Transcript for
Using cue-based infant massage to support infant mental health
Kerryn Roberts (00:00): If you teach a few strokes or you invite someone to Google something on massage, you potentially miss an opportunity to observe and scaffold a relational experience.
Narrator (00:11): Welcome to the Emerging Minds podcast.
Nicole Rollbusch (00:16): Hi, you’re with Nicole Rollbusch. On today’s episode, I’m joined by Kerryn Roberts, Coordinator of Infant Massage at Relationships Australia, South Australia, or RASA. Kerryn’s joining us today for Infant Mental Health Week, to talk about cue-based infant massage and how it can support infant mental health. So Kerryn, thank you so much for joining me, it’s great to have you here.
Kerryn Roberts (00:39): Thank you.
Nicole Rollbusch (00:39): Can you start by telling us a little bit about your role at RASA?
Kerryn Roberts (00:43): Sure, Nicole. First of all, I’d just like to acknowledge that we’re meeting on Kaurna lands. I would like to acknowledge the links of people to land, water, country and the importance of family for Aboriginal people and children, and that the traumas of the past still live with people today and will continue to affect Aboriginal people, and the work is about all of us working together and learning towards the future.
(01:05): So my role at Relationships Australia, I’ve been working in the space of being infant massage coordinator at Relationships Australia now for about 10 years. My background is nursing, midwifery and antenatal, postnatal education and support with families, and my focus is relational work with infants in their first three years of age and under, with a particular interest with children under 12 months of age because that’s a space where we do the work of infant massage, cue-based infant massage. I also work directly with families with Together for Kids, and that is a child-focused therapeutic service that’s working with families affected by domestic violence and homelessness and the implications that that brings for them as well. So that deepens my understanding of the therapeutic focus of our work as well.
Nicole Rollbusch (01:56): That’s such important work that you’re doing. You mentioned this concept of cue-based infant massage, and I know it’s not just about the massage and the strokes. So can you tell us a bit about the cue-based infant massage that you do?
Kerryn Roberts (02:11): Sure. So cue-based infant massage is really a child focused lens on the space, but it’s looking at … I suppose you could give an example of Jack Shonkoff and process of serve and return. So we’re looking at a space where exploring those child led principles of serve and return invites parents to actively develop their baby’s brain architecture. So we’re looking at the recognition awareness around baby cues, for example, if a baby gives a coo and then a parent responds with eye contact, words, sitting in that space with the infant, then neural connections and mirroring occurs and their understandings between them are strengthened. So conversely, if a baby cries and a parent recognises that cue, in this space of a fun programme that you can do together, there is always changing states for infants. So cue-bases means we ask permission of the infant, we wait and we watch that space first.
(03:11): So in some situations, and quite often, babies don’t have a massage in the space that we work in, but what we do is we celebrate the recognition of the cues that the baby is sharing and we teach the skills so that a parent can explore with their child what that means in a time that’s suitable for their infant to have the massage. So we’re learning relationally about each other, rather than acting upon a child to give strokes on them. There’s a lot of very keen parents to massage, but that pausing is very important because it’s a communication tool as well.
Nicole Rollbusch (03:41): Yeah, fantastic. I’m interested in what those cues might be. Can you give the audience a little bit of an idea of what would be a go ahead cue and maybe what would be a let’s stop and pause cue?
Kerryn Roberts (03:55): Sure. So we use dolls to communicate with as facilitators, so we’re asking a parent to sit in that space with their child while we model and sit with a doll, and we would invite them to say what are they seeing? But we also invite them to say, how does their baby let them know it’s a great time to engage with them? So we ask, we use open-ended questions, we ask, how does your baby let you know it’s a great time to play or to learn and those sort of things, and then we build on what a parent already knows. So if a parent knows that a baby is smiling, using their eyes, connecting, reaching out towards them, having a relaxed body or a kind of excited body, but not going into a tired state, really focusing on that quiet alert time, just perhaps when a baby wakes, but they’re not very hungry, those are times we’re looking at sort of that ideal time for massage.
(04:50): But if we’re in a group of people, we might say, what state is your baby in in that space? Parents can look around and see babies in all different states at once. So there’s mutual learning that goes on in that space for a family. Then as part of a community, they might see that another baby’s crawling across the floor, not interested at all, the cue’s really clear, I’m not ready for massage. And then parents feel supported in the fact that their baby might not want that that day, but we can also celebrate that another milestone is being demonstrated for a group of people, that this baby is showing their preference clearly. And that’s great that that parent is honouring what that baby is indicating or cuing in.
