RESEARCH ARTICLES

 
The use of massage to relieve colic and gases in newborns

Elizia Moraes Ramos^I; Liliane Faria da Silva^II; Emilia Gallindo Cursino^III; Maria Estela Diniz Machado^IV; Dayanna Santos de Paula Ferreira^V

ABSTRACT: It was aimed to analyze possibilities of the use of massage technique to ease colic and stomach gas in newborn babies performed by the mothers. Descriptive qualitative study, developed in conjunct housing of a University Hospital in Rio de Janeiro, through semi-structured interviews with 10 mothers. Data were submitted to content theme analysis. The mother’s knowledge about methods to ease colic and stomach gas is diverse. Some of them know the massage, but it’s not always used. However, it is recurrent the use of pharmacological methods many times without appropriated supervision. They showed receptive on demonstrating the massage technique because it is easy to use and pointed the possibilities and impossibilities of using it at home. It is concluded that the conjunct housing environment is propitious for the nurse to teach the massage technique to ease colic and stomach gas on newborn babies.

Keywords: Massage; colic; newborn; nursing.

INTRODUCTION

Infantile colic and gases (flatulence) consequently cause excessive crying representing source of stress for parents and one of the main complaints in child well fare¹. Therefore, it is important that the professional responsible for the care and care of the newborn learn about proper management to identify and relieve colic and gas.

The recognition of signals of pain or discomfort caused by the above situations, it is not so easy, and then it is necessary that professional caregivers, especially nurses, have the tools to decode the language of pain. Currently pain assessment is made using scales that assess physiological and behavioral parameters alone or combined, helping to determine the necessity or otherwise of specific intervention^2.3.

When mother and baby go home, the newborn may occasionally experience colic and gas. In this sense, nurses can guide the family as to the identification of pain signals and appropriate intervention with the use of methods to minimize this pain.

Actually, about care to newborns, the family is the primary caregiver and their participation is fundamental, so it is necessary that the health team in the east precautions to take, especially targeting those who may be performed after discharge⁴.

Often there are several forms of treatment to combat colic and gas, where pharmacological is the indicated by health professionals. Henceforth, studies show massage as a safe and effective intervention to combat the symptoms of colic and gas⁵.

After identification of the colic, mothers and other family members can be guided by professionals to intervene with the use of massage, which helps the baby relax, and thereby reducing colic, besides contributing to intestinal outgassing⁶. Thus, among the possible methods for relief of colic and gas found in studies^7-9, this research will address the massage. The choice of this type of intervention has to be easy to perform and can be employed for the relief of the main problems presented by infants after hospital discharge, including colic and gas¹⁰.

In this perspective, this study aimed to identify the methods that mothers known to relieve colic and gas in newborns; to advise mothers about the classical massage technique to relieve gas and colic in the post-discharge; and analyze the possibilities of application of classical massage technique to relieve colic and gas by mothers.

LITERATURE REVIEW

Infant colic is a common condition that affects newborns and interferes in the care of the parents to the baby. The family often has trouble dealing with the agitation and excessive infant crying, which increases the demand for the health professional and the use of allopathic and herbal self-medication. The prevalence of infant colic varies from 8% to 40% of live births, with a higher percentage due to the introduction of artificial milk and food. Another cause of variation may be the definition of infant colic studies^5.11.

Infant colic is considered a paradox of irritability, crying or shaking lasting for more than three hours per day, for more than three days a week and for more than three weeks, and the natural course of colic is resolved after 3 to 4 months^5,11,12. Recently, we developed a colic measurement tool more sophisticated, the Infant Colic Scale (ICS)12; parents fill out a daily form (ICS) in order to measure the amount of crying and irritability.

As symptoms of colic, it is observed in baby contracted motor activities, high legs, distended abdomen and excessive removal of gases, however the children are healthy. There are several mechanisms and causes of infant colic, as food allergy, immature gastrointestinal function, difficulties with mother-infant interaction and maternal smoking, being evident that the mechanisms are probably multifactorial^5.11.

