Baby Massage

Children’s Centres









Local Evaluation Report


Baby Massage








Prepared by Sarah Taragon
Red Door Associates

June 2004

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Contents

Exec Summary
Page 2


Introduction


BM
Page 3

Keystone BM courses
Page 4


Methodology
Page 5


Results

Observation
Page
5
Questionnaires
Page
5
Interviews
Page
7

Attendees – analysis
Page 8
Cost
Page
8


Conclusions

General
Page
9
Targets
Page
9

Cost benefit
Page 10


Recommendations Page
10


Tables
Table 1 - Targets Identified by Programme Manager for Baby Massage
Page 4
Table 2 - Targets Identified by Baby Massage Tutor


Page 7
Table 3 – Evaluators view of the targets currently met


Page 9
Table 4 - Indirect impact on targets and potential to meet

Page 10
additional targets


Appendices
Appendix A – References for information on impact of baby massage
Appendix B – Keystone’s targets
Appendix C – Evaluation Questionnaires and schedules


Notes
• Throughout this report “Keystone” has been used as a shortening for Keystone Sure Start
Children’s Centre
• The term “mother” is used to refer to the carer of the baby attending the course and
potentially covers other relationships (though in fact, all those attending to date have been
mothers).


Acknowledgements
Many thanks to Kay Beuzeval (Course leader) for her input and support with this evaluation and
also to all those attending the November/December courses.

Thanks to Sam Magne & Angela McTiernan of Red Door Associates for advice on editing of the
report.



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Exec Summary

This report provides an evaluation of the baby massage courses provided by Keystone, focused
mainly on courses delivered during November/December 2003. Courses consist of five weeks of
2 hour sessions and are run by Kay Beuzeval a local massage tutor specialising in baby massage.
Courses are run in local community centres/accessible venues and are attended by an average of
8 carers per course with their babies. Courses are run in an informal and practical way so that all
attendees are able to practice the different massage techniques and movements. As well as baby
massage, the courses teach about more general parenting skills and child development.

A number of research tools were used in evaluating the massage groups including: participant
observation by the researcher; evaluation questionnaires to attendees (completed by seven
carers); semi-structured interview with course leader; and desk research on benefits of baby
massage and analysis of monitoring data. This evaluation did not look at the long term impact of
baby massage for the baby (as this is already well documented) but focused on the benefits for the
mothers attending courses and the impacts/benefits of the courses in terms of Keystone’s targets.

The results show that the courses: are enjoyed by participants; are meeting their aims in teaching
baby massage skills; are low cost; are providing wider parenting information/skills; and provide a
good way for new mothers to network and get access to other support and groups. However,
those who could perhaps gain most from the courses are not attending (eg those with special
needs, bonding issues).

The following are the Keystone targets that the Baby Massage courses help to address:
• Parenting support & info available for parents
• Raised levels of confidence & self esteem & reduced stress experienced in relationships
between children and parents.
• Information & guidance provided for mothers on breast feeding, nutrition, hygiene and
safety.
• Promote up-take of learning opportunities for adults
• Cross referral between services, increasing access to support
• Creation of self-organised groups & support services

Recommendations based on the results, include the following:
• Continue to run the courses on a regular basis – and investigate ways of mainstreaming the
courses
• Targeting & widening attendees – eg trying groups for teenage mothers, babies with
special needs, and fathers. This would increase the targets the courses help to meet.
• Consider piloting one-to-one massage tutoring for families with particular needs
• Consider widening the scope of the courses to include more of the general parenting
information – or link people directly into follow on courses on other practical techniques or
parenting issues etc (eg learning to play courses).
• Formalise the links between the baby massage courses and the local parent & toddler
groups (eg Babalicious) so that it is easier for people to move on to these support/social
mechanisms.

Congratulations should go to the course leader for the positive impact these courses are making
for many families.

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Introduction
This report provides an evaluation of the baby massage courses provided by Keystone, focused on
courses delivered during November/December 2003. The Evaluation has been undertaken by
Sarah Taragon of Red Door Associates (Keystone’s Local Evaluators).