Nicole Rollbusch (05:30): Yeah, it’s so interesting. So in thinking about these things, what are some of those key practise principles of infant massage or cue-based infant massage? Because as you said, facilitators are always using a doll, those sorts of things. Why is that, and what other principles, I suppose, are there in infant massage?
Kerryn Roberts (05:49): Sure. So asking permission and safe touch are fundamental to the program. These are important rights and responsibilities that need to be practised by parents and learnt by children as early as possible. So if I was an infant and my carer listens to my preferences about personal touch and my body, then I will expect others to do the same. So it has a protective potential down the line because if this is reinforced each time, you ask permission, you wait, you don’t move forward until you get a cue that this is the right time for massage, you also take time with delivering it. So you give families time to explore preferences from babies over a week, not just a day, and impacting them with a whole lot of teaching at once. So it purposefully takes five weeks to undertake the program and sometimes longer if a parent wants more support.
(06:39): So if they need more support in that reflections of what they’re seeing and understanding, because it’s often the right time for us as adults to massage an infant when we come to an appointment or come to a program. So if a baby’s not in that right state, we carry extra dolls so that a parent can potentially still learn the tools, the strokes, they might learn on the doll if they feel comfortable with that, or they might watch us doing massage on our doll and watch the strokes alongside other families or by themselves if they’re learning themselves, but their baby can sleep, their baby can feed. We set up a space that’s parent, as well as child-friendly and safe.
(07:19): If a family is having trouble settling a baby, we can even model holding a baby and rocking and promoting positive movements, without directly saying you’re failing as a parent to meet those needs. We can be alongside that, we can see where someone’s struggling to learn something and we can position ourselves physically to be more visible to one family who might be experiencing difficulty or offer some insight for everyone into one particular thing without targeting that person’s nervousness or something that they’re struggling with to learn. So it’s really strengths based, honouring that permission and we ‘re hoping to build that relationship from where it already is.
Nicole Rollbusch (07:58): Can you tell me a little bit about this asking for permission to massage because I think that’s such an interesting concept and like you said, often parents are in a really good place to massage, but how do you ask a baby for permission and why is that important?
Kerryn Roberts (08:14): So the way we do it is based on training by Vimala McClure, which shows different techniques from around the world and is an international and research program of massage. So what we do is we rub our hands together. You can hear the swishing sound that I’m doing. So for babies, they learn in a variety of ways, just like we do as adults. There’s visual, there’s smell, there’s touch. So we don’t try and introduce a whole lot of other smells to the space that aren’t your parent either or caregiver. So just starting with the same sounds each time, being predictable, being safe in your approach, showing the baby your hands, that you’ve put some oil on them, that they’re hearing the noise, and then you have your hands above the baby where they can see your hands clearly, and you ask them the question directly, “Would you like a massage?” A few weeks into the process you find babies are very clear in their cues, whether it’s the right time because they know what happens next.
Nicole Rollbusch (09:13): Yeah, it’s lovely that babies start to learn what permission means. I’m also really interested in why a family might be looking to engage in infant massage. What sorts of reasons might a parent have for coming along to the program?
Kerryn Roberts (09:28): Sure. I think it’s really varied, like any program that can be run in a community setting, people sometimes come from a community mindset where they want to connect with other families, they want to meet people in their community and grassroots programs, this is something that can be offered in any space, one to one or in a group. So people might want to meet people from their community and in the space of fun, low cost, the ability to access this and connect with people with all different experiences of parenting, that can be one aspect to it.
(09:59): Another family might be thinking they want to feel more confident in their parenting styles and feeling scaffolded alongside that and learning what their baby’s cuing them and having conversations around that space can be really important for them, especially where they haven’t had that modelling themselves in their lives. So for some people, they might not have been modelled delight when they were a child in small things, so this space of being allowed to delight, allowed to wonder, allowed to wait, can be something that people would like to do. Sometimes they just hear that it’s about baby massage and they just want to explore that, but often it’s about purposeful time together that’s just about us.
Nicole Rollbusch (10:41): Are there any circumstances in which you might not use infant massage or you might avoid using it?
