Using Touch to Change Lives in the NICU and Beyond Jennifer Meyer, MA CCC-­‐SLP www.Feeding-­‐And-­‐Dysphagia-­‐Resources.com [email protected] Disclosure Statement: Relevant financial relationship(s) and relevant nonfinancial relationship(s) I have the following relevant relationships in the products or services described, reviewed, evaluated or compared in this presentation. • CEU Espresso, Inc. • Ownership interest, employee, speaker fee • Svetlana Masgutova Educational Institute, LLC • Family member helped greatly by the approach Key Principles and Concepts (The answers to these questions can be found at the above website or you may request the Handout via the above email.) 1.
Prematurity causes a host of disabilities including:
• Increased Mortality – single biggest cause of newborn death (WHO, 2012)
• Lifetime of Disability (WHO, 2012)
• Cerebral Palsy (Volpe, 2009)
• Visual Impairment (Gilbert, 2008)
• Hearing Loss (Graven 2000)
• Neurodevelopmental problems (Osrin, 2010; Shapiro-Mendoza and Lackritz, 2012).
• Learning Disorders (Morris et al, 2000; Gray & Philbin, 2004)
• Increased sensitivity to pain and anxiety with novelty (Grunau, 1998)
2.
The Tactile system is the first sensory system to begin development in utero.
3.
What role does Touch play in development?
It is the foundation for all the other senses.
4.
Different Types of Tactile Input include:
• Touch (Deep and Light), Temperature, Pressure, and Pain
5.
Purposes of Tactile Input:
• Immediate: calming and stabilizing
• Long-term: development
• Parental bonding
6.
Positive Touch, used wisely has great benefits for the premature infant including:
• Better:
• Autonomic stability
• Digestion and weight gain
• Sleep
• Muscle tone
• Development
• Social participation
• Breathing
•
7.
•
Lower:
•
•
•
Facilitating Reflexes
Cortisol levels
Aversion
LOS (Length of Stay)
However Touch must be applied appropriately.
• Stability cues include: Smooth, regular respirations, Hands active, near face,
Physiological flexion, Calm, focused, clear alertness, Good color , Eyes open –
contact, Good coordination of suck/swallow/breathe
•
Stress cues include: Yawning, Changes in color, Hiccoughs, Spitting up, Changes in
heart rate, Changes in oxygenation, Bowel movement, Sweating, Sneezing, Tone
Changes, Trembling, High-pitched “Crowing” sounds, “Stop sign”, Straightening/
stiffening arms or legs, Arching back or neck, Becoming limp, Head bob/chin tug,
Startle, Strain
8.
What is a Facilitated Tuck?
Keeping the infant in a flexed positioned by providing boundaries during a potentially
upsetting experience to facilitate calming.
9.
What are some benefits of Kangaroo Care?
• Improves Autonomic Stability (Gardner & Goldson, 2002; Ludington-Hoe et al, 2004)
• Improves breastfeeding (Cochrane Review: Moore et al, 2012)
• Reduces :Length of Stay (LOS), infection, morbidity, pain
• Improves: weight gain, state, sleep, breastmilk production in mom (Conde-Agudelo et
al, 2003; Feldman & Eidelman, 2003; Hendricks-Munoz, 2002; Ludington-Hoe,2005
10. What are some things you need to be sure you do when performing Infant Massage?
• Make sure the room is warm and quiet
• Take off all jewelry from the elbows down
• Wash your hands thoroughly under very warm water
• Rub your hands together until warm, if necessary
• Use baby lotion or oil (almond, apricot, grape seed or sesame seed)
• Be sure the infant has a pacifier or can reach hands to suck on and warm blanket.
11. Principles of Reflex Development and Integration:
• What is a reflex?
“A reflex is a body-brain system automatic response to sensory or proprioceptive
stimuli” (Masgutova)
•
What purpose(s) do reflexes serve?
Protection, survival, development, learning
12. Why does Intention matter?
Our thoughts and emotions can influence the effects of what we do.