Due to the air swallowed by babies while crying and feeding, and therefore an immature system, the propensity to produce larger quantities of these gases, which can cause discomfort and pain, corroborating distress of parents¹³.

The long-term consequences of colic and gas are little studied, and results in health, behavior and development are contradictory. Some surveys indicate future problems related to behavior, feeding and sleep pattern, although other studies showed normal on these  aspects⁵.

There is no effective and safe treatment for colic and treatment of gases. However, it is evident that many non-pharmacologic strategies are suggested against pain in newborns caused by gas and colic. So the health care professional embraces preventive measures (considering family predispositions, prenatal teaching and rooming-in), environmental measures (stress reduction, from the reduction of noxious stimulus) and behavioral measures (breastfeeding, classic massage with or without the aid of oils and multisensory stimulation)^5,11-13.

The classic massage is a method known traditionally in the treatment of colic, gas, over the generations, the most used by babies is massage for deep and superficial slip, and less often, it uses kneading, friction and tapping. The massage should be done in a comfortable, quiet and warm place, respecting the will of the child. The child should be naked and on a bed sheet, towel or diaper, or even on a pillow or the lap. Full massage lasts 20-30 minutes and may be accompanied by passive exercises^5-10. For babies under four weeks (including premature) the approximate duration is 10 minutes¹⁰.

Studies have shown that parental involvement in the care of the baby until three months of age, found that there is uncertainty in handling the baby for fear of hurting him, they prefer drug therapy, alternative therapy than the baby should be manipulated^5,11,14. These data reinforce the need for professional action to empower families to care.

Care may be targeted during the hospitalization in which the nurse during their guidance can assume a relationship with family cooperation and support, and after teaching, to observe whether the guidelines were learned and successfully seized⁴.

In this sense, the nurse can act together to mothers and caregivers of babies by promoting workshops for exchange of information and guidance for home care, and identification of gas and colic in newborns, and family intervention against such episodes.

METHODOLOGY

Descriptive qualitative research. This methodology allows unveiling social processes still unknown for particular groups¹⁵.

The scenery was rooming-in of a maternity a linked to a Federal University located in the State of Rio de Janeiro Hospital. The subjects were 10 mothers of newborns who were hospitalized to the accommodation during the period of data collection.

Inclusion criteria were: mothers aged 18 years old; mothers who were most of the day with their children. Exclusion criteria were: infants with congenital malformations that could offer technical risks; babies in unstable representing some risk.

Data collection took place in May 2013 and was conducted through semi-structured interviews. It happened in three stages: In the first stage we used the following interview questions: what methods did you know or use to relieve colic and gas? Do you know or have ever used the massage? The following answers were recorded.

In the second step, we demonstrated the technique of classical massage, with the aid of two dolls with cloth body. A doll was with the mother and the other with the researcher. The step by step massage was performed along with mothers and lasted approximately eight minutes.

After the demonstration of the massage, it was the third step - we continued the interview with the following questions: Tell me about the technique I demonstrated. Do you believe that you can do the massage at home?

The interviews were transcribed and subjected to thematic content analysis, developed in three stages: pre-analysis, selection of units of analysis and categorization process¹⁵. To that end, after successive readings for apprehension of meaning expressed in the contents and identification of emerging themes, it was proceeded to the organization, interpretation and analysis of these issues with their revealing excerpts from the speeches of the senses and perceptions of mothers about the possibility of the use of massage in the relief of colic and gas in newborns. The study was approved by the Ethics Committee of the hospital under paragraph 225.660/2013 opinion, concerning Resolution No. 466/12 of the National Health Council

Anonymity was preserved, which were identified by Mother 1, Mother 2... according to their number of study entry.

RESULTS AND DISCUSSION

With the process of analyzing the empirical material, the following thematic units emerged: the methods known by mothers to relieve colic and gas in newborn and possibility and impossibility of the use of massage by mothers after the demonstration of the technique of classical massage.