Kerryn Roberts (10:48): So for some infants there can be health conditions that might actually mean that it’s not appropriate. Sometimes when there’s congenital heart defects, when there’s respiratory issues, massage can take up a bit more oxygen in the body. So offering something that’s stimulating when your body’s trying to cope and not operating as efficiently as it might for various reasons, that’s really a time when we would say, “Can you connect in with your paediatrician and just check if this is the right therapeutic approach for you, in terms of something you might do with your infant?” With the support of that space, then that might still go ahead. But there can also be situations where we might need to tailor things, like for children with that there’s some conditions where muscles are more relaxed and there’s some conditions where you have more rigidity of muscles, so spasticity. So we might work in partnership then with the physiotherapist or an occupational therapist in regards to the type of techniques that were most useful for that infant.
(11:45): So it’s about not going beyond your scope of practise, but learning to the specific needs. And that might mean when children are in … when they’re having say hip dysplasias and things, it could mean that they only have a certain amount of time with their infant where they’re not in plasters or other things in a day, and is that time best spent doing infant massage or is it best spent having a cuddle, or how do they want to work that, and what’s most important in their relationship at the time? So it might be delayed for a little while rather than put off indefinitely, but there might be specific techniques that are more suitable for those families whose babies have been in casts perhaps, or with feet being in poor positions and needing some scaffolding around them so that it just might change how you do it. So anything that could trigger anything to worsen or be not helpful in a situation, could be a situation where we don’t move ahead. And obviously if a baby’s distressed, you’re not moving ahead in any circumstance if they’re not enjoying it because it’s about communication.
Nicole Rollbusch (12:49): So what are the benefits of infant massage or cue-based infant massage for infant mental health specifically?
Kerryn Roberts (12:57): So for infant mental health, I think if you look back at say where the program tools and strokes are sourced from, the International Association of Infant Massage would say that there is relaxation benefits, that there’s benefits of interaction, stimulation for baby’s bodies and some relief because babies have issues with wind, they have also developmental needs as well, and the stimulation of body can help support the body in how they’re feeling health wise as well due to circulation implications and other elements. So I think importantly from Relationships Australia’s perspective, this focus on interaction with others, the focus on the individual preferences of infants, the focus on being heard and the scaffolding for families for where they are in their parenting journey, rather than one size fits all, really supports that mental health and wellbeing focus for the infant because it’s fun, interactive and it acknowledges that babies continue to develop and change in relationships, and that first year of life, there’s immense changes going on for infants.
(14:05): So it’s scaffolding future mental health through relational work, and it’s also valuing something that is a shared time together. So for dads, perhaps it can mean a time when a mom might be able to go and do something for themselves, but they’re actually alongside each other in a moment of interaction that’s in the present. So it’s not watching television whilst holding a baby. This is truly done together, facing each other and with intonation, sometimes songs and delighting in the experiences of your infant in real time, or feeling empathy for them if they’re not in the right state and trying to work through what that could mean. So it’s intentionally together and it’s intentionally adaptable in real time.
Nicole Rollbusch (14:53): Yeah, it sounds like a lovely programme. Can you share a story of a time where you’ve seen these benefits with a client?
Kerryn Roberts (15:01): So I currently work alongside parents who are dealing with long-term challenges and implications of homelessness and domestic violence. So my work also takes me to community centres, children’s centres where families connect with other families locally. So one year in my own time, I went to a community education meeting as a parent, there I actually was on site in a place I’d provided infant massage delivery and scaffolded a new worker learning this process. And randomly I met a parent who’d attended one of the programs for cue-based infant massage at that centre, this parent began to tell me a story of the impacts of violence and homelessness that had occurred for them recently, being part of court systems, appointments, waiting for housing, looking for safe spaces to be. I immediately felt connected to this person because I’d met them and known them over a series of weeks, and I had that feeling of, wow, what kind of thing can I do in this space to support you now? Because it was the first thing that she spoke of.
(16:01): She looked at my face and saw that I was distressed for her, and she said, “It’s okay because I’m not worried about my son and his future being impacted by violence because we came to this massage course before this occurred in our house. We learned about positive touch and interaction and the value of it. Over the five-week programme, we built our relationship closer, basing it on positive consenting, relational touch.” Now, her child had just turned one and she said, “My child already knows that I will listen to his needs and we will always have positive touch in our lives, in our relationship. So I don’t fear for his future of touch being negative or affected by violence in the sense of he already has a platform of positive touch that was in our relationship before violence came into our world.”
