Prenatal and infant massage

1. Introduction

Version followed: prenatal massage as described in the American Massage Therapy Association (AMTA) Massage Therapy Journal feature on pregnancy (Salamon 2018) and the Mueller & Grunwald (2021) systematic review of relaxation massage in pregnancy; infant massage as the International Association of Infant Massage (IAIM) publishes its parent course (founder Vimala McClure), supplemented by the Relationships Australia SA practice account published by Emerging Minds and a UK local-authority baby-massage policy.

This entry covers two different things that share a name. Prenatal (pregnancy) massage is hands-on massage of a pregnant client by a licensed or registered massage therapist, adapted for pregnancy in positioning, pressure and screening. Infant massage in the IAIM tradition is not massage given by a professional: a trained instructor teaches parents to massage their own baby, demonstrating on a doll, and the parent asks the baby for permission and reads the baby's cues [source: IAIM FAQs for parents; IAIM classes for parents]. Neither is a psychotherapy. A psychotherapist does not give either massage within psychotherapy; their role is to suggest, refer, prepare, collaborate and integrate. A psychotherapist who completes IAIM instructor training may teach the parent course, since the instructor does not massage the baby [source: IAIM FAQs for parents] [synthesis: whether this fits a given practitioner's scope and code is for their own professional body; see section 3].

Core idea of change. For pregnancy massage, the stated aims are relief of stress, back and leg pain, anxiety and low mood in healthy pregnancies [source: Mueller & Grunwald 2021]. For infant massage, McClure's stated beliefs centre on respecting infants as aware people and supporting early parent-infant bonds that are loving and secure [source: IAIM founder page]; practitioners describe the change process as responsive interaction: parents learn to notice and answer their baby's cues, and asking permission is framed as an early experience of the baby's say over their own body [source: IAIM FAQs for parents; Emerging Minds transcript].

Origins. McClure began this work at an orphanage in northern India; in 1978, at the request of childbirth educators, she created a training programme combining strokes learned in India with Swedish massage, reflexology principles and yoga adapted for babies, and designed strokes for colicky babies; with registered nurse Audrey Downes she founded the International Association of Infant Massage Instructors, incorporated in the USA in 1986 [source: IAIM founder page]. Her book is Infant Massage: A Handbook for Loving Parents; the IAIM page dates it to 1978 [uncertain: not verified; edition dates of the book differ across listings]. Reflexology and yoga concepts in the routine belong to those traditions and are not established physiology [synthesis].

Evidence status (brief, for referral decisions only). Pregnancy: a systematic review of 12 RCTs found positive effects of relaxation massage in healthy, uncomplicated pregnancies, with few, mostly minor and transient side effects, but a small evidence base from a limited number of research groups and unclear risk of bias [source: Mueller & Grunwald 2021]. Infants: the Cochrane review of massage in typically developing infants under six months (34 RCTs) found that apparent benefits mostly disappeared when high-risk-of-bias studies were removed, found no effect on parent-infant interaction, and the authors did not support its use in low-risk parents and infants, suggesting future research in higher-risk groups such as socially deprived families [source: Cochrane plain-language summary, Bennett, Underdown & Barlow; CD005038.pub3, 2013] [uncertain: the summary page shows a 2022 date, likely a republication of the 2013 review]. For maternal postnatal depression, a 2023 systematic review of 8 studies (521 women) reported fewer depressive symptoms and better mother-infant interaction and maternal self-efficacy with mother-led infant massage; the authors frame delivery by public health nurses or community midwives as a possibility [source: Geary, Grealish & Bright 2023]. Infant massage is not a treatment for postnatal depression on its own [synthesis].

