Baby massage may seem superfluous or silly to some people, but it’s popularity is growing in the U.S. and it has actually been practiced for centuries in many cultures around the world. But, does it have any significant health benefits? You might be surprised at how much it does. In fact, touch plays a much more important role in human development than scientists first imagined.

Consider these facts:

• Skin is by far the largest of all of our sense organs.
• It develops early in utero – at less than 8 weeks, when the fetus is less than an inch long, the sense of touch is already highly developed – before there are eyes or ears.
• Between the pulsing of the amniotic fluid and the contracting and expansion of the walls of the womb, the uterine environment is a space of constant massage.
• When a baby is born, his vision is still fuzzy, but touch is a primary way he can interact with the world for the first few months.

Just from these basic biological facts, it becomes clearer that touch must be important for infant development. But, to what extent? Here’s a snapshot of the myriad medical benefits researchers have discovered over the years.

• In 1986. Dr. Tiffany Fieldand her colleagues gave preterm infants a 15-minute massage, three times per day, for ten days resulting in 21-47% greater weight gain than standard care alone. Those infants were also discharged six days earlier on average than control infants, saving approximately $10,000 in hospital costs per infant. Since then, they’ve also found:
  • Infants who experienced massage therapy cried less and had lower cortisol levels, suggesting lower stress.
  • Touch stimulation can positively affect physiological, behavioral, and social development among infants.
  • Young children with eczema who received daily massage from their parents saw symptoms decrease.

• Dr. Kathryn Barnard at the University of Washington found that infants who were held more showed superior cognitive development as long as eight years later.

• Research by Theodore Wacks, a psychologist at Purdue, showed that infants who experienced more skin-to-skin contact had an advantage in mental development in the first six months of life.

 
It turns out infant touch benefits pretty much all systems of the body – nervous, circulatory, digestive, respiratory, endocrine – the impacts are profound.

And, the benefits aren’t just for babies. You can probably guess that parents sleep better when babies sleep better (which they do with infant touch). And, it reduces parental stress levels, too! Field found that mothers who do infant massage report lower levels of depression, they seem to be more sensitive to their baby’s cues and the babies are more responsive to the mother through the whole first three months.

Still question whether touch is as important as eating and sleeping? Consider one more landmark study.

In the 1960s, Dr. Harry Harlow separated infant monkeys from their mothers at six to twelve hours after birth and substituted “surrogate” mothers made either of heavy wire mesh or of wood covered with cloth. Both mothers were the same size, but the wire mother had no soft surfaces and was equipped with a bottle from which the baby could “nurse”while the other mother was cuddly, covered with foam rubber and soft terry cloth, but had no food. Despite the fact that only one surrogate mother could feed them, the infants still spent more time cuddling with the cloth mother. (They also found that the monkeys“raised” by wire mesh moms were very aggressive as adults.) These results led researchers to believe closeness and affection are as imperative to healthy development as food.

In today’s busy world, it’s all-too-common for parents to give a child a pacifier or put them in front of a video screen to keep them calm and quiet. But, those convenient moments of calm may be having subtle impacts on your child’s development. Take time to slow down. Take time to touch. Take time to cuddle. They aren’t babies for long and your investment of time and touch is a priceless investment in their health and well-being.

It can be a challenging time in many ways to have your baby placed in the NICU. It wasn’t the new beginning you hoped for. Here are a few things you can do to that can make a difference:

1) Breast milk is a powerful gift for babies in general, and all the more so for babies who start life in the NICU. If possible, it’s well worth the effort (for your baby’s health and for your own).

2) Many babies in the NICU can’t feed by mouth yet. Others can take oral feeds, but aren’t strong enough to nurse. Others could nurse but need extra fortification mixed with their feeds. In all of these situations, start pumping and saving breast milk as soon as practical.

3) Ask to see a lactation consultant, even if you’re not ready to start pumping or nursing. This could easily fall through the cracks in a NICU, so don’t wait, ask. They’ll be glad you did. (So will you and your baby!)

4) Be sure the containers you use to store and feed breast milk are free of BPA and phthalates — like all of the products made by BornFree. This goes for the pump and tubing too. BPA and phthalates act like hormones. No one benefits from being exposed, but this is especially true for vulnerable babies.

5) Hold your baby when you can, as appropriate. Skin-to-skin contact is even better. Sometimes the only contact may be a brush of your finger, but even that can be powerful.