(16:57): So she was telling me that to help me through the fact that I was hearing her story of trauma. So we were both in tears afterwards because what she was giving me was hope that something unexpected that just actually coming to something, joining other families, being educated in a lot of other things already, what this meant for them was that there was a safe space that already existed in their relationship and it had been as supported through this program.
Nicole Rollbusch (17:24): That’s quite a powerful story, isn’t it? And that contrast between that safe touch and experiencing violence and how important having that established safe touch was for that parent and child. Yeah, it’s very powerful.
Kerryn Roberts (17:39): I think for me as a professional, it added weight to the importance of the work in the space and confidence to continue to develop work in that space and awareness around this because people have preconceived ideas of what baby massage means. For them it might be Googling some strokes. For some people it might mean getting a short moment of strokes to relieve symptoms of abdominal tension and other things. But this is relational work as well, and it has that relational potential to add value to people’s perceptions of how they feel in safety perhaps in this space as well, before you even have words for it.
Nicole Rollbusch (18:20): Yeah, absolutely. And what about some of the challenges you’ve faced in delivering this program?
Kerryn Roberts (18:27): I think sometimes the challenges are those preconceptions, what is baby massage, and that didn’t work for me or that did work for me, and I used to do that. Sometimes it’s about being able to meet people in the changing times of how we access people during things like COVID. So it’s not something we teach in a telehealth situation, that to and fro, serve and return easily in that moment with a vulnerable infant in that space from a distance because we may not be able to respond to something that concerns us in real time with a baby under one. But I know that for some, if you’re thinking about what do we do to kind of meet that space sometimes in your question, we had practitioners talking about the space of permission and what are they seeing and serve and returned in that sense of maybe would you like to do this?
(19:18): And whatever that activity was, what parents were learning was how their baby affirmed the next thing they were doing together. So it wasn’t always about massage, it was sometimes people would actually talk permission on telehealth and they would hear from a parent what the response is to what they’re asking in real time, which was less concerning about the strokes and the techniques and whether you were getting that right. Sometimes babies aren’t with parents too, but they want to do this skill and learn it, and that provides space for talk about cues and what are behaviours that their baby might be sharing with them, and to wait and wonder, and even before doing massage, you might explore what does that look like when we are together? And then we can reflect on that sometimes before we move to the time when a parent and child are together.
(20:07): So sometimes there is potentially a space there in reunification when we contemplate the future and how we feel we can build on what we already know in that space without being judged for our parenting deficits. How can we build on what we know and what can we bring to it, can be a reversal of perhaps mindset in the professional space of when we look at capacity for parenting and reflective abilities.
Nicole Rollbusch (20:34): So you’ve talked about potentially using infant massage in situations of reunification, and I’m really interested in what settings you have used infant massage in, because it sounds like it’s quite varied.
Kerryn Roberts (20:49): Yeah, there’s areas obviously that I’m doing it more commonly in. I think for me, the space of reunification is a very new space. I have worked with families who are about to have their babies who are very … in the antenatal period, where we are very aware of how we’d like to parent. We are not affected yet by sleeplessness. We’re not affected yet by concerns of money in the same way that we might be affected when we have to return to work spaces and juggle parenting demands at the same time. So I’ve introduced it in times when people are about to have a baby and contemplating what they will do with their infant when their baby is clearly giving those cues back. So there can be other spaces where it can work quite effectively because of the mindset of the parent in that journey of pregnancy or just pre becoming parents, of how they might like their journey to be different or what they would like to add to their journey with their child and learn.
(21:43): I think the importance in terms of where we provide infant massage is about thinking about the need of the caregiver and where they feel most comfortable to learn. So one-to-one work, I’ve worked with families in community who maybe are building that relationship with their child, they might be recently reunified, and I’ve worked one-to-one in that setting of building confidence. And the pauses we make sometimes are about acknowledging the work that a parent still might individually need to do in their own journey of mental health and wellbeing. I’ve met families occasionally where a baby not wanting massage, about showing different body movements could reflect some of the recent violence they’ve experienced from a partner or an intimate partner. And so that might be a trauma space that we first have to work with with that family, and finding support for that parent to move through those feelings might be more important than beginning infant massage at the time.