2. Framework

2a. Prenatal massage (delivered by a massage therapist)

Who delivers. In the USA, massage therapists are licensed in most states; FSMTB lists licensure in 49 states or territories, registration in Vermont, optional certification in California and no state regulation in Kansas, Minnesota and Wyoming; licensure typically requires postsecondary education, clinical experience, the MBLEx and continuing education [source: FSMTB consumer information]. In the UK, massage therapy and sports massage are among the therapies on the Complementary and Natural Healthcare Council (CNHC) voluntary register [source: CNHC complaints leaflet]. Board certification by NCBTMB exists as a voluntary credential beyond licensure [uncertain: not verified]. In Canada, five provinces regulate massage therapy through a college that licenses therapists, sets standards and publicly reports discipline (Ontario, British Columbia, New Brunswick, Newfoundland and Labrador, Prince Edward Island); elsewhere the profession is not government-regulated and therapists join associations [source: HHR-RHS Canada; CBC 2021]. In Australia, there is no national registration; massage therapists fall under the National Code of Conduct for health care workers not registered under the national scheme, applied by state health complaints entities (in WA the implementing bill was still before parliament in September 2022), and AMT members can be reported to AMT's Discipline Committee [source: HaDSCO WA 2022; AMT]. Pregnancy-specific training is continuing education, e.g. AMTA's foundation and advanced pregnancy courses [source: AMTA 2018].
Phases. (1) Referral and the client's discussion with their prenatal care provider where there are complications; (2) intake: gestational stage, prenatal diagnoses, past pregnancy problems, medications, prior bodily trauma and massage history; (3) each session: re-check blood pressure, medications and changes; (4) massage in adapted positions; (5) postpartum continuation if wanted [source: AMTA 2018].
Criteria for proceeding. Uncomplicated pregnancy, or medical release where complications exist; postponement if DVT is suspected or diagnosed or with placental problems unless the physician approves [source: AMTA 2018; Mueller & Grunwald 2021].
Session count and format. Not fixed by sources [uncertain: not verified]; individual sessions, booked by the client.

2b. Infant massage (IAIM parent course)

Format. A course of five sessions (IAIM pages also describe a 5–6 week course) for parents with babies from birth to one year; group classes, or private one-to-one sessions for families who cannot or prefer not to attend a group; expectant parents are encouraged to wait until the baby is born [source: IAIM classes for parents; IAIM FAQs for parents]. A UK family-centre policy offers baby massage from 6–8 weeks, up to five weeks, with a booking form listing medical conditions [source: Barnsley Family Centre policy].
Who delivers. An IAIM-trained instructor who is an IAIM member; IAIM advises parents to confirm this [source: IAIM FAQs for parents]. Employers require a recognised, up-to-date qualification and a risk assessment before sessions [source: Barnsley policy].
Phases within the course. (1) Welcome, booking information and medical conditions; (2) each week: environment and oil, asking permission, new strokes taught one at a time and built on the previous week's, observation of cues, facilitated parent discussion (sleep, feeding, crying, returning to work, siblings); (3) a colic, wind and constipation routine is part of the curriculum; (4) continued home use, flexibly: a single leg, the tummy at a nappy change, or whole body at bath time [source: IAIM classes for parents; IAIM FAQs for parents].
Criteria for moving on. Strokes are added only gradually so parents gain confidence; the pace gives families a week to explore cues; the course can extend for a parent who wants more support [source: IAIM FAQs for parents; Emerging Minds transcript]. On any day the criterion is the baby's own: quiet alert and engaged means proceed; disengagement means stop [source: IAIM FAQs for parents; Emerging Minds transcript].

2c. The psychotherapist's track (both)

Assessment of fit and readiness, referral or signposting, preparation (especially for trauma-affected clients or parents), parallel psychotherapy, integration of what was felt or observed, monitoring for adverse effects and boundary problems [synthesis]. In parent-infant psychotherapy and perinatal mental health work, an infant massage course is an adjunct, offered alongside, not instead of, treatment of the parent's depression or trauma [synthesis; Emerging Minds transcript notes that a parent's trauma and wellbeing may need to come first].