Three things I learned that will change how I practice next week:
Using Touch to Change Lives in the NICU and Beyond
Last Updated: 5/6/14
Disclosure Statement
Using Touch to
Change Lives
in the NICU
and Beyond
Jennifer Meyer, MA CCC-SLP
Feeding and Dysphagia Resources
Our Path Today
Neurological Development in Prematurity
Relevant financial relationship(s) and relevant
nonfinancial relationship(s)
I have the following relevant relationships in the
products or services described, reviewed,
evaluated or compared in this presentation.
•  CEU Espresso, Inc.
•  Ownership interest, employee, speaker fee
•  Svetlana Masgutova Educational Institute, LLC
•  Family member helped greatly by the approach
Long-term Effects of
Prematurity
•  Increased Mortality –
single biggest cause
of newborn death
•  Hearing Loss (Graven
•  Lifetime of Disability
Shapiro-Mendoza and
Lackritz, 2012).
(WHO, 2012)
Touch as a Therapeutic Modality
(WHO, 2012)
•  Cerebral Palsy
2009)
How to Use It
(Volpe,
•  Visual Impairment
(Gilbert, 2008)
2000)
•  Neurodevelopmental
problems (Osrin, 2010;
•  Learning Disorders
(Morris et al, 2000; Gray &
Philbin, 2004)
•  Increased sensitivity
to pain and anxiety
with novelty (Grunau,
1998)
Neurological
Development
Neurological
Development
•  14 weeks: cortex is smooth
(no sulci/gyri)
24 weeks gestation
40 weeks gestation
•  26 weeks: central and
lateral sulci evident; axonal
myelination beginning (Ian,
et. al. 2000)
•  28 weeks and forward:
period of tremendous
synaptogenesis;
significant susceptibility
to environmental
influence (Pomeroy & Volpe,
http://www.beginbeforebirth.org/in-the-womb/fetal-programming
1992)
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
1
Using Touch to Change Lives in the NICU and Beyond
Sequential Theory of
Sensory Development
Last Updated: 5/6/14
Order of Sensory
Development
•  Sensory systems develop at different times and rates
(Turkewitz & Kenny, 1985)
•  Stimulation of one sense effects the others and can be
positive or negative depending on the amount, type, and
timing of the stimulation. (Lickliter, 2000; Graven, 2004)
• If a sense is stimulated
prematurely, this can negatively
impact development.
Tactile
Vestibular
Olfactory
Gustatory
Auditory
Visual
(Graven, 2004)
Tactile is the
foundation for
all the other
senses
Tactile
•  130 disturbances per day (Lynam, 2006)
•  Touch, Temperature,
Pressure, and Pain
•  Average 14 painful procedures per day (Simons,
•  Starts to develop at 8
weeks and is
functional by 12
weeks gestation
•  Most sensitive areas: nose, mouth, hands,
feet (Gardner and Goldson, 2002)
2003)
•  Can cause altered pain perception, and
pathway development (Grunau, et al, 2006; Weiss and Wilson,
•  Particularly sensitive
around nose, mouth,
palms, and feet
2006)
Further Neurological
Development
•  Vestibular - Functional by 3
mos gestation
•  Taste and smell happen as
early as 14 weeks.
•  Infants consistently respond
to sound by 25 weeks
gestation
•  Visual development may
begin as early as 22 weeks
and continues into the first
year post-partum.
(Gardner and Goldson, 2002; Lagercrantz et al, 2002; Lasky
an Williams, 2005, Lutes, Graves & Jorgensen, 2004)
How can I use
Touch to my
advantage?
(and the baby’s?)
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
2
Using Touch to Change Lives in the NICU and Beyond
Purposes of Therapeutic
Tactile Input
Last Updated: 5/6/14
Benefits of Positive
Touch
•  Immediate calming and stabilizing
Better
Decreased
•  Long-term development
•  Autonomic stability
•  Parental bonding, empowerment
•  Sleep
•  Aversion
•  Muscle tone
•  LOS (Length of Stay)
•  Digestion and weight gain
•  Cortisol levels
•  Development
•  Social participation
•  Breathing
•  Facilitating Reflexes*
*More on Reflexes coming up
Facilitative Tuck
Swaddle
n Keeping the infant in a flexed positioned by
providing boundaries during a potentially
upsetting experience to facilitate calming.