Background - Baby Massage
There is much research that has been done internationally to document the impact of baby
massage – both for the baby and their carer. The following benefits are widely documented (in this
case sourced from “Benefits of Baby Massage”, Saasha Pleka - www.beyondfertility.com):
• Premature infants who are regularly massaged are hospitalized an average of six fewer
days than non-massaged babies (USA today, May 28 1996)
• All infants, whether premature, underweight or healthy/full-term, thrive and benefit from
massage
• One study showed massaged infants gained 47% more weight than unmassaged infants
given the same number of calories (Tiffany Fields, Uni of Miami School of Medicine, “Tactile
Kinesthetic Stimulation Effects on Preterm Neonates” Pediatrics Journal 777, 1986)
• Massaged babies are more alert when awake, more easy to soothe and readily able to
sleep
• Massage teaches a baby how to relax
• Massaged babies showed better performance on the Brazelton Scale with habituation,
orientation, motor activity and regulation of behaviour
• Massage promotes emotional security, respect and a healthy body image
• Infant massage stimulates digestion, passing of gas, and relieves symptoms of colic
• Massage increases circulation and can assist with normal growing pains
• When parents massage their babies, they promote quality time, create better bonding and
increase confidence in their own parenting skills. They enhance intimacy, understanding
and the ability to nurture
• Nurturing touch is a natural way to relieve stress for both care giver and baby
• A parent who massages his or her infant becomes more aware of the baby’s cues and
learns to understand the baby’s special and unique needs

As Carla Steptoe (a nurse and massage practitioner) states (www.infantmassage.com):

Benefits for infants
• Improves immune system
• Helps baby learn to relax
• Promotes sounder and longer sleep
• Promotes positive body image
• Promotes bonding and communication
• Helps to regulate digestive, respiratory, and circulatory systems
• Helps relieve discomfort from gas and colic, congestion & teething
• Decreases production of stress hormones

Benefits for parents
• Provides a special focused time that helps deepen bonding
• Helps parents to understand and respond appropriately to baby’s nonverbal cues
• Promotes feelings of competence and confidence in caring for baby
• Improves parent-infant communication
• Increases parents ability to help child relax in times of stress

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• Eases stress of parent who must be separated from child during the day
• It is fun and relaxing for parents to massage their children

Other benefits
• Cross cultural studies show that babies who are held, massaged, carried, rocked and
breast fed grow into adults that are less aggressive and violent and are more
compassionate and cooperative.
• Recent research shows benefits for premature infants, children with asthma, diabetes and
certain skin disorders.
• Mothers with post natal depression have shown improvement after starting infant massage
• Teenage mothers have shown improved bonding behaviour and interactions with their
infants.

Please see Appendix A for further references to research related to baby massage impacts.


Keystone’s Baby Massage Courses
The programme runs regular baby massage courses. Courses consist of five weeks of 2 hour
sessions and are run by Kay Beuzeval a local massage tutor specialising in baby massage.
Courses are run in local community centres/accessible venues and are attended by an average of
8 carers per course with their babies. Courses are run in an informal and practical way so that all
attendees are able to practice the different massage techniques and movements. As well as baby
massage, the courses teach about more general parenting skills and the importance of eg building
in time for one-to-one space with your baby, and the importance of bonding/respect for your baby.
The courses pass on an ethos of parent/child time and teaches about communicating with young
babies and reading their needs. The courses give parents confidence in listening to their child
which builds self esteem and permission to behave positively to their child. The courses also build
in the opportunity for parents to learn from each other and discuss practical and emotional issues
involved with being new parents.

The Sure Start Programme Manager identified the courses as hitting the following targets for the
programme: ie the reasons for running the courses (please see Appendix B for more details of the
objectives and targets of Keystone’s programme):

Table 1 - Targets Identified by Programme Manager for Baby Massage

Improve Social & Emotional Development
1.4N Parenting support and information available to parents
1.2N Agree & implement (in culturally sensitive way) care for mothers with Post Natal Depression
2.9L Provide support to parents in times of crisis
Raised levels of confidence and self esteem amongst parents and reduced stress experienced in
relationships between children & parents.

