Journal of Maternal and Child Health (2022), 07(01): 64-74 Meta Analysis

Masters Program in Public Health, Universitas Sebelas Maret

Meta-Analysis the Effect of Baby Massage in Increasing

Quality of Sleep and Infant Body Weight
Raina Lola Fauzia1), Uki Retno Budihastuti2), Rita Benya Adriani2)
1)Masters Program in Public Health, Universitas Sebelas Maret
2)Faculty of Medicine, Universitas Sebelas Maret

ABSTRACT

Background: Sleep patterns and weight in infants are identified as one of the most important
topics related to infant growth and development. Baby massage is a slow and gentle stroke move-
ment throughout the baby's body starting from the baby's feet, stomach, chest, face, hands and
back. Baby massage is a form of touch stimulation. Babies who are massaged experience an
increase in vagus nerve tone (10th brain nerve) which will lead to increased levels of gastrin and
insulin absorption enzymes. Thus the absorption of food will be better. Therefore, body weight and
sleep quality increased more than those who were not massaged.
Subjects and Method: This was a systematic review and meta-analysis conducted using PRISMA
flow diagrams. Search articles through journal databases including: PubMed, Science Direct,
Google Schoolar and SpingerLink by selecting articles published in 2010-2020. The keywords used
were (“baby massage” OR “infant massage”) AND (“sleep quality” OR “baby sleep quality”) AND
(“weight gain” OR “baby weight gain”) AND “randomized controlled trial”. Inclusion criteria were
full paper articles with Randomized Controlled Trial (RCT) research methods, the relationship
measure used was Mean SD, the intervention given was baby massage, research subjects were
infants aged 0-3 years. Eligible articles were analyzed using the Revman 5.3 application.
Results: A meta-analysis of 16 articles showed that baby massage improved sleep quality (SMD
0.70; 95% CI= -0.05 to 1.46; p=0.07). In addition, baby massage increased body weight (SMD
0.52; 95% CI= 0.08 to 0.96; p=0.02).
Conclusion: Baby Massage has an effect on improving the quality of sleep and baby's weight.

Keywords: baby massage, sleep quality, baby weight gain.

Correspondence:
Raina Lola Fauzia. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami
36A, Surakarta 57126, Central Java. Email: [email protected] Mobile: 081215278321.

Cite this as:

Fauzia RL, Budihastuti UR, Adriani RB (2022). Meta-Analysis the Effect of Baby Massage in Increasing
Quality of Sleep and Infant Body Weight. J Matern Child Health. 07(01): 64-74. https://doi.org/10.26911/-
thejmch.2022.07.01.07.
Journal of Maternal and Child Health is licensed under a Creative Commons
Attribution-NonCommercial-ShareAlike 4.0 International License.

BACKGROUND the journal Pediatrics stated, as many as

Babies are children under one year of age 33% of infants had sleep disorders (Sadeh,
who have just entered the early stages of life 2012). In Indonesia, from several studies
marked by rapid development. The baby's conducted in 2017, 44.2% of children under
body will produce growth hormone while 3 years of age experienced sleep disorders
sleeping, so babies need enough sleep to get (Nugraheni et al., 2018).
optimal development (Dalili et al., 2016). Infant sleep quality is a measure used
Sleep disturbances in infants are a form of to assess the ease with which a baby can ini-
problems faced by parents. WHO in 2012 in tiate and maintain sleep. Sleep quality is