3. Guiding principles

Consent before and during all touch. Practical meaning: the pregnant client agrees to each area and pressure and can stop at any moment; the baby is asked and their response is honoured [source: IAIM FAQs for parents] [synthesis for the adult wording].
The baby can say yes or no. Parents ask when the baby is quiet and alert, teaching that the baby "can say yes or no to touch" [source: IAIM FAQs for parents]. Practical meaning: a turned head, crying or crawling away ends or pauses the massage.
Parents touch their own babies; instructors demonstrate on a doll. Practical meaning: the professional's hands stay off the infant during teaching [source: IAIM FAQs for parents; Emerging Minds transcript]. One practitioner notes modelling holding and rocking when a family is struggling to settle a baby, which is not massage [source: Emerging Minds transcript].
Predictability. Same sounds, same routine, no unfamiliar smells [source: Emerging Minds transcript]. Practical meaning: a consistent ritual before each massage.
Strengths-based scaffolding. Work with families, not for them, building on what they already do; offer group insights without singling anyone out [source: Emerging Minds transcript]. Practical meaning: comment on what the parent is getting right before any suggestion.
Stay within scope; consult the infant's clinicians. For heart defects, respiratory problems, spasticity, hip dysplasia or casts, consult paediatricians, physiotherapists or occupational therapists; techniques may be tailored or delayed [source: Emerging Minds transcript; Barnsley policy].
Screen every pregnancy session. Practical meaning: blood pressure, medications and changes are reviewed each time, not only at first intake [source: AMTA 2018].
Positioning protects circulation. Side-lying is favoured and prolonged supine lying avoided because of supine hypotension [source: AMTA 2018; Mueller & Grunwald 2021].
Never sexual; intimate areas off-limits. Practical meaning: pregnancy massage does not involve breasts, genitals or perineum; any pelvic-floor or perineal concern is referred to a midwife, obstetrician or pelvic-health physiotherapist [synthesis]. Abdominal massage is avoided in the review's precautions [source: Mueller & Grunwald 2021].
The psychotherapist does not combine psychotherapy and hands-on bodywork unless their own professional code allows it and they hold the training; mainstream codes (BACP, UKCP, BPS, HCPC, APA, AAMFT) contain no explicit touch provision but require competence and prohibit sexual contact, and body-psychotherapy codes (USABP, EABP) regulate touch directly [source: BACP 2018; UKCP 2019; BPS 2009; HCPC 2023; APA; AAMFT 2015; USABP Code VIII; EABP 2020]. Practical meaning: refer for massage; if trained as an IAIM instructor, keep the instructor role (doll demonstration, no touching the infant) distinct from the therapy contract and document which role is in use [synthesis].
Trauma-informed choice. Prior bodily trauma is part of pregnancy-massage intake [source: AMTA 2018]; practical meaning: offer choice of position, clothing and areas, and a stop signal agreed in advance [synthesis].
Safeguarding first. Practical meaning: a baby who consistently avoids touch, or a parent who handles roughly or cannot respond, is a prompt to think about the family's safety and wellbeing (one practitioner links avoidance to recent partner violence), not to push on with the routine [source: Emerging Minds transcript] [synthesis for the safeguarding step].

4. Intervention inventory

Part A covers prenatal massage: what the massage therapist does (described so the psychotherapist can prepare and monitor the client) and the psychotherapist's own tasks. Part B covers the IAIM infant massage course, which an IAIM-trained instructor (including a psychotherapist with that training) can deliver. The individual stroke sequence of the IAIM routine is taught in instructor training and illustrated in McClure's book; it is not reproduced here [uncertain: stroke-by-stroke content not verified from a primary source].

Part A. Prenatal massage

A1. Deciding whether to suggest pregnancy massage (psychotherapist)

Purpose / when: a pregnant client with stress, anxiety, low mood or back and leg discomfort who is interested in touch-based self-care; healthy, uncomplicated pregnancy is where the evidence sits [source: Mueller & Grunwald 2021].
Steps: (1) Ask what the client hopes for and how they feel about being touched by a stranger in pregnancy. (2) Ask whether their midwife or obstetrician has flagged any complication (blood pressure, placenta, clotting, diabetes). (3) If complications exist, the client raises massage with that clinician first; a massage therapist may ask for a medical release [source: AMTA 2018]. (4) Present massage as an adjunct, not treatment for perinatal depression or anxiety [synthesis]. (5) Explain how to find a licensed (US) or registered (UK CNHC) therapist with pregnancy training [source: FSMTB; CNHC; AMTA 2018].
Example language (illustrative): "Some people find pregnancy massage helps with tension. Before you book, it's worth checking with your midwife, especially given the blood pressure readings you mentioned."
Watch for: the client using massage to avoid a mental health referral; unexplained one-sided leg swelling or new facial or hand swelling mentioned in passing (direct to their maternity team) [source: AMTA 2018].