The known methods for mothers to relieve colic and gas in newborn

When asked about the methods they knew to relieve colic and gas, eight mothers talked about some known methods and two respondents did not know any method.

Among mothers who knew some method, seven cited the pharmacological method and they used allopathic medicines, Luftal ® and Buscopam ®.

Ah! Only medicine that everyone uses: Luftal, buscopam. (Mother 3)

Only Luftal and buscopam, but it's because I use it to myself. (Mother 6)

Newborns are vulnerable to popular customs and beliefs, since this is the period that is totally dependent on the mother care¹⁶. In this perspective, the medicines, Luftal ® and Buscopam ®, being commonly used by their mothers are sometimes offered to the child without prescription, being self-medication.
Self-medication is a practice that can be defined as the use of medicines (allopathic and/or herbal) by individuals or their guardians to treat disease or relieve symptoms. This practice can be harmful to health, especially when dealing with children, such as adverse events, errors in dose, intoxication or even worsening of the disease¹⁷. The main cause of drug poisoning among children under five years old comes from self-medication, which refers the use of drugs without proper prescription or medical supervision and guidance. Self-medication can occur in cases of common diseases, especially fever, colic and common cold¹⁸.

Besides having stressed the use of allopathic medications, mothers also cited the use of “funchicórea” medicine and teas.

That little powder (funchicória) on a pacifier. (Mother 7)

Tea in the bottle. (Mother 10)

The “funchicórea” is an herbal medicine, presenting in powder form, which can be diluted in the bottle or put it in a pacifier. It consists of extract of chicory root powder, the essence of the plant called fennel, sugar and magnesium carbonate. It is noteworthy that the use of funchicórea was banned by the National Health Surveillance Agency (ANVISA) in February 2012 because its therapeutic effects are not proven¹⁹.

Regarding the use of teas, studies have shown that widespread use by parents of medicinal teas to various complications in the baby's routine, and the act of offering tea to children occurs, part of the culture of the last families for generations^16.20.

Regarding the use of teas and funchicória in the pacifier is necessary to understand that these can interfere with the maintenance of breastfeeding, which is a recommendation of the World Health Organization (WHO), being wxclusive in the first six months and complementary for 2 years or more²¹. The attitude of not offering pacifiers, as well as delaying the introduction of water and/or teas children are characteristics and behaviors associated with the increased possibility of continuation of breastfeeding²².

Some mothers cited the position belly to belly, the belly massage and movement of the legs of the newborn to simulate pedaling the bike as methods that assist in relieving colic and gas.

I put the baby´s belly with mine. (Mother 3)

Put the baby´s belly with mine and do little bicycle movement on his legs. (Mother 9)

Massage the belly and legs. (Mother 10)

The possibility or impossibility of the use of massage by mothers after the demonstration of the technique of classical massage

In the third stage of the interview, after the demonstration of massage with the dolls, mothers talked about the technique demonstrated and the possibility to use it at home.

Three themes emerged in this subunits theme: the possibility of the use of massage to relieve colic and gas in newborns; the possibility of the use of massage associated with medications to relieve colic and gas in newborns; and the impossibility of the use of massage to relieve colic and gas in newborns.

The possibility of the use of massage to relieve colic and gas in newborns

Five mothers positively evaluated the use of massage stating that they will use in their routine home care.

I found it the proper technique and completed [...] I think it is good to use it at home, because during the baby care we want most is to be snuggle, caressing, and that massage can help to have this moment. (Mother 5)

I found it very interesting and easy to do, I will do it with my daughter. [...] I liked it because we don´t need to fill the girl with medicine because child has colic as hell. (Mother 8)

The statements above have pointed out that the use of massage is easy to perform, contribute to the rapprochement between mother and baby to provide a moment of affection and avoid the indiscriminate use of medication, since gas and colic are a common occurrence in newborn.

Considering the benefits of massage and responsiveness of mothers with respect to the learning massage technique, it was observed that during the service of the mother-infant rooming-in environment, nurses can perform actions on health education. Such educational measures should be aimed at helping mothers in the use of massage in order to collaborate appropriately for baby care at home, contributing to the promotion of child health.