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

good if the length of sleep is balanced bet- and the environment, and physical abnor-
ween night and day sleep (Tekgündüz et al., malities such as cleft lip and cerebral palsy
2014). Babies with poor sleep quality have a (Pitre, 2012). Emotional and behavioral dis-
negative impact on their development, such orders, such as anxiety that affects social
as babies becoming emotional easily and interactions, examples of anxiety experi-
decreasing concentration and body immu- enced by children, namely anxiety about se-
nity. Factors that affect sleep quality in paration from parents, anxiety after expe-
infants include activity or fatigue, environ- riencing trauma (Sulis et al., 2017).
ment, health conditions and nutritional ful- According to several studies on the
fillment (Mardiana & Martini, 2014). Babies effectiveness of baby massage, babies who
aged 6-12 months need adequate sleep, so it receive baby massage therapy, growth and
is necessary to provide external stimulus in development of motoric, sensory, language
the form of massage therapy. One of the and social are faster and optimally according
massage therapies that can be done is baby to the baby's age. Their babies sleep more
massage (Sadeh, 2012). quietly, babies are not fussy and the baby's
Growth and development is a process appetite increases (Field, 2016).
that starts from conception to adulthood. Baby massage or baby massage is the
The period of infant growth and develop- oldest comprehensive touch therapy that has
ment is a golden period as well as a critical been practiced for decades which is believed
period of a person's development, namely at to affect infant development (Hartati et al.,
the age of 0-12 months (Massaro et al., 2012). Baby massage has benefits that can
2010). The golden period of infancy is very affect gross motor development in infants
short and cannot be repeated. It can be said besides that, baby massage is also useful for
to be a critical period because at this time increasing bounding and attachment bet-
babies are very sensitive to the environment ween mother and baby, increasing body
and need good nutrition and stimulation for weight, and increasing the quantity of baby
growth and development (Soetjiningsih & sleep (Khan, 2015). Baby massage helps in-
Ranuh, 2017). crease serotonin secretion levels. Serotonin
Problems that often arise in growth is a neurotransmitter hormone or hormone
and development include impaired physical that delivers messages from one part of the
growth, motor development, language, emo- brain to another. This serotonin hormone
tion and behavior (Hartati et al., 2020). will be converted into melatonin. The func-
Physical growth disorders include growth tion of melatonin is to provide stimulation in
disorders above normal and growth disor- the form of drowsiness and provide calm
ders below normal, weight monitoring can which helps the baby to sleep soundly (Pitre,
be seen using KMS (Kartu Towards Healthy) 2012).
(Kulkarni et al., 2010). Motor development Another study stated that after
disorders are disorders that cause delayed massage was performed in the intervention
motor development due to many things, group, there was an increase in sleep quality
including muscle tone abnormalities and compared to the control group. This re-
lack of stimulation to babies with babies searcher also found that one of the factors
who are often carried and placed on baby that greatly affect the quality of sleep in
walkers. Language development disorders infants is age, which affects the body's im-
are caused by many factors, including hear- mune system. A baby's immune system that
ing loss, lack of interaction between children is still weak is easily attacked by germs, cau-

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

sing his sleep quality to be disturbed was carried out by considering the eligibility
(Saputro & Bahiya, 2021). criteria defined using PICO, namely, Popu-
Based on the number of cases of pro- lation: infants aged 0 months – 3 years,
blems with sleep patterns and baby weight Intervention: baby massage, Comparison:
that occur and the need for appropriate no baby massage, and Outcome: sleep qua-
intervention, the researchers are interested lity and baby weight. Baby massage, massa-
in studying the effect of baby massage on ge that is carried out closer to fine strokes or
sleep quality and baby weight. The data ob- tactile stimulation performed on the surface
tained will be analyzed using meta-analysis of the skin, manipulation of body tissues or
by synthesizing the results of studies carried organs aims to produce effects on the
out to reduce bias. nerves, muscles and respiratory system and
facilitate blood circulation (Rahmatnezhad
SUBJECTS AND METHOD et al., 2018 ). Infant sleep quality is a mea-
1. Study Design sure used to assess the ease with which a
This research was conducted using a baby can initiate and maintain sleep. Sleep
systematic review and meta-analysis study quality is good if the length of sleep is
design. Using the PRISMA flow chart balanced between night and day sleep
guidelines. Article searches were carried out (Tekgündüz et al., 2014). Infant weight is the
using journal databases including: PubMed, most important anthropometric measure
science Direct, Google Scholar and and should be measured at every oppor-
SpingerLink articles in the 2010-2020 range tunity to examine the health of children in
with the keywords (“baby massage” OR all age groups. Body weight is the result of
“infant massage”) AND (“sleep quality” OR an increase or decrease in all existing tissues
“baby sleep quality ”) AND (“weight gain” in the body, including bone, muscle, fat,
OR “baby weight gain”) AND “randomized body fluids and others (Vivian et al., 2010).).
controlled trial”. 5. Instrument
2. Inclusion Criteria The instruments in this study were the Brief
This study has inclusion criteria, including: Infant Sleep Questionnaire (BISQ) as a mea-
Full paper article with a Randomized sure of infant sleep quality and the Growth
Controlled Trial (RCT) study design, articles Chart or KMS as a means of measuring
published in Indonesian and English, the infant weight.
size of the relationship used with Mean SD, 6. Data Analysis
The intervention provided was baby massa- Data analysis in this study was carried out
ge, Research subjects infants aged 0 – 3 using the Review Manager application
years and measuring sleep quality using (RevMan 5.3). Data were analyzed based on
BISQ and measuring weight using Growth variations between studies by determining
Chart (KMS). the use of random effects analysis models.
3. Exclusion Criteria
This study has exclusion criteria, including: RESULTS
Infants who have a fever or have infection Research from the primary study related to
problems, have heart problems, motor the effect of baby massage on the quality of
problems and often have seizures (Khan, sleep and baby's weight contained 16
2015). articles with a total sample of 1418
4. Operational Definition participants, 708 participants for the inter-
The formulation of the research problem vention and 710 participants for compa-