A2. Intake and per-session screening (massage therapist)

Purpose / when: every pregnancy massage client, at intake and each visit.
Steps: document gestational stage, prenatal diagnoses, past pregnancy problems, medications, prior bodily trauma, exercise habits and massage history; at each session re-ask about blood pressure, medications and changes [source: AMTA 2018]. Check health status before each session and consult the obstetrician for high-risk pregnancies [source: Mueller & Grunwald 2021].
Example language (illustrative, therapist to client): "Has anything changed since last time: blood pressure, medications, anything your midwife has said?"
Watch for (psychotherapist): whether the client felt safe disclosing trauma history at intake; a client who omitted it may need help with what and how to tell [synthesis].

A3. Contraindication and caution handling (massage therapist; psychotherapist should know these)

Purpose / when: whenever a complication is present or suspected.
Steps (as sources state):
- Deep vein thrombosis: check for left-right differences such as swelling or heat in one leg; postpone the massage if DVT is diagnosed or screens positive [source: AMTA 2018]. Avoid deep muscle massage of the legs and arms because of the risk of unrecognised DVT; superficial lymphatic drainage and gentle stroking were considered acceptable in the review [source: Mueller & Grunwald 2021]. A published case report describes life-threatening consequences of leg massage with unrecognised DVT in pregnancy [uncertain: not verified].
- Varicose veins and leg swelling: do not massage over varicose veins; with significant varicosities or swelling, skip long upward strokes on the legs and work only on the feet [source: AMTA 2018].
- Pre-eclampsia (after 20 weeks): massage only with the doctor's permission; facial or hand swelling may be a warning sign [source: AMTA 2018].
- Placental problems (previa, accreta, abruption): postpone or obtain physician approval [source: AMTA 2018].
- Gestational diabetes: blood sugar should be controlled before massage [source: AMTA 2018].
- Abdomen: abdominal massage is avoided [source: Mueller & Grunwald 2021].
- Essential oils: avoid highly concentrated oils [source: Mueller & Grunwald 2021].
- High-risk pregnancy generally: consult the obstetrician [source: Mueller & Grunwald 2021].
- First trimester and so-called forbidden pressure points are not addressed in the sources used here [uncertain: not verified].
Example language (illustrative, psychotherapist): "You mentioned one calf has been sore and swollen. That's something to get checked by your midwife or GP before any massage."
Watch for: clients told by an unregulated provider that massage is safe without screening; seek urgent medical care for symptoms of DVT, per NHS guidance [uncertain: not verified].

A4. Positioning (massage therapist)

Purpose / when: all pregnancy sessions, increasingly as pregnancy advances.
Steps: side-lying is recommended, with left side-lying described as safest; lying on the back can cause supine hypotensive syndrome (dizziness, weakness, nausea, breathlessness); one practitioner uses side-lying after about 20 weeks and a rolled pillow or towel under the right hip to tilt the client left; for heartburn, an incline or support under the abdomen in side-lying; for morning sickness, elevate the upper body and avoid rocking or shaking techniques [source: AMTA 2018]. Lateral or sitting positions rather than prone, and no prolonged supine positioning [source: Mueller & Grunwald 2021].
Example language (illustrative, therapist): "If you feel dizzy, sick or short of breath at any point, tell me and we'll change position straight away."
Watch for: dizziness, nausea or breathlessness on the back; a trauma-affected client may find some positions (face-down, or a person behind them in side-lying) frightening; offer choices [source: AMTA 2018] [synthesis for the trauma point].

A5. Preparing a trauma-affected pregnant client for massage (psychotherapist)

Purpose / when: a client with a history of sexual, physical or medical trauma, or birth trauma in a previous pregnancy, who wants to try massage [synthesis].
Steps: (1) Explore what touch, positions, undressing or a closed room bring up. (2) Help the client write down what they want the massage therapist to know (no-go areas, preferred position, clothing, a stop word, door or music preferences). (3) Rehearse saying "stop" or "less pressure" aloud in session. (4) Agree that they may end a massage early without explanation. (5) Suggest a first, shorter or clothed session if the therapist offers it, decided by the client [synthesis]. (6) Encourage disclosure of bodily trauma at intake, which AMTA lists as an intake item [source: AMTA 2018].
Example language (illustrative): "You're in charge of your body on that table. What's one sentence you'd like to be able to say if something doesn't feel right?"
Watch for: freeze or compliance (the client saying they will 'just put up with it'); dissociation reported after massage; if so, slow down and revisit whether massage is right for now [synthesis].