Promote Self-Regulation
Sucking
Hands to face
Do we have evidence for
using Touch or is it just that
we think it’s a good idea?
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
3
Using Touch to Change Lives in the NICU and Beyond
A 1-minute
Introduction to
Quantum
Physics
“All living
organism
s emit an
energy
filed” –
Last Updated: 5/6/14
“All matter is
energy” – Einstein
“The
energy
field
starts it
all.” – Prof.
Semyon D. Kirlian,
USSR
Harold Burr, Ph.D.
Yale
Caroline Leaf
•  “Every thought has a
corresponding
electrochemical
reaction in your
brain…These
chemicals produce
electromagnetic
waves…” (Dr.
Caroline Leaf, SLP,
Clinical
Neuroscientist)
•  “Body Chemistry is governed by quantum
cellular fields.” Prof. Murray Gell-Mann,
Stanford; Nobel Prize Laureate (1969)
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
4
Using Touch to Change Lives in the NICU and Beyond
“Treating humans
without the concept of
energy is treating dead
matter.” – Albert SzentGyorgyi, M.D. Nobel
Prize Laureate (1937),
Hungary
Last Updated: 5/6/14
Our thoughts and emotions can
influence the effects of what we do.
The Development of Potentially
Better Practices to Support the
Neurodevelopment of Infants in the
NICU
WF Liu, S Laudert, B Perkins, E MacMillan-York, S Martin and S Graven,
for the NIC/Q 2005 Physical Environment Exploratory Group
A Literature Review to examine the existing evidence used to identify
potentially better care practices that support newborn brain
development
Published in Journal of Perinatology (2007) 27, S48-S74.
Implementing
Potentially Better
Practices To Support
The
Neurodevelopment Of
Infants In The NICU
S Laudert, WF Liu, S Blackington, B Perkins, S Martin, E MacMillanYork, S Graven and J Handyside on behalf of
the NIC/Q 2005 Physical Environment Exploratory Group
Journal of Perinatology (2007) 27, S75–S93
Kangaroo Care
Implementation
at 31-32 Weeks
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
5
Using Touch to Change Lives in the NICU and Beyond
Last Updated: 5/6/14
Kangaroo Care
Kangaroo Care
Reduces :Length of Stay
(LOS), infection,
morbidity, pain
•  Improves Autonomic
Stability (Gardner & Goldson,
2002; Ludington-Hoe et al, 2004)
Improves: weight gain,
state, sleep, breastmilk
production in mom
•  Improves
breastfeeding (Cochrane
Review: Moore et al, 2012)
(Conde-Agudelo et al, 2003; Feldman &
Eidelman, 2003; Hendricks-Munoz, 2002;
Ludington-Hoe,2005)
http://kayleighannefreeman.blogspot.com/2008/07/7808-kangaroocare.html
Long-term Benefits of
Kangaroo Care
Long-term
Benefits of
Kangaroo Care
At 3yrs of age:
•  In free play, mothers &
children were smiling
& laughing more.
•  Fewer infections at 6 &
12months
•  Less fussy/crying and more alert
states
• 
•  Mothers more
encouraging &
instructing towards
children
Smiles more often at 3 months
•  Ahead in social, linguistic, fine/
gross motor indices at 1 year
(de Chateau & Weiberg, 1977a,b, 1984)
Infant Massage
Infant massage
•  Improves ANS
stability (Guzetta, 2011;
Smith et al, 2012)
•  Improves oral feeding
performance (Fucile, et al,
2011)
•  Better weight gain (Field
et al, 2011)
Photo: http://news.nationalgeographic.com/news/2002/11/photogalleries/1114_skin4.html
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
6
Using Touch to Change Lives in the NICU and Beyond
Infant Massage: Getting
Ready
(in your handout)
•  Make sure the room is
warm and quiet
•  Take off all jewelry from
the elbows down
•  Wash your hands
thoroughly under very
warm water
•  Rub your hands
together until warm, if
necessary
•  Use baby lotion or oil
(almond, apricot, grape
seed or sesame seed)
•  Be sure the infant has a
pacifier or can reach
hands to suck on and
warm blanket.
