Understanding the different types of attachment

Knowledge of the different stages of infant/parent attachment is important in infant massage in understanding the different needs of the baby at that point in time. We know the important role infant massage can play in enhancing attachment, but what exactly is it?

Attachment is the bond between parent and child which provides a sense of security to children. Attachment is deeply emotional and is an important part of child development in helping them feel safe to explore their environment while being able to return to the adult carer during times they may feel distressed. Attachment develops between the ages of 0 to 5 years and influences early brain development.

Attachment generally occurs over 3 phases:


  1. Undiscriminating Responses (0-3 months)

Newborns seek comfort in a variety of ways which are primarily the result of reflexes such as sucking, grasping, crying and other autonomic responses. Caregivers at this important stage help the baby in responding to these ‘cues’ which are indicative of biological needs (feeding, the need to be close for regulating temperature and so on)

2. Discriminating Behaviour (3-6 months)

There is a preference at this stage by the infant for a particular caregiver, usually the mother. The mother and infant typically become more attuned to one another. Feelings of attachment at this stage increase by the infant as she associates her needs being met by the availability of the caregiver.

3.      Formation of Secure Base (6-24 months)

At this stage the infant has a need for closeness with the preferred caregiver while at the same time a developing sense of autonomy and independence. At this stage babies are learning to crawl and walk, and as they explore their environment, will be looking for their preferred caregiver for feelings of safety and security while they learn about the world around them.


Information from the St. Joseph’s Women’s Health Centre, Canada, ‘Attachment across cultures’ project. http://www.attachmentacrosscultures.org/about/about15.htm

Infant massage found to be one of the most effective preventative interventions in enhancing sensitivity in depressed mothers: meta-analysis

The importance of improving maternal sensitivity in depressed mothers has been documented as an important element in increasing positive outcomes for children of such mothers. This meta-analysis involved a detailed look at 10 studies concerning different interventions for mothers with depression and approaches to improve maternal sensitivity.


Interventions such as mother-infant therapy groups, home-visits and infant massage were some of the approaches which were under investigation in the study.  Infant massage was found to be “the most effective and robust technique to improve maternal sensitivity” (p. 375). These findings are highly significant in that they demonstrate a focus only on purely treating the mother for depression may not be as powerful as approaches which involve both the mother and the child. It is thought that massage therapy is beneficial to mothers in teaching them to be more observant of their babies’ and signals and therefore more responsive. This then has the knock-on effect of increasing the mother’s confidence and enhancing the bond between mother and child.  


Kersten-Alvarez, L., Hosman, M.H., Riksen-Walraven, J.M., van Doesum, K., & Hoefnagels, C. (2011). Which preventative interventions effectively enhance depressed mothers’ sensitivity? A meta-analysis. Infant Mental Health Journal, 32(3), 362–376 (2011), DOI: 10.1002/imhj.20301

Infant massage – a positive way to enhance the bond between teen mothers and their babies: study

Poor infant outcomes have been identified in various studies for those babies who have teen mothers. These outcomes are often as a result of the mothers becoming parents while experiencing the typical stresses of adolescence.

A study in the US, however, has found that teaching infant massage to teen mothers has positive outcomes for both the mothers and babies.  25 adolescent mothers participated in the study, with 9 being the intervention group and 16 the control group.

Participants were trained in baby massage techniques and asked to massage their babies daily over a 2 month period. At the end of this time the mothers completed questionnaires on their perceived levels of depression and maternal stress.

Maternal confidence was reported as higher in the intervention group than the control group. The mothers’ perceptions of their babies’ temperaments was also a significant difference between the two groups – the mothers in the intervention group indicating more positive feelings regarding their babies’ temperaments than the control group. This particular finding is significant in that that being adept in infant massage may make mothers better equipped to recognise and understand their baby’s cues, and as a result are more likely to respond in appropriate ways.

Oswalt, K., Biasini, F., Wilson, L., & Mrug, S. (2009). Outcomes of a massage intervention on teen mothers: A pilot study. Pediatric Nursing, 35(5), 284 – 317

Infant massage and positive effects on both mother and child: study

A study involving mothers who have HIV has found positive outcomes for both themselves and their babies as a result of doing infant massage on their babies.

The participants consisted of 17 mothers, with 8 mothers being part of the group who were taught infant massage with the remaining 9 being assigned to the control group. Infants ranged in age from 5 to 10 weeks of age.

The mothers in the intervention group were taught infant massage strokes and information about various infant behavioural cues, interpreting the different cries of their babies as well as information about the benefits of massage for both mother and baby.

Mothers were asked to massage their babies daily for 10 weeks. Participants were then asked to complete a series of questionnaires about their levels of depression, parental stress and physical contact. Infants were measured and weighed.

Significant differences were found between the intervention and control groups regarding the level of depression in the mothers, feelings of stress and maternal confidence, which all pointed towards the positive effects of infant massage. Furthermore, the babies whose mothers were trained in infant massage were significantly heavier and longer at the end of the 10 weeks than those in the control group.


Oswalt, K. & Biasini, F. (2011). Effects of infant massage on HIV-infected mothers and their infants. Journal for Specialists in Pediatric Nursing, 16 (2011), 169–178.


Massaging newborns may help with weight gain up to 2 months of age: study

A Chilean study has revealed the potential benefits of infant massage for newborns in increasing their weight gain.

The study involved a sample 35 infants whose mothers were encouraged to massage them every day for 10-15 minutes at a time, from the age of 15 days until 4 months.

While no significant differences in weight were found when the babies were 4 months old, there were differences between the massaged infants and the control group at 2 months of age.

Although a small study, the researchers concluded that their findings add to a growing body of literature regarding the positive correlation between infant massage and weight gain in newborns. Serrano, Doren and Wilson suggest that a number of factors such as mother’s heightened awareness of their newborn brought about by greater bonding and attachment as well as better recognition of their baby’s cues may have been factors.