6) Get the rest, food, support, help you need for yourself. You deserve it. And it will help your baby too. Airplane instructions remind us, in the event of an emergency, to put on our own masks first, and then help our children. This wisdom applies to the NICU. First taking care of yourself helps your baby (and your milk supply) in many ways.

These NICU days may seem very long right now, but they will end and soon become a memory. Hopefully these tips will help you make the most of these unrepeatable moments.

Note: Dr. Greene teamed up with BornFree in September of 2008 to help teach families about important issues concerning BPA, phthalates, and PVC.

Get ready for some surprising recommendations. Eczema, asthma, and food allergies are all on the rise in children, each having more than doubled in the last several decades. This rapid increase has lead to many differing recommendations on the timing and selection of foods offered to babies, to err on the side of caution before scientific studies were completed.

A January 2008 evidence-based policy from the American Academy of Pediatrics turns some of this conventional wisdom on its head.

For preventing allergies, when is it best to start solids for babies?

Previously, it was recommended to delay solids until 6 months if possible, and to limit the choices to things like rice cereal, oatmeal, or barley if they must be started sooner. The new policy reports that solids should not be started before 4 to 6 months, but that there is no convincing evidence that delaying any solids beyond this period helps to prevent allergies.

In fact, with some foods, starting on the earlier side may even help. What about highly allergic foods such as eggs, peanuts, milk, or fish? The previous guidelines were that in allergic families, whole cow milk should be delayed until 12 months of age; eggs until 2 years; and nuts, peanuts, and fish until age 3. The new guidelines say that there is no convincing evidence that delaying even eggs (yolks or whites), fish, milk, nuts, and peanuts beyond 6 months prevents allergies!

A few things to keep in mind: First, this discussion is only about preventing asthma, eczema, and food allergies. There are other reasons to delay certain foods (e.g. honey to prevent botulism, whole peanuts to prevent choking). Second, if a child does show signs of an allergic reaction, removing the possible culprits from the diet is wise — these guidelines are about preventing, not treating allergies. Third, these new guidelines are not the final word, they are just the current state of the science. Other benefits of particular timing may one day be uncovered. Finally, I am a fan of introducing a wide variety of healthy foods to babies between 6 and 12 months old,  but I prefer organic foods for babies in the first year when possible. Particularly, if I were going to give some of the more allergenic foods like eggs, or cheese, milk, or nuts, I would be even more inclined to choose organic.

AAP Clinical Report: Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and the Section on Allergy and Immunology. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics2008; 121: 183-191.

Zutavern A, Brockow I, Schaaf B, von Berg A, Diez U, Borte M, Kraemer U, Herbarth O, Behrendt H, Wichmann H, Heinrich J (The LISA Study Group). Timing of Solid Food Introduction in Relation to Eczema, Asthma, Allergic Rhinitis, and Food and Inhalant Sensitization at the Age of 6 Years: Results From the Prospective Birth Cohort Study LISA. Pediatrics 2008; 121: e44-e52

Dr. Greene’s Answer:

Most of us have some sort of a picture collection from our childhood — maybe a baby book, or a family scrapbook, or even a box of pictures and memorabilia from our first few years of life. In that collection there are several common pictures. There’s the wonderful shot of those tenuous first steps; the picture of a grinning baby covered ear to ear in not only a smile, but green peas, yellow squash, and smashed banana; and the snapshot of a baby sitting in a bathtub, hair slathered with shampoo and piled on her head complete with Cupie Doll curl. Bath time is an important part of childhood.

Emily probably got her first mini-bath a short time after delivery. Jeanne, I hope you and your husband were able to spend some time with her right after she was born. Then, what seems all too soon for most parents, she was taken into the nursery for a few tests, her first immunization, and her first bath. In the nursery, a skilled nurse carefully laid her on a table (not unlike a kitchen or bathroom sink counter top that is very, very clean) and cradled her head in one hand. With the other hand, he or she gently washed Emily with a warm (not hot) washcloth. As soon as the bath was over, the nurse put a clean diaper on your baby and wrapped her in a warm blanket. Until the umbilical stump has fallen off, and the belly button is dry, you can follow this pattern. (One day you may have a son, so I will give you pointers for boys as we go along.) For circumcised boys, you can follow this pattern until his penis has healed from the surgery. Here are some practical bathing tips:

• Plan a special time for your baby’s first bath at home. It doesn’t matter what time of day it is (babies adapt well to different times of the day for baths, though many enjoy a bath right before bed), but you will want to select a time, Jeanne, when both you and your husband are home.
• Get out the camera. It’s not time for that Cupie Doll shot just yet, but you will want a picture to record this event.
• Select a convenient place. I mentioned using a kitchen or bathroom counter. You may also want to try a changing table or bed. Cover the area with a thick towel or waterproof pad if needed.
• Get everything you will need ready before you start! The list includes warm water (of course), washcloth, alcohol pads, bath towel (with hood if you have one), clean diaper, any items you routinely use during a diaper change (for little circumcised boys this would include Vaseline and gauze squares), and fresh clothes. I do not recommend using soap or shampoo on babies this age. Newborns do not get sweaty or dirty except in the diaper area or if they spit up. Even these messes can be easily cleaned with water, which is so much better for most babies’ sensitive skin than soap.
• Babies lose body heat very quickly, so make sure the room is warm — 75 to 80 degrees Fahrenheit is ideal.
• Gently cradle your baby’s head in one hand and use the other hand to remove her clothing. Gently wash her with a soft, warm washcloth, and dry her off with a towel. Take time to admire her individual parts — all too often we bundle up our babies and never adore those precious feet or that soft bottom. If you like, you can wash one area at a time and put a fresh item of clothing on as soon as an area is washed and dried. This is not necessary unless you are in a chilly room.
• It is a good idea to start with the “less dirty” areas first, i.e. leave the diaper area until last. As you go, be sure to gently wash behind her ears; the crevices in her neck, elbows, and knees; and in between her fingers and toes. I had a friend who would make her one-year-old giggle while bathing her by saying, “Got to wash between those digits!”
• It’s a good idea to wash a newborn’s hair near the end of bath time. This will help prevent him or her from losing too much body heat. Most newborns don’t have much hair, so it is easy to sponge it with water much the same way you do the rest of the body. Almost all babies dislike getting their eyes wet. If you tip the head back just a bit and work your way from the front to the back, you can avoid getting water in your baby’s eyes.
• When it’s time to wash the diaper area, remove her diaper and sponge off the skin on her belly and bottom. Usually babies’ genitals need only gentle cleansing. For little girls, wash from the front to the back. Don’t be concerned if you see a white discharge or vaginal bleeding. These are both normal for newborn girls, and the discharge does not need to be wiped completely away. Leave whatever does not come off with one gentle pass. If you do have a son, do not retract or pull back the foreskin on an uncircumcised penis! Do not wash the head of a circumcised penis before it is healed.
• Dress your fresh, clean, and oh-so-cuddly baby.

Some babies love bath time, though that is unusual at this age. Most babies are a bit frightened by the experience of having their clothes taken off and being exposed to the air. If Emily falls into this category, you can comfort her by talking or singing to her during the bath. Your soothing voice will remind her that she is safe.

If Emily loves her bath, feel free to make it part of your daily routine. If she doesn’t love it, it isn’t necessary to bathe her daily. As long as you are changing her diaper regularly and cleaning her diaper area after poops (I don’t recommend using prepared wipes that contain alcohol, soap, or perfumes), and spot cleaning after spit-ups, she shouldn’t need to be bathed more often than every three or four days. Longer is okay for some babies — if she starts to smell you will know it’s time for a bath! If your baby’s skin is drying out too much you will want to cut back on the frequency of baths and apply an alcohol-free, unscented baby lotion daily — and especially after each bath. After Emily’s umbilical stump falls off and her belly button is dry, you will be ready to give her a tub bath. By that time you will feel like a pro, and you will be able to adapt the ideas I’ve already outlined to the tub. There are, however, a few additional things that I should point out:

• Never, never leave your baby alone in a bath! Not even long enough to answer the phone or turn off the stove. If you remember that you left the stove on in the middle of bath time, take Emily out of the bath, wrap her in a towel, and take her with you into the kitchen to turn off the stove. On your way back to the bath, grab a dry towel to use when her bath is complete.
• You only need to use a couple of inches of water in the tub, and make sure the water is warm — not hot. Babies’ skin is very sensitive to heat. If you are unsure about a safe temperature, you can buy an inexpensive bath thermometer at a local baby store or drug store. These simple devices change color to indicate safe and unsafe heat levels. (Note: If you haven’t already done so, you need to turn down your hot water heater to no higher than 120 degrees Fahrenheit.)
• Use a tub that is the right size for your baby. Most baby tubs you purchase come with an insert for young babies. This makes it much easier for you to keep your child’s head out of the water.
• Gentle soaps really are better for baby’s skin during the first year or so. (Note: Ivory is not a gentle soap. Try an alcohol-free and perfume-free soap such as unscented baby soap or Dove, Basis, or Neutrogena.) Use soap sparingly and avoid scrubbing.
• Don’t use adult shampoo on your baby. The no-tears advertisements for baby shampoos are for real.
• Make bath time fun. Use age-appropriate toys to engage Emily in the whole experience. At first this might be something as simple as giving her a clean washcloth to suck on during the bath. Later, plastic cups and bowls make excellent pouring toys.