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

rison. Articles were obtained from 2 conti- study quality assessment was carried out
nents, namely, 12 studies came from the qualitatively and quantitatively. Assess-
Asian continent and 4 studies came from ment of research quality using the Critical
the Americas. Each study had a sample of Appraisal Skills Program (CASP) can be
less than 100 participants. The outcome for seen in Table 1. Each of the 11 questions
some articles is that there is an increase in was answered with the answer choices: Yes,
the quality of sleep and baby's weight after No and Unclear. After assessing the quality
being given a baby massage. of the study, a total of 16 articles included
The article search was carried out in the quantitative synthesis process of the
using a database based on the PRISMA flow meta-analysis were analyzed using RevMan
diagram, which can be seen in Figure 1. The 5.3.

Articles identified through Deleting duplicate data (n= 937)

database search (n= 1,890)

Articles issued (n= 538)

The title is irrelevant (n= 208)
Filtered articles (n= 953)
Not an RCT study (n= 146)
1. Does not written in English/
Indonesian (n= 68)
2. Not full text (n= 95)
3. Inaccessible (n= 21)

Complete articles deemed Full text articles issued, with reasons

eligible (n= 382) (n= 361)
1. Population does not match (n= 128)
2. Inappropriate intervention (n= 106)
3. Does not include Mean SD (n= 36)
Articles included in the
4. Outcome is not sleep quality (n= 52)
systematic review (n= 16)
5. Outcome is not weight gain (n=39)

Articles included in the meta-

analysis (n= 16)

Figure 1. PRISMA Diagram

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

Table 1. Assessment of Research Quality Effect

Kusumastuti Hartanti et Rouzafzoon Smith et al Edraki et Lu et al
No. Questions et al (2016) al (2019) et al (2021) (2013) al (2015) (2018)
Score Score Score Score Score Score
1. Does the experiment 1 1 1 1 1 1
answer the clinical
problem clearly?
2. Was the intervention 1 1 1 1 1 1
given to the patient
randomized?
3. Are there blinding of 1 1 1 1 1 1
patients, health workers,
and researchers?
4. Were the study groups 1 1 1 1 1 1
similar at the start of the
study?
5. Outside of the 1 1 1 1 1 1
intervention under study,
were the study groups
treated equally?
6. Were all patients included 1 1 1 1 1 1
in the study properly
accounted for in the
conclusions? were all
patients analyzed
according to the
randomized study groups?
7. Is the effect of the 1 1 1 1 1 1
intervention large
enough?
8. How precise is the 1 1 1 1 1 1
estimation of the effect of
the intervention?
9. Are the results applicable 1 1 1 1 1 1
to the context of practice
or local populations?
10. Are all other clinically 1 1 0 1 1 1
important outcomes
considered in this article?
11. Do the benefits provided 1 1 1 1 1 1
by the intervention
outweigh the costs and
disadvantages?

