Healthcare providers can integrate touch therapies into existing programs easily.

Hospitals, clinics and other health care providers can implement infant massage and other "touch interventions" relatively easily. Some suggestions include:

• Obstetricians and neonatologists can recommend that nurses and other staff members-and parents-learn infant massage.

• Just as breast-feeding and baby care are taught in childbirth and parent-education classes, so can infant massage classes be offered as a routine service of hospitals, midwifery clinics and other facilities.

• Labor-and-delivery nurses can incorporate massage strokes into newborn assessments or early neonatal care, as a way of introducing the baby to the parents and encouraging the quiet alert state in the neonate.

• Hospitals can offer infant massage classes to volunteers, such as older "grandparent surrogates," and have those volunteers give massage on neonatal units.

Infant massage instruction can be easily incorporated into prenatal or parent education classes.

INFANT MASSAGE TECHNIQUE: OVERVIEW FOR CLINICIANS

The type of massage that is taught in many infant care settings today, and which is advocated by the International Association of Infant Massage, is generally an amalgam of Swedish and Indian massage techniques. However, massage technique per se is not of critical importance. Infant massage guidelines are designed mainly to aid parents and to impart techniques that may be enjoyable or beneficial to the baby. Health care providers should communicate to parents that massage is not a rigid "protocol" that they must learn and "perform" unchanged. Rather, parents need to understand that regular, mutually enjoyable contact with their baby is most important and the primary goal of infant massage.

In recommending or teaching infant massage to parents, caregivers may wish to convey the following key points:

• Follow baby's cues. Parents should be attuned to the "cues" their baby gives during massage. Is the baby resistant to the massage? Maybe the parent should try later, or another day. Does the baby dislike certain body parts being touched? Does he especially enjoy others?
  Infants, like adults, have their individual preferences, and parents should not be discouraged or disappointed if their baby reacts negatively to some types if massage strokes. By "tuning in" and responding to their baby's cues, parents can make massage as enjoyable and effective as possible, for both themselves and the baby.

• Use different massage for different age groups. For healthy term infants, massage can be started immediately after birth, and can continue through the first year or two or beyond, depending on whether the child wishes to continue. (Many children, once they begin walking, prefer other means of tactile and social stimulation.)

Massage during the first two months, when the baby's sensory-motor system is still developing, should be only a simple massage: general stroking of the face, limbs and back. After two months, babies are better equipped to respond to (and may prefer) more complex massage strokes. Massage of preterm infants in neonatal intensive care calls for other techniques and considerations.