(22:39): So it’s adaptable, it could be one-to-one that scaffolds you in confidence to get to a group setting, and it’s wonderful if what you expect is going to happen in that community setting reflects some of the things you’ve already learned and the values of that. And I suppose the area that I’m exploring more now is the contemplative of time together. So this is my learning journey at this moment, is what can we learn in theory together with a doll and two dolls and learning strokes and learning permission, and then well, how do we integrate that into that space of being together?
Nicole Rollbusch (23:11): It’s fantastic that it’s so adaptable as well and can be used in different scenarios, even if there isn’t a baby present as well. I think that’s amazing.
Kerryn Roberts (23:20): Yeah. And that’s the challenge because if you don’t work from a relational format with this, you can get it very wrong. So if you only work from strokes, I’m going to teach strokes to a parent, you miss the mark of all the other opportunities that could exist for that parent within that framework.
Nicole Rollbusch (23:37): That leads me to my next question, which is about what you would suggest for practitioners who are listening and they’re interested in learning more about this cue-based infant massage, what would you suggest for them?
Kerryn Roberts (23:50): Sure. I suppose it’s thinking about is it professional development that you’re learning of scaffolding of families and holding alongside them, developing your own confidence in not doing for them, but doing with them or invitations to cheer them on and support positive styles in a way that doesn’t have to take over that responsibility. So families might be coming to a children’s centre space, everybody is connected to infants and they want to hold infants and say, “I can be that other person for your infant and you can do something.” But in this space, we’re not interrupting that relationship. So is the mindset of why you want education, is it about learning to hold that space with the family and build on what you see exists as strengths, or is it to take over in that moment and teach, which can sometimes come under an educational model for children as they grow as well, where we read the book to children rather than scaffold a parent to support a child to explore a book.
(24:48): So this is that alongside work, so I think it depends on why you want to do a program. In June this year, the Australian Institute of Social Relations is launching baby massage, cue-based infant massage as a professional development program. So that specifically is looking at that space of whether people are coming from a health model or a community-based model and looking at their own professional development of infant led practise in this space, using the tools of infant massage to work with and alongside families.
Nicole Rollbusch (25:21): Oh, that’s fantastic that RASA has a program coming out and we have a link on our website that people can access if they want to learn more or want to express their interest in joining that program. We’re coming to the end of our time together, so I just wanted to ask you about any final words you have or wanted to share about infant massage and infant mental health.
Kerryn Roberts (25:43): Sure. I just wanted to say that though we might use the language cue-based infant massage or baby massage, the massage of babies is actually an ancient practise which has been shared across all the world continents for hundreds or thousands of years. There are probably as many different styles and approaches to massage across the world, but to most cultures, the concepts are universally familiar. So it’s not a program that’s going to be seen as something not helpful in most circumstances, it’s going to be seen as adding value to things that you might do with parenting with your child. And in our case as well, where the relationship is truly built on and valued is our approach model, that’s why we add the word cue-based in our services. One of the issues of not having universal competency standards in relation to infant massage is that if you teach a few strokes or you invite someone to Google something on massage, you potentially miss an opportunity to observe and scaffold a relational experience.
(26:43): For example, in the space of looking and wondering, if a parent has a condition like postnatal depression, and it’s difficult for them to maintain eye contact and respond with the appropriate affect because this might be difficult in the situation they’re in. If we’re not alongside them, we can miss that opportunity to support their awareness about healthier connections and other pathways to support this to happen, potentially even to better support a lifelong relationship with their infant and have stronger foundations in that space. So perhaps rather than doing two, by just handing off as much information as we can quickly, in this space of relational work we’re doing with, and then with, that cycle gets repeated, not doing two, or having to discover the world for yourself or realise in retrospect, that was a point that might have helped to have someone scaffold or be alongside you or even just celebrate what’s happening.
Nicole Rollbusch (27:39): Yeah. So that the relationship between the parent and the baby and also that alongside relationship of that dyad with the practitioner, is the important part of this work.
Kerryn Roberts (27:53): Yes, it is. It is. And the celebration of growth in us all, I think.
Nicole Rollbusch (27:58): Yeah. Well, thank you so much for joining me today, Kerryn, I’ve loved talking to you about cue-based infant massage and learning about it. So really appreciate your time and so thank you.
Kerryn Roberts (28:10): Thank you, Nicole. It’s been a pleasure.
Narrator (28:13): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practise. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health, under the National Support for Child and Youth Mental Health Program.