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

Table 2. Quality assessment of studies on the effect of baby massage in infants body weight
Diego Abdallah Ho et Rangey et al Gonzalez Ang et Zhang Moghadam Fallah Lu et
et al et al al (2014) et al al et al et al et al al
No. Question
(2014) (2013) (2010) (2010) (2012) (2019) (2015) (2013) (2011)
Score Score Score Score Score Score Score Score Score Score
1. Does the experiment answer the clinical 1 1 1 1 1 1 1 1 1 1
problem clearly?
2. Was the intervention given to the 1 1 1 1 1 1 1 1 1 1
patient randomized?
3. Are there blinding of patients, health 1 1 1 1 1 1 1 1 1 1
workers, and researchers?
4. Were the study groups similar at the 1 1 1 1 1 1 1 1 1 1
start of the study?
5. Outside of the intervention under study, 0 0 1 0 1 1 1 1 1 1
were the study groups treated equally?
6. Were all patients included in the study 1 1 1 1 1 1 1 1 1 1
properly accounted for in the
conclusions? were all patients analyzed
according to the randomized study
groups?
7. Is the effect of the intervention large 1 1 1 1 1 1 1 1 1 1
enough?
8. How precise is the estimation of the 1 1 1 1 1 1 1 1 1 1
effect of the intervention?
9. Are the results applicable to the context 1 1 1 1 1 1 1 1 1 1
of practice or local populations?
10. Are all other clinically important 0 1 1 1 1 1 1 1 1 1
outcomes considered in this article?
11. Do the benefits provided by the inter- 1 1 1 0 1 1 1 1 1 1
vention outweigh the costs and
disadvantages?

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

Figure 2. Forest plot of Baby Massage on Sleep Quality

Figure 3. Funnel plot of Baby Massage on Sleep Quality

Figure 4. Forest plot of Baby Massage on Body Weight

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

Figure 5. Funnel plot of Baby Massage on Body Weight

1. The effect of baby massage on sleep characterized by the asymmetry of the right
quality and left plots.
a. Forest plot baby massage on sleep 2. The effect of baby massage on body
quality weight
Interpretation of the results of the meta- a. Forest Plot baby massage on body
analysis process can be seen through the weight
forest plot. Figure 2 shows as many as 6 arti- Interpretation of the results of the meta-
cles of baby massage can improve sleep qua- analysis process can be seen through the
lity compared to other interventions or no forest plot. Figure 4 shows as many as 10
intervention. Meanwhile, there was high articles reporting that baby massage can
heterogeneity between experiments (I2= increase body weight compared to other
94%; p< 0.001). Thus, the Random Effect interventions or not given the intervention.
Model (REM) was used to analyze the data Meanwhile, there was high heterogeneity
in the forest plot. The results of the analysis between experiments (I2= 90%; p<0.001).
of the baby massage intervenetion were Thus, the Random Effect Model (REM) was
found to be -0.70 times having an effect on used to analyze the data in the forest plot.
improving sleep quality compared to other The results of the analysis of the inter-
interventions or no intervention, but statis- vention of baby massage obtained as much
tically not significant (SMD 0.70; 95% CI= - as -0.52 times the effect of increasing body
0.05 to 1.46; p=0.07). weight compared to other interventions or
b. Funnel Plot baby massage on sleep no intervention, and statistically significant
quality (SMD= 0.52; 95% CI= 0.08 to 0.96; p=
A funnel plot is a plot that represents the 0.02).
approximate size of the effect of each study b. Funnel Plot baby massage on body
on the estimate of its accuracy which is weight
usually the standard error. Figure 3 funnel Figure 5 funnel plot of baby massage on
plot of baby massage on sleep quality, shows body weight, shows that there is a publica-
that there is a publication bias which is tion bias which is indicated by the asym-
metry of the right and left plots.