Improve Health
2.2N Information & guidance provided for mothers on breast feeding, nutrition, hygiene and safety
2.8L Increased health promotion work

Improve Ability to learn
4.6L Promote take-up of learning opportunities for adults

Strengthening Families & Communities
4.3N, 4.7L Families empowered to steer Sure Start programme, services & planning through
positions on parent & exec boards, parent forums and working groups
Cross referral between Sure Start services, increasing access to support



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Consultation Methodology
This evaluation has not looked at the long term impact of baby massage for the baby – as this is
already documented we are taking this as a given (see evidence in the Introduction to this report).
We have focused on the particular benefits for the mothers attending courses and the additional
impacts/benefits of the courses, particularly in terms of the Keystone targets.

A number of research tools were used in evaluating the November/December massage groups:
• Participant observation by the researcher (and her baby) in one course
• Evaluation questionnaires to attendees at both courses (see Appendix C) – nb at one
course, one of the questionnaires was completed on large wall posters
• Semi-structured interview with course leader
• Informal feedback from other Keystone staff
• Desk research on benefits of baby massage

In addition, analysis of monitoring data of attendees of courses between November 2003 and May
2004 was undertaken.



Results

Observation
Participant observation in the course gave the evaluator the best possible understanding of the
way the courses are run and the experience of attending the courses. A summary of her main
observations can be found below, and her experience in attending the course underlies the rest of
this report.

• All those attending enjoyed the experience – babies and carers
• Courses provide an excellent bonding opportunity for mothers/carers through joint learning
in a safe space
• The tutor was excellent at making the space feel comfortable and relaxed and understood
that the babies all had individual needs and may not be fully partaking in massage at all
times
• Mothers were made to feel very comfortable to let their babies cry, sleep, feed etc
• The course was an excellent way to pass on more general parenting advice and
information – particularly on respect for your baby, non-verbal communication, physical and
quality time with your baby etc – and the tutor made good use of this opportunity
• The course was practical and non academic (therefore accessible to all) and gave a large
amount of information enabling attendees to take the skills away with them
• Good back up sheets & written information was provided along with references for
additional books/resources for those who wanted them
• The course enabled sharing of much information between mothers on issues they were
facing, on equipment and on solutions to problems/queries
• The course provided a good introduction to Sure Start activities and was well linked to the
local parent & toddler group (Babalicious) and the toy and book libraries (which visited the
venue during a couple of the sessions)

Questionnaires
“Gained information outside
Feedback from the course participants is summarised below. For a
of massage from other
copy of the questionnaires used and the post-it consultation process,
mums and what they do with
please see Appendix C. Three people completed the two
their babies.”

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questionnaires, and four gave comments on the post-it consultation (around 60% of those signed
up for these two courses).

What people liked was:
“Learning a new skill and
• Gaining a new/improved skill (7)
being able to help my
• The atmosphere (5)
baby when he has wind.”
• Sharing experiences with other mothers (5)


The only thing people said that they disliked about the course, was it starting so early in the day.

Three people gave ideas for future courses, and one stated that it didn’t need improving:

“perhaps watching a video – perhaps a couple of weeks longer”
“me being there every week – but Kay very good at showing what we had missed”
“I don’t think there was enough time allowed to feed, change, sleep & massage. Cushions
for mums to sit on”

The majority of comments made about changes to their own
“Aware of making baby
behaviour, focused on spending more time with their baby (3),
& surroundings less
relaxing more with and around their baby (4) and being more
stressful and aware of
aware of the things that stress their baby (2).
their ways of

expressing themselves.”

Learnt… “that babies
“Confidence in

pick up on your feelings
handling my baby”

and behaviour”



Seven comments were made relating to their baby’s behaviour. Most simply stated that their baby
enjoyed the massage. One person said that their baby slept better following a good massage and
another that massage had calmed her baby down before her bedtime feed.

