A Cochrane review [Abstract] 1 included 34 studies with a total of 3 981subjects. Studies that randomised healthy parent-infant dyads (where the infant was under the age of 6 months) to an infant massage group or a 'no-treatment' control group were included. 14 meta-analyses assessed physical outcomes. Nine meta-analyses showed significant findings favouring the intervention group for weight (MD -965.25 g, 95% CI -1360.52 to -569.98; 18 studies, n=2 271), length (MD -1.30 cm, 95% CI -1.60 to -1.00; 11 studies, n=1 683), head circumference (MD -0.81 cm, 95% CI -1.18 to -0.45; 9 studies, n=1 423), arm circumference (MD -0.47 cm, 95% CI -0.80 to -0.13; 2 studies, n=225), leg circumference (MD -0.31 cm, 95% CI -0.49 to -0.13; 2 studies, n=225), 24-hour sleep duration (MD -0.91 hr, 95% CI -1.51 to -0.30; 4 studies, n=634), time spent crying/fussing (MD -0.36, 95% CI -0.52 to -0.19; 4 studies, n=341), deceased levels of blood bilirubin (MD -38.11 mmol/L, 95% CI -50.61 to -25.61; 2 studies, n=410), and there were fewer cases of diarrhea (RR 0.39, 95% CI 0.20 to 0.76; 2 studies, n=310). Non-significant results were obtained for cortisol levels, mean increase in duration of night sleep, mean increase in 24-hour sleep and for number of cases of upper respiratory tract disease and anaemia. Sensitivity analyses were conducted for weight, length and head circumference, and only the finding for length remained significant following removal of studies judged to be at high risk of bias. These three outcomes were the only ones that could also be meta-analysed at follow-up; although both weight and head circumference continued to be significant at 6-month follow-up, these findings were obtained from studies conducted in Eastern countries only. No sensitivity analyses were possible.
18 meta-analyses measuring aspects of mental health and development were conducted. A significant effect favouring the intervention group was found for gross motor skills (SMD -0.44, 95% CI -0.70 to -0.18; 2 studies, n=237), fine motor skills (SMD -0.61, 95% CI -0.87 to -0.35; 2 studies, n=237), personal and social behaviour (SMD -0.90, 95% CI -1.61 to -0.18; 2 studies, n=237) and psychomotor development (SMD -0.35, 95% CI -0.54 to -0.15; 4 studies, n=466); although the first three findings were obtained from only 2 studies, one of which was rated as being at high risk of bias, and the finding for psychomotor development was not maintained following removal of studies judged to be at high risk of bias in a sensitivity analysis. No significant differences were found for a range of aspects of infant temperament, parent-infant interaction and mental development. Only parent-infant interaction could be meta-analysed at follow-up, and the result was not significant.
Comment: The quality of evidence is downgraded by study limitations (lack of allocation concealment and blinding), by inconsistency (unexplained variability in results), and by imprecise results (few patients for each comparison).
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