Right now your little Emily is so tiny and fragile. When you look at her, it’s hard to picture that Cupie Doll shampoo-do. When I was a child, I remember hearing adults talk about how “having kids makes time fly.” Well, I’m an adult now, and I have pictures of my kids with Cupie Doll shampoo-dos. Time does fly; it won’t be long before you have a picture of your Emily, in the bath, in that same time-honored pose.

Dr. Greene`s Answer:

Today in the office, a great mom asked me about her son’s newly acquired habit of licking garden snails. Little boys often have a very different sense of hygiene than their mothers. They delight to splash in muddy water, and think nothing of the trail of mucus running down the nose that prompts many mothers to action. Most little boys will not spontaneously wash their hands or clean their penises.

If this conflict weren’t enough, sources of childcare information have very different recommendations for care of uncircumcised penises. Some advocate aggressive wiping using cotton swabs and alcohol to clean under the foreskin. At the other extreme, some authorities suggest doing nothing at all until puberty, saying that the collection of cheesy material under the foreskin is natural and desirable. One popular childcare book even differs from itself, saying in a caption, “The uncircumcised penis requires meticulous hygiene; the circumcised penis … requires no special care,” while the accompanying text says, “Contrary to what was once believed, no special care is needed for the uncircumcised penis.”

I recommend a more moderate approach.

Structurally, the penis consists of two main parts, the shaft and the head (which is called the glans). Urine and semen exit the body through a tiny opening at the tip of the glans. At birth, the shaft and the glans are covered by a single continuous layer of skin. If circumcision is performed, the part of this skin that covers the glans is cut off. Immediately after circumcision the glans appears swollen, tender, and vivid red, since the foreskin was firmly attached to the glans before it was forcibly separated and then cut off.

In uncircumcised boys, the foreskin at first remains firmly attached to the glans, but gradually over time the attachments are broken (mostly by the stretching resulting from repeated normal erections). In 90% of boys the foreskin is loose and mobile by age 2, but the process can sometimes take five or more years. When the foreskin has separated from the glans, the foreskin can easily be retracted, or pulled back, to leave the glans exposed. Throughout life, a cheesy white material called smegma, consisting primarily of dead skin cells and secretions from sebaceous glands, will accumulate under the foreskin.

In uncircumcised boys, forcibly ripping the foreskin from the glans in the name of hygiene can lead to pain, scarring and adhesions. Do not try to forcibly retract the foreskin or to clean under an adherent foreskin with swabs, antiseptics, or even water. On the other hand, even though doing nothing at all may be considered natural, similar reasoning would lead to not cutting the hair, trimming the nails, washing the hands, or cleaning the bottom after a poop. Gentle hygiene enhances health.

Only the outside of the foreskin needs to be cleaned during the first year. It should be cleaned and bathed with soap and water just like the rest of the diaper area. After his first birthday, you might want to very gently pull back on the skin of the shaft to see if the foreskin retracts. If it doesn’t at all, don’t worry — and don’t force it! There is certainly no rush. If urine can flow freely, the hole in the foreskin is big enough. As long as the foreskin doesn’t easily retract (even in a ten year old), only the outside needs to be washed. If the foreskin retracts a little, it would be okay to gently clean the exposed part of the glans with water (but don’t use soap while the foreskin is still partially attached to the glans, since this can irritate this tender area). After cleaning, always pull the foreskin forward to its usual position. This is very important — otherwise it can get stuck and lead to serious damage.

Once the foreskin has completely separated and retracts freely, begin to teach your son to retract his own foreskin and clean underneath it when he bathes, or at least once a week. For most little boys this personal cleaning will not become a habit unless you encourage it. Mentioning it positively and frequently throughout the years can instill an important sense of responsibility, prevention, and health that will benefit him for years to come.

Your bathtimes together are precious now, but the habits you help your son develop might also reduce sexually transmitted diseases and cancer of the penis (and cervix in his partner) when your little boy becomes a man.