Seven mothers completed the second evaluation questionnaire (see Appendix C). Four attended
the Stonehouse course and three the Keyham one. Two people had found out about the course
from the midwife, two at antenatal classes, one through their health visitor, one from a friend and
one from a leaflet in a shop. The reason most people attended the course was to learn baby
massage, share an experience with their baby. All the respondents said the course had given
them the information and skills they expected.

One person had used other Sure Start services – the others were all new to the programme’s
services. Two of the new users, have gone on to use other Keystone services. All the
respondents said they might (5) or would definitely (2) use other Keystone services in future.

The following are suggestions for other support/activities respondents felt that Sure Start could
provide:
• Family outings, holiday activities, parent groups, other courses on new skills
• Would like to attend Indian head massage course (for pampering)
• Baby signing
• More baby and parent groups


Attendees at all the courses fill out an evaluation form devised by the Tutor. Details from
seventeen of these forms (from courses held April 2003 – March 2004) were available to the
evaluator. These showed that those attending find the courses clear to understand and

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comfortable to take and see some change in their relationship with their baby following the course.
All the attendees said they would recommend the classes to others. The following are quotes
taken from the forms:


I feel much happier
“I have really enjoyed the

“I thought baby massage
with my baby now.
massage class. It’s given me

was good as I thought I
Massage has given us
a chance to learn massage

bonded with my baby a bit
something special to do
properly, bond more with my

better – it also helped to
together.”
baby and meet other mums

& babies.”
relax and unwind.”




Interview with Tutor
Part of the interview with the course tutor (Kay Beuzaval) focused on the Keystone targets and part
on what benefits she sees from the course and the informal feedback she had received (see
Appendix C for a copy of the interview schedule).

The targets that the tutor felt that the baby massage courses helped to meet are shown below.

Table 2 - Targets Identified by Baby Massage Tutor

Improve Social & Emotional Development
1.4N Parenting support and information available to parents
1.2N Agree & implement (in culturally sensitive way) care for mothers with Post Natal Depression
1.5L Reduce incidence of domestic abuse in families
local Raised levels of confidence and self esteem amongst parents and reduced stress
experienced in relationships between children & parents.

Improve Health
2.2N Information & guidance provided for mothers on breast feeding, nutrition, hygiene and
safety

Improve Ability to learn
3.5L Provide services for children with special needs

Strengthening Families & Communities
4.3N, Families empowered to steer Sure Start programme, services & planning through positions
4.7L on parent & exec boards, parent forums and working groups
4.6L
Promote up-take of learning opportunities for adults
Local Creation of self-organised groups and support services
Local Cross referral between Sure Start services, increasing access to support

Discussions with the tutor on the benefits of the course mainly focused on the additional benefits ie
assuming the documented benefits of massage itself. Much of the discussion was focused on the
group support that occurs within the courses – the courses are particularly effective in building
strong links between attendees which are often developed after the courses finish. The best
example of this was the setting up of Babalicious (a parent and toddler group) by attendees at one
of the courses. However the tutor is aware of many informal networks that the course has
enabled. Within the courses much support and learning takes place between attendees – the
courses are run in such a way to enable this to occur.

The tutor felt the link with Keystone was valuable – the programme provides the venues, materials
(towels, mats, oil etc) and publicises the courses. The courses often provide a good introduction to

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Sure Start which builds an involvement with the programme. The tutor works with the community
development worker to try and involve attendees in other Sure Start services.

Because of the nature of the courses (ie practical), they are accessible to all and anyone attending
can learn a lot from them. There are no barriers due to literacy, past experience or language.
However, there may be some cultural issues for women from some ethnic backgrounds in
massaging male children in public.


Analysis of Attendees (November 03 – May 04)
During the six month period November 2003 – May 2004, a total of 41 mothers with their babies
attended baby massage classes run by Keystone. 51% (ie 21) were from within Keystone’s area.
Three families (7%) attending had one parent whose ethnic background was other than white
british (2 white – other, and one other mixed). One family attending spoke Spanish as their first
language – all other families had English as their main language spoken in the home. Two of the
attending mothers (5%) had disabilities/special needs.