A6. Integrating the body experience (psychotherapist)

Purpose / when: after a client has had pregnancy massage [synthesis].
Steps: ask what they noticed in their body, emotions and thoughts during and after; link relief or distress to current themes (body changes, fears about birth, relationship to the baby); note any memories that surfaced and process them in therapy rather than on the massage table [synthesis].
Example language (illustrative): "When the tension in your back eased, what else did you notice, maybe in your feelings about the pregnancy?"
Watch for: idealising the massage therapist or bringing therapy material to them; distress that persists after sessions [synthesis].

A7. Recognising adverse effects and boundary violations; how to report (psychotherapist)

Purpose / when: any report of physical symptoms after massage, or of sexualised or boundary-crossing behaviour by a practitioner.
Steps: (1) Physical symptoms (one-sided leg swelling or pain, breathlessness, chest pain, bleeding, reduced fetal movements, severe headache or visual disturbance) go to maternity services or emergency care at once [synthesis; DVT and pre-eclampsia signs from AMTA 2018]. (2) Any sexual or genital touch, or touch of breasts or other areas without consent, is misconduct: support the client, attend to their safety and consider police reporting with them [synthesis]. (3) US: complaints go to the state massage board; FSMTB directs consumers to their state licensing board and notes that in unregulated states there is "no path for consumer recourse" [source: FSMTB]. UK: CNHC investigates complaints about a registrant's conduct, including abuse of trust and stepping outside professional boundaries, in writing on its complaint form, generally within two years of events [source: CNHC complaints leaflet]. (4) Follow your own code on confidentiality and disclosure [synthesis].
Example language (illustrative): "What you're describing isn't part of pregnancy massage. It shouldn't have happened, and you have options about what to do next."
Watch for: self-blame and minimising; a client who returns to the same practitioner [synthesis].

Part B. Infant massage (IAIM parent course)

B1. Course intake and screening

Purpose / when: before a family joins.
Steps: collect a booking form with the baby's medical conditions, and ask parents to report changes [source: Barnsley policy]. Ask about treatment under specialists; for heart defects, respiratory conditions, spasticity, hip dysplasia or casts, consult the baby's clinicians and tailor or delay techniques [source: Emerging Minds transcript]. Note the parent's own wellbeing and any perinatal mental health support already in place [synthesis].
Example language (illustrative): "Is there anything about your baby's health, or anything a doctor or physio has said, that I should know before we start?"
Watch for: parents who are reluctant to disclose; a family already known to safeguarding services (coordinate with the lead professional) [synthesis].

B2. When not to massage

Purpose / when: a check at the start of every class and every home massage.
Steps: do not massage when the baby does not give permission (crying, asleep, disengaged); when unwell, e.g. a high temperature; with a soft-tissue injury or any fracture; during specialist treatment unless medical permission has been given; with known or suspected hip problems; with severe eczema or a skin infection such as chickenpox; families should not attend when the child is ill or immediately after vaccinations [source: Barnsley policy]. Avoid tired states [source: Emerging Minds transcript].
Example language (illustrative): "If your baby's had their jabs today or is running a temperature, just cuddle and watch today. You can practise on the doll."
Watch for: parents feeling they have 'failed' by not massaging; normalise skipping [synthesis].

B3. Preparing the setting and oil

Purpose / when: before each massage.
Steps: choose a good time, e.g. morning, after a bath or before bed [source: IAIM FAQs]; a soothing environment and positioning are course topics [source: IAIM classes]; bring a receiving blanket and a pillow [source: IAIM FAQs]. Use a vegetable oil, preferably organic and cold-pressed with little odour, so the parent's own scent comes through [source: IAIM FAQs]. Keep sounds and routine the same and avoid unfamiliar smells [source: Emerging Minds transcript]. Allergy or patch-test practice is not covered in sources used here [uncertain: not verified].
Example language (illustrative): "Your baby knows your smell best, so we use a plain oil that doesn't cover it up."
Watch for: scented or nut-based products brought from home; a room that is too busy or noisy for the baby [synthesis].