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

DISCUSSION massage on infant sleep quality. The forest

Sleep is a top priority for babies, because at plot results showed that baby massage could
this time neuro-brain repair occurs and improve infant sleep quality by 0.70 times
about 75% of growth hormone is produced. compared to other interventions or no inter-
During sleep, the baby's brain will develop vention was given, but it was not statistically
and reach its peak because the body will significant (SMD 0.70; 95% CI= -0.05 to
produce more growth hormone than when 1.46; p=0.07).
the baby is awake. In addition, in the first There are 10 research articles with
year the baby's brain will grow 3 times from randomized controlled trials study design as
its birth state or about 80% of the adult a source of meta-analysis of the effect of
brain (Dehghani et al., 2018). Each baby is baby massage on infant weight. The results
expected to grow optimally and to achieve of the forest plot show that baby massage
optimal growth in infants is the result of the can increase baby's weight by 0.52 times and
interaction of various interrelated factors, has an effect on increasing baby's weight
namely genetic, environmental and behavi- compared to other interventions or no inter-
oral factors, as well as useful stimuli or sti- vention, and statistically significant (SMD
mulation (Bannet et al., 2013). 0.52; 95% CI= 0.08 to 0.96; p=0.02 ).
One of the most important indicators The results of this study are in line
in assessing growth in infants is to assess the with Kulkarni et al. (2010) regarding the
baby's weight (Pitre, 2012). Body weight is effect of baby massage on infant sleep qua-
the most important anthropometric measu- lity in Iran. This study states that one of the
re, which is used at every opportunity to responses that can be seen if massage is
check the health of babies in all age groups. done regularly is the sleep response. Sleep is
There are many interventions that can part of a healing, repair and physiological
be given to babies who have sleep problems process that rotates and alternates with
and are underweight, one of which is baby longer periods of wakefulness. Achieving
massage. This intervention is a non-phar- good quality sleep is as important for health
macological management that is quite often as recovering from illness. Half of all baby's
used in managing infant growth and deve- sleep time is used for active sleep or Rapid
lopment (Bahrami et al., 2016). Eye Movement (REM) sleep.
Baby massage is giving a touch to the This statement is also in line with
baby or child's body that is useful for Sadeh (2012). The study concluded that
stimulating the growth and development of some babies experienced poor sleep quality.
the baby and as a way to express parental This may be influenced by external factors
love for their child. Touch and massage such as the presence of an uncomfortable
therapy in infants has many benefits on the environment where the temperature of the
quality of sleep and weight gain of babies. baby's room tends to be stuffy and the influ-
Several mechanisms can explain the basic ence of stimulus from other people or the
mechanism of infant massage, including the baby's family. In addition, the baby's activi-
release of beta endorphins, vagus nerve ties also affect the quality of sleep where
activity, and serotonin production (Basiri- during the day the baby is brought by the
Moghadam et al., 2015). mother to move outside the house for a long
There are 6 research articles with ran- time so that the baby often wakes up at night
domized controlled trials study design as a and the duration of awakening is more than
source of meta-analysis of the effect of baby

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Fauzia et al./ Baby Massage in Increasing Quality of Sleep and Infant Body Weight

1 hour. Fatigue in infants will cause a short- Massage for infantile colic: Review and
ening of the first period of REM sleep. literature. Int J Pediatr. 4(6): 195319-
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This statement is also in line with CD005038. https://doi.org/10.1002/-
Rahmatnezhad et al. (2018) where it was 14651858.CD005038.
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AUTHOR CONTRIBUTION Effect of breast Oketani-massage on
Raina Lola Fauzia is the main researcher neonatal weight gain: A randomized
who selects the topic, searches and collects controlled clinical trial. Evid Based
research data. Uki Retno Budihastuti and Care J. 8(3): 57–63. https://doi.org/-
Rita Benya Adriani analyze data and review 10.22038/ebcj.2018.32347.1817.
research documents. Field T (2016). Massage therapy research
review. Complement Ther Clin Pract.
FUNDING AND SPONSORSHIP 24: 19–31. https://doi.org/10.1016/j.-
This study is self-funded. ctcp.2016.04.005.
Guzzetta A, D’Acunto MG, Carotenuto M,
CONFLICT OF INTEREST Berardi N, Bancale A, Biagioni E, Bold-
There is no conflict of interest in this study. rini A, et al. (2011). The effects of pre-
term infant massage on brain electrical
ACKNOWLEDGMENT activity. Dev Med Child Neurol. 53(4):
The researcher would like to thank the 46–51. https://doi.org/10.1111/j.1469-
database providers PubMed, Science Direct, 8749.2011.04065.x.
Google Scholar and SpingerLink. Hartati S, Desmariyenti, Hidayah N (2020).
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