Ten of those mothers attending, joined
Attendees Ward (Keystone Area)
Keystone directly at the Baby Massage
course – however, only 2 of these were
actually with Sure Start’s area. The
14
courses are aimed at babies under 6
12
months, and the majority of babies
(64% of those for which we have
10
information) were 3 months or less
8
when they started the courses.
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2

St Peter
Keyham
Stoke
0



Cost
The overall costs of the classes are as follows: £250 for tutorial fees; £5 p/h venue rental (£75 per
course). In addition, during the first 2 years of running courses, £600 has been spent on
equipment (including massage mats, books, oils etc). The overall cost of each course is, therefore,
£325 plus a proportion of equipment costs – in the case of the 6 month period for which we look at
attendee statistics, this would work out to around £3.65 per person (£150 over 6 months to 41
attendees). The cost per person per course (based on an average of 8 mothers and their babies)
is, therefore £44.28 for a five week course (including handouts and oil) ie £4.41 per hour. This
would be generally comparable with the cost of an evening class if taken with a local college. It is
considerably cheaper than the alternative of using a health visitor to show a mother how to
massage - the average cost for hourly child contact being £34 (Source: NESS Cost Effectiveness
Evaluation Methodological Report, Sep 2001).

Currently, attendees do not pay anything towards courses whether they are in the Keystone area
or not, so all costs fall to Keystone.



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Conclusions
The results show that the courses are enjoyed by participants, are meeting their aims, are low cost
and provide a good way for new mothers to network. The following bullet points summarise the
conclusions made based on this Evaluation:

• The courses are providing a positive (often initial) introduction to Keystone to local mums
• The courses are enjoyed by attendees and provide a comfortable way to learn a new skill
and more about babies and parenting
• The courses provide a good way to meet other mothers and to get plugged into informal
support networks and other parent & toddler groups
• Attendees are learning more than just massage techniques – also about respecting their
baby, learning their distress signals and how to listen to their needs, and how their own
behaviours and stress impacts on their baby
• The courses have a low unit cost for something that gives new mothers support and
techniques for coping now and in the longer term
• Massage is well documented as being beneficial to babies health and to the relationship
between baby and carer
• 50% of attendees are not from within the Keystone area


Taking into consideration all the feedback, my own experience in attending the courses and the
views of the course leader, the following tables show the keystone targets that the Baby Massage
courses are currently helping to meet, and those which there is potential for them to meet or which
are being met in an indirect way. Those marked with (a) were those targets originally identified by
the Programme Manager and those marked (b) are those the course tutor identified.

Table 3 – Evaluators view of the targets currently met
Target
Target Comments

Ref
Improving Social & Emotional Development
1.4N
Parenting support & info available for
Through informal parenting information and sharing of
(a) (b)
parents
experiences between attendees. There is scope to
develop the impact the courses have on this target.
Local
Raised levels of confidence & self
The courses provide a means of mothers/carers
(a) (b)
esteem & reduced stress experienced
gaining confidence in handling their baby and
in relationships between children and
techniques to relax baby & mother. This target is
parents.
probably the one the course has the most impact on.
Improving Health
2.2N
Information & guidance provided for
Through informal parenting information and sharing of
(a) (b)
mothers on breast feeding, nutrition,
experiences between attendees. There is scope to
hygiene and safety.
develop the impact the courses have on this target
through extending the courses.
Strengthening Families & Communities
4.6L
Promote up-take of learning
Attendees learn a new skill through attendance on the
(a) (b)
opportunities for adults
course (ie a learning opportunity in itself)
Local
Cross referral between services,
The courses are well linked to other Keystone
(a) (b)
increasing access to support
services thru the venues and the community dev
worker.
Local
Creation of self-organised groups &
There is one good example where one of the courses
(b)
support services
led to the setting up of a parent & toddler group by
those attending the massage course. The courses
are excellent for bonding through the shared learning
experience.



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