B4. Asking permission

Purpose / when: at the start of every massage, and again when the baby's state changes.
Steps (as one IAIM-trained practitioner describes): rub oiled hands together to make the same sound each time; show the baby the hands, held where the baby can see them; ask directly whether the baby would like a massage; wait and watch the response [source: Emerging Minds transcript]. Ask when the baby is quiet and alert [source: IAIM FAQs]. After a few weeks, babies typically give clear cues about whether it is the right time [source: Emerging Minds transcript].
Example language: the question as quoted by the practitioner, "Would you like a massage?" [source: Emerging Minds transcript]. Instructor to parents (illustrative): "We ask every time, even though they can't answer in words. Watch what your baby does with their face and body."
Watch for: parents asking and then starting regardless; parents who find the ritual silly (link it to respecting the baby's body ownership, as IAIM frames it) [source: IAIM FAQs] [synthesis for the first point].

B5. Reading engagement and disengagement cues

Purpose / when: throughout the massage; it is the core skill of the course.
Steps: look for engagement cues (eye contact, smiling, reaching out, relaxed or excited body, quiet alert state shortly after waking and not hungry) and disengagement cues (crying, distress, turning away, crawling off); do not continue if the baby is distressed or not enjoying it [source: Emerging Minds transcript]. IAIM asks parents to read cues to tell whether the baby is still enjoying it or has had enough [source: IAIM FAQs]; the curriculum covers infant behaviours and reflexes [source: IAIM classes]. Instructors ask open questions such as how the parent's baby shows it is a good time [source: Emerging Minds transcript].
Example language (illustrative): "What did your baby do just then when you moved to the tummy? What do you think that was telling you?"
Watch for: parents interpreting every cue as rejection of them personally (common in low mood); reflect the cue as information about the baby's state [synthesis].

B6. Doll demonstration and stroke-by-stroke teaching

Purpose / when: each class, for each new stroke.
Steps: the instructor demonstrates on a doll while parents copy on their own baby; strokes are taught one at a time and introduced gradually week by week, building on earlier ones [source: IAIM FAQs]. Spare dolls let parents practise when their baby is not ready; babies may sleep or feed nearby [source: Emerging Minds transcript]. The specific strokes are in the IAIM curriculum and McClure's book and are not described here [uncertain: not verified]. No pressure or duration instructions are given in this guide.
Example language (illustrative): "Watch my hands on the doll first, then try just this one stroke with your baby if they're up for it."
Watch for: the instructor reaching to adjust the baby; keep corrections on the doll or the parent's own practice [source: IAIM FAQs, parents massage their own babies] [synthesis for the correction method].

B7. Colic, wind and constipation routine

Purpose / when: babies with colic, wind or constipation; IAIM includes a specialised routine and McClure designed strokes for colicky babies [source: IAIM classes; IAIM founder page].
Steps: taught within the course by the instructor [uncertain: steps not verified]. Unwell babies, or persistent crying, vomiting, poor feeding or fever, go to the health visitor or GP first [synthesis].
Example language (illustrative): "This is a comfort routine, not a cure. If the crying is getting worse or something seems wrong, check with your health visitor."
Watch for: a parent exhausted by colic who needs mental health support as well [synthesis].

B8. Flexible home use

Purpose / when: between classes and after the course.
Steps: use whatever part fits the day: one leg, the tummy at a nappy change, or the whole body at bath time; regular use is encouraged, always guided by cues; some babies enjoy more than once a day [source: IAIM FAQs].
Example language (illustrative): "It doesn't have to be a full routine. A few leg strokes at a nappy change, if your baby is enjoying it, counts."
Watch for: massage becoming another task the parent feels they are failing at [synthesis].

B9. Facilitated parent discussion

Purpose / when: part of each session.
Steps: facilitate discussion of sleep, feeding, crying, returning to work and siblings [source: IAIM classes]; groups are described as helping with reassurance, socialising, isolation, the baby blues and postnatal depression [source: IAIM classes]; offer insights to the whole group without singling out one parent [source: Emerging Minds transcript].
Example language (illustrative): "A lot of parents tell me the evenings are the hardest. What's that been like for you all?"
Watch for: a parent who is withdrawn, tearful or expresses hopelessness or thoughts of harm; follow up privately and use perinatal mental health pathways [synthesis].

