased TcPO2 levels, increased heart rate, or signs of behavioral distress. Kangaroo care may have positive effects such as maintenance of stable temperatures, oxygen saturation , and heart rate levels, promotion of quiet sleep, and promotion of increased co-regulation between infants and parents. However, transferring intubated infants from the incubator to the parent may be stressful, and infants less than 1.2 kg may not tolerate kangaroo care for prolonged periods.
Peters 65 recommended the use of “care milestones” to determine when individual infants are able to tolerate different types of stimulation. Nurses and parents can assess infants’ physiological and behavioral responses to determine the most appropriate types and amounts of touch to provide to promote comfort and reduce stress. Physiological cues that might indicate distress and a need to modify stimulation include decreased oxygen saturation or heart rate levels and increased heart rate or blood pressure levels. Behavioral cues that might indicate distress include increased agitation, facial grimace, finger splay, grunting, gaze aversion, and extension of arms and legs.
Behaviors that suggest a positive response to stimulation include maintenance of a quiet alert state, relaxed body tone, eye to eye contact, and flexed posture. However, it must be recognized that infants’ behavioral responses may be influenced by many factors, including GA, morbidity status, behavioral state, and prior exposure to handling or painful procedures.66
The findings from research to date suggest that when infants are physiologically fragile, they may respond best to still, gentle touch. As these infants mature and become more stable, caregivers can begin to provide gentle stroking and massage, as well as kangaroo care, observing the infants’ responses and modifying their tactile stimulation accordingly.