•  Watch infant’s
responses/cues and
respond appropriately.
•  A firm, gentle pressure
is usually best. (Push on
your eye)
•  Work Head to Toe.
Infant Massage - Arms
Arms
Last Updated: 5/6/14
Infant Massage – Head
& Face
•  Head – stroke gently
in circular motion
being very careful of
the fontanel(s) or
soft spots.
•  Face – stroke down
the sides of the face
from the crown
Infant Massage –
Tummy
•  Do BEFORE feeding so the stomach is EMPTY.
•  Place your hand on her shoulder and let the
weight of your hand rest there as her muscles
relax.
•  Support her arm/hand with your other hand.
•  2-3 fingers in clockwise “circles” or
“horseshoes” from lower right side up and
across upper abdomen and down the baby’s left
side. (Following the Colon)
•  As tension releases, come down her arm to her
hand, giving a slight pressure at palm
(Proprioceptive input).
Infant Massage - Legs
•  Place you hand on her hip/upper thigh, letting
the weight of your hand rest there until her
muscles relax. Support her leg/foot with your
other hand.
Infant Massage - Feet
•  She may pull her leg into flexion due to a ‘recoil’
reaction. If she is showing no other signs of
stress, this is fine and can actually be a good
neurological sign.
•  Gently massage the heel in a circular motion.
•  As the tension releases, stroke down her leg to
his foot, being careful of her heel (due to heel
sticks), but giving a little squeeze to her foot as
you end the stroke.
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
7
Using Touch to Change Lives in the NICU and Beyond
Infant Massage - Back
Last Updated: 5/6/14
Infant Massage Sidelying
•  Place one hand on her bottom allowing
weight of your hand to rest.
•  Place your other hand at the nape of her neck
stroking down her back to her bottom
replacing your other hand on her bottom.
•  Keep repeating. Go slow (approx. 30 sec per
stroke) depending on her reactions.
•  This may help with tolerating Tummy Time
later.
Photo: http://news.nationalgeographic.com/news/2002/11/photogalleries/1114_skin4.html
Reflexes
“A reflex is a body-brain system
automatic response to sensory or
proprioceptive stimuli.”
(Masgutova & Masgutov, Facial p.11)
“Reflexes are the
fundamental neurological
building blocks for our
developmental processes
and learning, and critically
influence our brain function
and mental/intellectual
processes as mature”
Masgutova & Masgutov, Facial p.12
Protection. Survival, Development, Learning
Steps in Reflex
circuit
1. 
Sensory
stimulation
(input)
2. 
Processing
3. 
Motor Response
(output)
Types of Tactile Input
reshmakumar.blogspot.com
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
8
Using Touch to Change Lives in the NICU and Beyond
Last Updated: 5/6/14
Types of Tactile Input
•  Golgi Receptor – where muscles insert into
tendons; sensitive to ‘force’, pain, temp; and
cause muscles to lengthen, Decreases Tone
Reflexes
•  Need the right stimulation to emerge
•  Stimulation missing or distorted in the NICU
environment?
•  Must appear at the proper time, develop,
and mature in a sequential pattern (Masgutova &
Masgutov, 2011, Facial, p.17)
•  Spindle Receptors –muscle belly; sensitive
to passive stretch, pressure, vibration;
Increases Tone in the muscle
6-Ended Star
•  An “archetype”
movement; original
pattern or model
foundational for many
other reflexes; the
earliest motor pattern to
develop; seen in a Moro
reflex pattern
Babkin Palmomental
Purpose: improve feeding; may decrease oral
sensitivity long-term.
• 
• 
Sensory stimulation - Press on center of
palms. (See handout)
Motor Response:
• 
Infant will open his mouth and bend his
head forward to the chest.
• 
If stimulate one hand, the head will
bend forward to the corresponding side.
Natural response in adult, if reflex is
integrated is a slight relaxation in the
jaw
• 
•  Sensory stimulation:
See Handout
•  Notes: Be sure to only
do one shoulder/ hip at
a time.
