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Interventions to Support Early Relationships - Infant Massage

Angela Underdown PhD, MSc, BEd, HV, RGN
Associate professor of public health in the
early years, Warwick Medical School,
University of Warwick

Jane Barlow DPhil, FFPH
Professor of public health in the early years,
Warwick Medical School, University of Warwick


Interventions to support early relationships: mechanisms identified within infant massage programmes


This paper appeared in the Community Practitioner April 2011 Volume 84 Number 4.

The Community Practitioners' and Health Visitors' Association (CPHVA) is the UK professional body that represents health visitors, school nurses, practice nurses, district nurses and other registered nurses who work in a primary or community health setting. With 18,500 members, it is the third largest professional nursing union and is the only union which has public health at its heart. Community Practitioner is the monthly, professional journal of the CPHVA and is sent free to members. It features all the latest news and features of interest to community nurses, along with articles on the professional, clinical and labour relations issues relevant to members.


The sensitivity of early interactions, conveyed through eye contact, voice tone, facial expression and gentle touch is an essential element in the development of neural connections, affect and behavioural regulation, and secure attachments (eg Schore, 1994; Fonagy et al, 2004; Glaser, 2000). The UK Healthy Child programme recommends offering observational assessment, and coaching where needed, to stimulate sensitive reciprocal parent-infant interaction, and points to the potential value of evidence-based ‘dyadic therapies’ such as infant massage to increase sensitivity (DH, 2009: 42). Infant massage programmes are now provided routinely during the postnatal period in a variety of settings including Sure Start and children’s centres. However, a survey of parenting support provided as part of Sure Start provision found that although infant massage was one of the most commonly provided perinatal interventions, there was little data regarding uptake, quality or output of these programmes (Barlow et al, 2007). In order to bring about change, interventions and treatment programmes must be underpinned by appropriate ‘mechanisms of change’. Mechanisms of change refer to the factors that have been identified theoretically as playing a part in the aetiology of particular problems, and so need to be addressed to facilitate change. For example, sensitive and reciprocal interactions are underpinned by an awareness of the infant’s cues. This suggests that in order to improve parentinfant interaction, it is necessary to help parents to recognise and respond to such cues. Similarly, maternal mood and in particular postnatal depression has been identified as being a key factor influencing poor mother-infant interaction, with postnatally depressed mothers being less sensitive and more intrusive (Murray, 1996). This points to the potential benefits of using infant massage to provide opportunities for parents to socialise with one another. This paper reports the findings of a study that aimed to use both data and theory to identify the potential mechanisms of change that should underpin the delivery of infant massage programmes to socio-economically deprived families, alongside the extent to which such mechanisms were being offered across a small number of programmes.

Aim of the study

The overall aim of this study was to examine what factors influence the uptake, delivery and outcomes of infant massage programmes delivered to mother-infant dyads living in socio-economically deprived areas. This paper reports on mechanisms identified as being necessary to the successful uptake and delivery of such programmes, and the extent to which such mechanisms were provided.