The nurse is a professional who has the education of patients as one of its main functions, so this can transform the health service in place conducive to learning through educational activities in health. It is important that different strategies are used in health education and create situations that address content that contribute to learning and enable some personal and social transformation²⁵. Therefore, with the attitude of awareness among mothers, the professional will give subsidies for empowering them as the care of the child in the context of the household.

The role of the nurse is recognized as a crucial strategy in coping with multiple health problems that affect people and their social contexts. Nurses have highlighted, since it is the leading player in the healthcare through health education process²⁶.

The possibility of the use of massage associated with medications to relieve colic and gas in newborns 

Two mothers said they would use the technique at home, though one said the use of the technique would occur with the medication already known to her, and another mother who would be an alternative if there is not an available medicine.

I think I'll use it, but not alone, I will give the medicine together. It is good that the effect will get faster. (Mother 4)

Ah, it is a way if we don´t have the medicine [...] I'll try to use it. (Mother 3)

These statements refer to the issue of self-medication, as they said they would use it together, moreover, were reluctant to accept that the use of massage alone can solve the discomfort provided by colic and gas.

Study in which the authors followed a baby for two months and taught the mother how to perform the massage, and at regular intervals, concluded that massage led to the abolition of the use of drugs, thus becoming an instrument for pain relief to the baby, being an incentive to use the massage⁹.

Knowing the risks of self-medication, especially for newborns and infants, it is confirmed the need for health education aimed at discouraging drug use without indication and guidance of a qualified professional¹⁷.

From this perspective, it is believed that mothers have the contact information for the management of colic and gas non-pharmacological methods such as the massage, may decide safer by adopting them.

The educational activity should promote reflection and understanding of mothers and other family members, as they can act decisively in the routine care of the child, using their knowledge and experience to recognize signs of distress in the baby that deserve appropriate interventions.

The impossibility of the use of the massage to relieve colic and gas in newborns

Even after the demonstration of the technique, two mothers were unsafe to use the technique at home. They were afraid of doing something wrong, because they found the technique difficult and even said they would need more time to train.

It is very simple, and it seems that even helps the baby. I do not know whether to use at home, because alone I think I'll be afraid to do it wrong. (Mother 3)

It's pretty cool the way to do it, but I found it a bit difficult. I do not know whether to use at home, and if I did mistake? I'm insecure, but I'll try, I promise. [...] I need to train more, but it's cool the way to do it. (Mother 6)

The nurses needs to understand the context and the mother and help her in the care directed to her child, or the mother should consider cultural care and their past experiences, as well as she does not feel with scientific and technical knowledge but articulate these aspects in order to make beneficial the care of the newborns¹⁶.

It is in this perspective that the teaching of massage to relieve colic and gas in newborns aims to promote healthy stocks after discharge, then it becomes critical to advice the mother properly. The evaluation of the effectiveness of the guidance offered noteworthy in this context, since two mothers reported being afraid of performing the maneuvers of the massage alone.

The massage should be inserted slowly into the routine of the baby and should be a time of enjoyment, not a torture. It is up to each parent to decide the best way and time to do the massage on their child, so that is pleasurable for both. Currently, it is understood that the role of nurses passed the simple act of guiding or to impose, to favor the awareness of people about the situation in which they live and the consequences of their choices for their health. In this sense, it is not just teaching the technique, it is necessary to assess whether the means used are adequate to achieve the objectives outlined²⁶.

CONCLUSION

The mothers' knowledge about methods to relieve colic and gas was varied. The use of drugs and medicinal teas showed a strong culture on the use of pharmacological and herbal or allopathic methods, most times without the proper guidance of a health professional. It was noticed that some mothers already knew the massage but not always used it.

The action of the nurse in guiding about this practice could help reduce the indiscriminate use of drugs and allow mothers to develop a welcoming, resolute, nurturing touch so necessary to the baby in painful situations, and strengthen the parent/child bond.

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