• 
Embracing Squeeze
Note: “Reflex of Joy”
Embracing Squeeze
•  Purpose:
•  Stimulate the proprioceptive system and Free nerve
endings
•  Activate connections between skin-muscles, muscles –
tendons, tendons-bones
•  Sensory Stimulation: deep firm touch through rounded
cupped hands applying even pressure from all
directions.
•  Motor Response: Relaxation of muscles
•  Notes:
•  Think “Blood Pressure Cuff”
•  Skip over the joints.
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
9
Using Touch to Change Lives in the NICU and Beyond
How much is 1-2PSI of
applied pressure?
Last Updated: 5/6/14
Masgutova Lingual-Pharyngeal
Sucking Reflex (LPSR)
•  Slight indentation in
the skin
•  Purpose: Facilitate stronger, better
coordinated suck
•  Balance full 16 ounce
water bottle on your
finger
•  Sensory stimulation:
•  Breastfeeding!
•  Pulse under chin at posterior submandibular
space upward moving base of tongue up
toward soft palate/velar space. 7 repetitions
of 9 pulses.
•  Motor Response: stronger suck
Masgutova Lingual-Pharyngeal
Sucking Reflex (LPSR)
Go Back to Happy
Read the Cues! J
We make no guarantees. Only good work.
The rest in the hands of God, and we will watch.
– Pamela Curlee , SLP
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
10
Using Touch to Change Lives in the NICU and Beyond
Last Updated: 5/6/14
Jennifer S. Meyer,
M.A. CCC-SLP
Feeding and Dysphagia Resources, P.C.
Feeding-And-Dysphagia-Resources.com
Care-To-Collaborate.com
[email protected]
“FeeDR Pediatric Dysphagia Group” on Facebook
Copyright © Jennifer S Meyer M. A. CCC-SLP 2014
11
Basic Infant Massage Jennifer Meyer, M.A. CC-­‐SLP Feeding-­‐and-­‐Dysphagia-­‐Resources.com 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Make sure the room is warm and quiet Take off all jewelry from the elbows down Wash your hands thoroughly under very warm water Rub your hands together until warm, if necessary Use baby lotion or oil (almond, apricot, grape seed or sesame seed) Be sure the infant has a pacifier or can reach hands to suck on and warm blanket. Watch infant’s responses/cues and respond appropriately. A firm, gentle pressure is usually best. Work Head to Toe. If the baby is on his Back: a. Head – stroke gently in circular motion being very careful of the fontanel(s) or soft spots. b. Face – stroke down the sides of the face from the crown c. Arms – Place you're hand on his shoulder and let the weight of your hand rest there as his muscles relax. Support his arm/hand with your other hand. As tension releases, come down his arm to his hand, giving a slight pressure at palm (Proprioceptive input). d. Abdomen – Do BEFORE feeding so the stomach is EMPTY. 2-­‐3 fingers on clockwise circles from lower right side up and across upper abdomen and down the baby’s left side. e. Legs – Place you hand on his hip/upper thigh, letting the weight of you hand rest there until his muscles relax. Support his leg/foot with your other hand. As the tension releases, stroke down his leg to his foot, being careful of his heel (due to heel sticks), but giving a little squeeze to his foot as you end the stroke. He may pull his leg into flexion due to a ‘recoil’ reaction. If he is showing no other signs of stress, this is fine and can actually be a good sign. Gently massage the heel in a circular motion. 11. Variation if the baby is on her Tummy: a. Be sure she is tucked, flexed and supported. b. Head c. Back -­‐ Back Stroke: Place one hand on her bottom allowing weight of your hand to rest. Place your other hand at the nape of her neck stroking down her back to her bottom replacing your other hand on her bottom. Keep repeating. Go slow (approx. 30 sec per stroke) depending on her reactions. This may help with tolerating Tummy Time later. d. Arms e. Legs Other Notes: • Can do in sidelying too. • May swaddle upper part of body with flexion of upper extremities and hands to face while massaging lowers. • Remember: Touch is Communication. Make sure you are Relaxed and Calm and Enjoying the experience too. Ask yourself: “What do I want to communicate?” Auckett, AD ( 1981) Baby Massage. NY: Newmarket Press Morris, S.E. & Klein M.D. (2000) Prefeeding Skills, Tucson: Therapy Skill Builders. Waitzman, K. A. (Producer & Director). (2005). The listening touch massage. United States: Creative Therapy Consultants. SVETLANA MASGUTOVA EDUCATIONAL INSTITUTE LLC
®
!