Serrano, M.S.C, Doren, F.M., & Wilson, L. (2010). Teaching Chilean Mothers to Massage Their Full-Term Infants: Effects on Maternal Breast-Feeding and Infant Weight Gain at Age 2 and 4 Months. Journal of Perinatal, Neonatal Nursing, 24 (2), 172 – 179.

Infant massage helps to reduce levels of jaundice in newborns: study

A study from Japan has shown how baby massage can help reduce levels of jaundice in otherwise healthy full term newborn babies.

The research involved 20 babies born with no complications who received a daily massage of 15-20 minutes twice daily. The control group of 22 babies received phototherapy. Researchers monitored stool frequency and jaundice levels via a jaundice metre and blood samples.

The treatment group were found to have much more frequent passing of stools than the control group on the first and second days of treatment. The researchers concluded that the massage may help to stimulate infants in assisting the passing of meconium in stools which has the benefit of aiding the reduction of jaundice.

Massage helps in increasing blood flow and stimulation of the lymphatic system, aiding in the collection and excretion of waste products from the body. The stimulation of the vagus nerve also increases gastric fluids, aiding in digestion and increasing appetite. Babies were then more likely to nurse more frequently.  Massage also helps decrease the stress hormone cortisol. As a result the babies in the treatment group were found to have lower levels of jaundice than the control group.

The results of the study are significant in that jaundice is a common problem which affects more than 50% of full term infants and the majority of preterm infants. Furthermore, treatments for jaundice such as phototherapy can cause side effects such as dehydration, rashes and diarrhoea. Mothers and babies can also experience anxiety caused by forced separation when a baby needs to undergo such treatment.  Clearly, treatment by massage does not bring with it these side effects and has the added benefit of strengthening the bond between mother and baby.


Chen, J., Sadakata, M., Ishida, M., Sekizuka, N., Sayama, M. (2011). Baby massage ameliorates neonatal jaundice in full-tem newborn infants. Tohoku Journal of Experimental Medicine, 223 (2), 97-102.

Infant massage has positive effect on electrical brain activity in preterm babies: study

A positive correlation between massage therapy given to preterm babies and the development of the maturation of their electrical brain activity has been found in an Italian study, the results of which were published in 2011.

The research involved twenty newborns who were considered ‘low risk’ – that is, those who were considered relatively healthy and not suffering from significant complications. The gestational age of the babies was between 30 and 33 weeks.

Massage therapy was started when the babies were around 10 days old and consisted of a total of 15 minutes of massage on the back, head, neck, shoulders, buttocks, legs and arms. Electrical brain activity was measured using an EEG (electroencephalography) system.

The researchers concluded that in low risk preterm babies “massage therapy favours a process of maturation of brain electrical activity similar to that observed in utero in term infants” (p. 50).

Guzzetta, A. et al. (2011). The effects of preterm infant massage in brain electrical activity. The Journal of Developmental Medicine and Child Neurology, 53 (4), 46 – 51.

Infant massage beneficial for new dads too: study

Infant massage beneficial for new dads too: study
A 2011 study from Toronto, Canada has found that participation in infant massage classes by fathers had a significant effect on reducing their stress levels.
Twelve fathers attended classes with their babies over a four week period, attending a minimum of three classes. The fathers were asked to complete questionnaires regarding their levels of stress as new dads before taking part in the classes.
Interviews were carried out with the fathers which showed that an impressive 92% described their experience with baby massage as positive. Fathers reported feeling less isolated and more competent as a valued caregiver, and also felt a greater sense of attachment with their babies as a result of doing the baby massage classes.
Cheng, C.D., Volk, A., Marini, Z.A. (2011). Supporting fathering through infant massage. The Journal of Perinatal Education. 20 (4), 200 – 209.

Infant massage more effective than rocking for relieving colic: study

A study carried out at a university in Iran has found that infant massage is a more effective approach to help relieve the symptoms of colic than rocking a baby.

Colic is characterised by bouts of extreme crying in otherwise healthy infants three months old and under. There is usually no specific underlying cause.

The study involved 100 babies who had been referred for help with colic, between 1 and 2 weeks of age.  The mothers were assigned to one group who used massage or a second group who held and rocked their babies. In the massage group, mothers were asked to massage their child three times per day over a period of 7 days. In the rocking group mothers rocked their child during the periods of crying every day over 7 days. In both groups mothers recorded the duration of their infant’s cries by using a checklist.

In the massage group the average crying time and duration of crying for infants was more at the start of the week than in the rocking group. However by the end of the week the results showed a mean difference in crying time duration reduce to 1.32 hours/day in the massage group compared to 2.14 hours/day in the rocking group. There was also a more significant reduction in the times per day a baby cried in the massage group than in the rocking group.

The researchers therefore concluded that infant massage not only reduces how many times a baby cries and duration of crying in infants with colic but can also enhance the relationship between mother and child.


Gazerani, N., Nahidi, F., Yousefi, P., & Abadi, R. (2012). The effect of infant massage in comparison with rocking on the duration and frequency of crying time in patients with infantile colic. Arak Medical University Journal. 15 (60), 9 -103.

Breastfeeding Promotes Healthier Weight: Study

A study led by Aligarh Muslim University and the University of California-Davis has concluded that breastfeeding promotes healthy weight gain in babies.

It was found that, through breastfeeding, babies gain weight naturally at their own unique rate. Dr Hessa Khalfan Al Ghazal, director of the Executive Committee for the Sharjah Baby Friendly Emirate Campaign (SBFEC), said of the study: “In some cases, babies have gained weight faster through artificial methods, but faster or bigger is not necessarily better.

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