B10. Supporting a parent with postnatal depression

Purpose / when: a parent with depression who finds eye contact and responsiveness hard [source: Emerging Minds transcript].
Steps: position yourself alongside the parent to support connection rather than letting the moment pass [source: Emerging Minds transcript]; notice and name small moments of mutual engagement; build confidence in parents who did not experience delight and responsiveness in their own childhood [source: Emerging Minds transcript]. Make sure the depression itself is assessed and treated (GP, health visitor, perinatal mental health team, psychotherapy) [synthesis]. Evidence: a 2023 review found fewer depressive symptoms and better interaction with mother-led infant massage [source: Geary et al. 2023].
Example language (illustrative): "Did you see that? When you said her name, she looked straight at you."
Watch for: flat affect, not responding to the baby's cues, risk indicators; screen with your usual tools and escalate per local risk procedures [synthesis].

B11. When the baby avoids touch or the parent is affected by trauma or violence

Purpose / when: a baby who consistently avoids massage or certain movements, or a parent with trauma.
Steps: consider that avoidance may reflect recent partner violence; supporting the parent's trauma and wellbeing may need to come first [source: Emerging Minds transcript]. Follow local safeguarding procedures: record observations factually and consult your safeguarding lead [synthesis]. Do not use the course to assess abuse [synthesis].
Example language (illustrative): "It seems your little one isn't keen on this right now. How are things at home for the two of you at the moment?"
Watch for: unexplained bruising or marks seen during massage, rough handling, fear of a partner; these go through safeguarding procedures the same day [synthesis].

B12. Adaptation for reunification and telehealth

Purpose / when: families reunifying after separation, or remote delivery.
Steps: one service adapts the approach for reunification, including permission talk over telehealth [source: Emerging Minds transcript]. Details of the adaptation are not given in that source [uncertain: not verified].
Example language (illustrative): "Let's do the asking part together on screen: hands where your baby can see them, then ask."
Watch for: contact arrangements and orders that limit who may handle the baby; check with the case worker [synthesis].

B13. Premature babies and babies with special needs

Purpose / when: preterm infants or those with disabilities or medical conditions.
Steps: IAIM says the programme can be used for premature babies and children with special needs, and instructors may refer families to a more experienced instructor [source: IAIM classes; IAIM FAQs]. Consult the baby's paediatrician or therapists, and tailor or delay as advised [source: Emerging Minds transcript]. On neonatal units, infant massage is delivered under unit guidance [uncertain: not verified].
Example language (illustrative): "Let's check with his physio which areas and positions are fine before we add anything new."
Watch for: signs of stress specific to the condition, as the baby's clinicians describe them [synthesis].

B14. Strengths-based reflection and celebrating progress

Purpose / when: end of sessions and the end of the course.
Steps: reflect what each family is already doing well and celebrate progress [source: Emerging Minds transcript]; ask parents what they have learned about their baby's signals [synthesis].
Example language (illustrative): "Five weeks ago you weren't sure what she liked. Now you can tell me exactly when she's had enough."
Watch for: comparison between babies in the group [synthesis].

B15. Suggesting an infant massage course within psychotherapy (psychotherapist)

Purpose / when: a parent in perinatal or parent-infant work who wants a structured, low-pressure way to be with their baby, isolation, or low confidence in reading the baby [synthesis; group benefits from IAIM classes].
Steps: (1) Check that the parent is well enough to attend and that it will not add pressure. (2) Signpost to an IAIM-trained, IAIM-member instructor running a 5–6 week course, or a one-to-one option [source: IAIM FAQs]. (3) With consent, liaise with the health visitor or perinatal team. (4) Keep therapy and course roles separate if you also instruct [synthesis].
Example language (illustrative): "There's a baby massage group at the family centre. It's less about technique and more about learning your baby's signals, and you'd meet other parents."
Watch for: the parent hearing the suggestion as criticism of their parenting [synthesis].