!
Six%Ended!Star!Sensory%Proprioception!Awareness!
For!sensory!or!sensorimotor!stimulation!place!one!
hand! on! the! area! of! the! gravity! center,! lower! than!
the!navel,!and!press!lightly!so!they!feel!the!“center!
for! orientation”! in! the! Six<Ended! Star! and! its!
dynamics.! Touch! and! press! lightly! on! the! ends! of!
the! links! of! the! Six<Ended! Star! to! accent! the!
kinesthetic! awareness! of! the! person.! Hold! your!
pressure!for!7<10!seconds!in!each!position.!In!all!of!
the!steps!below,!one!hand!remains!below!the!navel!
in!the!area!of!the!gravity!center!on!the!core!and!the!
other!hand!rests!on!the!end!of!each!link:!!
- 1)!Core!–!Upper!Chest!
- 2)!Core!–!Sacrum!
- 3)!Core!–!Arm!(right!shoulder)!
- 4)!Core!–!Arm!(left!shoulder)!
- 5)!Core!–!Leg!(right!hip)!
- 6)!Core!–!Leg!(left!hip)!
!
!
!
!
!
!
!
!!!
!
WWW.MASGUTOVAMETHOD.COM
SVETLANA MASGUTOVA EDUCATIONAL INSTITUTE LLC
®
!
!
Babkin!Palmomental!Sensory!Stimulation!
Invite! your! partner! to! experience! the! sensory! stimulation! of! the! Babkin!
Palmomental! Reflex! zone<points! on! the! palms.! Press! with! a! flat,! soft! and! deep!
pressure!at!the!points!in!the!middle!of!the!palms!on!both!hands!at!the!same!time!for!!
7–8!seconds.!Repeat!for!3–5!times.!
!
!
!!
!
!
!
!!
WWW.MASGUTOVAMETHOD.COM
!
SVETLANA MASGUTOVA EDUCATIONAL INSTITUTE LLC
®
!
!
Embracing!Squeeze!
Use! deep! steady! round! proprioceptive! touch! on! the! upper! and! lower! limbs! using!
both!your!hands.!The!touch!must!be!deep,!soft,!round,!and!comfortable!using!your!
whole! palm! and! hold! for! 7–8! seconds.! ! The! pressure! is! 360–800! grams! per! cm2!!
(which! is! approximately! 1–2! psi! of! pressure),! which! corresponds! to! the! pressure!
that! we! experienced! in! the! utero! time! of! development.! Long<term! use! of! this!
technique! demonstrates! very! effective! benefits,! especially! for! children! and! adults!
with! challenges,! like:! ADHD,! Autism,! cerebral! palsy,! sensory! processing! disorders,!
and!other!developmental!issues!that!affect!bonding!and!the!ability!to!thrive.!Begin!
the! embracing! squeeze! from! the! distal! end! of! extremities! and! move! proximally!
towards!the!center.!Begin!with!upper!extremities!and!then!move!to!the!lower!limbs.!
Repeat!each!exercise!a!minimum!of!three!repetitions!for!each!limb.!
!
!!!
!
!
!
!!
WWW.MASGUTOVAMETHOD.COM
!
Using Touch to Change Lives in the NICU and Beyond Selected Bibliography (For complete and updated Reference List, please go to www.Feeding-­‐And-­‐Dysphagia-­‐Resources.com) Als H, Duffy FH, McAnulty FB et al. Early experience alters brain function and structure. Pediatrics 2004; 113:846-­‐857. Arditi, H., Feldman, R., & Eidelman, A.I. (2006). Effects of human contact and vagal regulation on pain reactivity and visual attention in newborns. Developmental Psychobiology, 48(7), 561-­‐573. Beachy, JM (2003). Premature infant massage in the NICU. Neonatal Netw. 2003 May-­‐Jun;22(3):39-­‐
45. Bond C. (2002). Positive touch and massage in the neonatal unit: a British approach. Semin Neonatol; 7: 477–486. Bonnier, C. (2008). Evaluation of early stimulation programs for enhancing brain development. Acta Paediatrica, 97, 853-­‐858. Born Too Soon: The Global Action Report on Preterm Birth _WHO 2012 http://www.marchofdimes.com/downloads/MOD003-­‐FullReport_v08_043012.pdf Conde-­‐Agudelo A, Diaz-­‐Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003; 4: CD002771 (Available at: http://www.nichd.nih.gov/cochrane/conde-­‐agudelo/conde-­‐ agudelo.htm). Conde-­‐Agudelo and Belizan. (2009) Kangaroo mother care to reduce morbidity and mortality in low birthweight infants – Cochrane Review Corff, K.E., Seidema, R., Venkataraman, P.S., Lutes, L., and Yates, B. (1995). Facilitated tucking: a nonpharmacological comfort measure for pain in preterm infants. Journal of Obtetrical, Gynecological and Neonatal Nursing 24 (), 143-­‐147. De Chateau P, Holmberg H, Jakobsson K, Winberg J. (1977). A study of factors promoting and inhibiting lactation. Dev Med Child Neurol. 1977 Oct;19(5):575-­‐84. De Chateau P, Wiberg B. (1977). Long-­‐term effect on mother-­‐infant behaviour of extra contact during the first hour post partum. I. First observations at 36 hours. Acta Paediatr Scand. 1977 Mar;66(2):137-­‐43 De Chateau P, Wiberg B. (1977). Long-­‐term effect on mother-­‐infant behaviour of extra contact during the first hour post partum. II. A follow-­‐up at three months. Scand. 1977 Mar;66(2):145-­‐51. Diego, MA., Field, T., & Hernandez-­‐ Reif, M. (2005). Vagal activity, gastric motility, and weight gain in massaged preterm neonates. Journal of Pediatrics, 147, 50-­‐55. Diego, MA., Field, T., & Hernandez-­‐Reif, M. (2008). Temperature increases in preterm infants during massage therapy. Infant Behavior Development, 31, 149-­‐152. Dieter, J.N., Field, T., Hernandez-­‐Reif, M., Emory, E.K., & Redzepi, M. (2003). Stable preterm infants gain more weight and sleep less after five days of massage therapy. Journal of Pediatric Psychology, 28, 403-­‐411. Dusing S, Murray T, Stern M. (2008) Parent references for motor development education in the neonatal intensive care unit. Pediatr Phys Ther; 20(4):363-­‐368. Ferber, S. G., Kuint, J., Weller, A., Feldman, R., Dollberg, S., Arbel, E., et al. (2002). Massage therapy by mothers and trained professionals enhances weight gain in preterm infants. Early Human Development, 67, 37-­‐45. Fern, D (2011). A NeuroDevelopmental Care Guide to Positioning & Handling The premature, Fragile or Sick Infant. DF Publishing: NY Field T, Diego M, Hernandez-­‐Reif M. (2011) Potential underlying mechanisms for greater weight gain in massaged preterm infants. Infant Behav Dev. 2011 Jun;34(3):383-­‐9. Epub 2011 May 13. Review. Field, T., Hernandez-­‐Reif, M., Diego, M.(2006) Newborns of Depressed Mothers Who Received Moderate Versus Light Pressure Massage During Pregnancy. Infant Behavior & Development 29:54-­‐8. Fucile S, Gisel EG, McFarland DH, Lau C. (2011). Oral and non-­‐oral sensorimotor interventions enhance oral feeding performance in preterm infants. Dev Med Child Neurol. 2011 Sep;53(9):829-­‐35. doi: 10.1111/j.1469-­‐8749.2011.04023.x. Epub 2011 Jun 27. Gardner SL, Goldson E (2002). The neonate and the environment: impact on
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