B16. Integrating the course into parent-infant psychotherapy (psychotherapist)

Purpose / when: after classes, or when a parent describes home massage [synthesis].
Steps: explore what the parent felt when the baby said yes or no; link to the parent's own history of touch, consent and care; use observed cues as material for mentalising the baby; track mood and bonding over time [synthesis]. The Cochrane review found no effect on parent-infant interaction in low-risk families, so frame the course as one support, not the mechanism of change [source: Cochrane summary].
Example language (illustrative): "When he turned away, you said it felt like being rejected. Whose voice does that remind you of?"
Watch for: strong feelings about touch from the parent's own childhood surfacing; pace accordingly [synthesis].

5. Handling problems

The sources describe few problem scenarios; most guidance below is [synthesis] unless tagged otherwise.

Pregnant client keen on massage but with an unassessed complication (swollen leg, high blood pressure, placental diagnosis). Response: no massage until the maternity team has seen them; the massage therapist may require a medical release [source: AMTA 2018]. Frame it as protecting the pregnancy, not refusing support; offer non-touch relaxation work in therapy meanwhile [synthesis].
Client feels unable to say stop on the table. Rehearse the words in therapy, agree a signal, choose a therapist who checks in during the session; consider a clothed or shorter first session if the therapist offers it; or postpone massage [synthesis].
Distress, flashbacks or dissociation during or after pregnancy massage. Stop or pause massage; process in therapy; review position, areas and therapist choice; if repeated, massage may not be right for now [synthesis].
Adverse physical event after massage (leg pain or swelling, breathlessness, bleeding, severe headache, reduced fetal movements). Urgent maternity or emergency care; tell the massage therapist so they can review practice [synthesis; DVT and pre-eclampsia signs from AMTA 2018].
Boundary violation or sexual misconduct by a practitioner. Believe and support the client; safety first; explain reporting routes (US state massage board; UK CNHC for registrants; police where a crime may have occurred); respect the client's choice about reporting except where your own safeguarding duties apply [source: FSMTB; CNHC complaints leaflet] [synthesis for the rest].
Baby repeatedly says 'no'. Treat as information, not failure: change timing to quiet alert states, shorten to one area, or simply hold and talk; practise on the doll [source: Emerging Minds transcript; IAIM FAQs]. If avoidance is persistent or specific, consider the family's circumstances and the parent's wellbeing first [source: Emerging Minds transcript].
Parent pushes on despite disengagement cues. Name the cue gently, model pausing on the doll, ask what the parent thinks the baby is saying [synthesis; cue lists from Emerging Minds transcript]. If roughness or disregard is persistent, discuss with your safeguarding lead [synthesis].
Parent with postnatal depression who stops attending (non-adherence). Contact with warmth; offer a one-to-one session, which IAIM provides for [source: IAIM classes]; check the depression is being treated; do not let the course stand in for treatment [synthesis].
Parent feels judged in the group (rupture). Speak privately, acknowledge, repair; avoid singling out in the group [source: Emerging Minds transcript] [synthesis for repair].
Unwell baby, recent vaccination, skin infection, hip problem or injury. No massage that day; parent practises on the doll; seek medical advice where needed [source: Barnsley policy].
Parent asks whether massage will 'fix' colic, sleep or weight gain. Give the honest picture: the Cochrane review found benefits doubtful in low-risk families once high-risk-of-bias studies were removed [source: Cochrane summary]; present massage as time together and a way to learn the baby's signals [synthesis].
Safeguarding concern arises during class (marks seen, disclosure of violence, parent intoxicated). Follow local procedures the same day; record facts; the course does not continue as normal for that family until the concern is addressed [synthesis].
Dual-role tension for a psychotherapist who also instructs. Keep separate contracts, settings and records; do not teach your own therapy clients in a group without discussing the role change with them; take it to supervision; check your own professional code [synthesis]. Codes ask you to avoid dual relationships that risk harm, and EABP asks you to discuss parallel services with the client [source: BACP 2018 para 33(b); UKCP 2019 item 8; EABP 2020 6.b].
Cultural practices of infant massage (e.g. family traditions using particular oils or vigorous strokes). Respect the tradition and the family's knowledge; share the safety points (when not to massage, cues, oil choice) without dismissing their practice; IAIM's founder supported other cultural traditions that strengthen the parent-baby bond [source: IAIM founder page] [synthesis for the rest].

Sources

Professional codes and massage regulators cited above:

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