Transcript: The Power of Touch For Premature Babies

This is a text transcript from The First Time Mum’s Chat podcast. The episode is called The Power of Touch For Premature Babies and you can click on the link to view the full episode page, listen to the episode and view the show notes.

Helen Thompson: As a baby massage instructor, I’m always striving to impart to new parents the importance and massive benefits of massaging and touching their little one. When they are born after nine months in a safe, nurturing environment, they find themselves in a very different place with much to adjust to.

However, their journey is far more challenging and dramatic when they are born prematurely. Firstly, they’re likely to find themselves in the NICU, with the goal of keeping them alive and then they face being poked and prodded with the endless barage of tests. Can you imagine what that’s like for a baby? This week’s guest Tracey Kondrasuk-Brander is no stranger to this environment. Tracey is a neonatal and early intervention occupational therapist, as well as a licensed massage therapist and has worked with children from birth to three, as well as premature infants, over many, many years.

So in this episode, you’ll hear Tracey and I talk about why touch is even more important with babies born prematurely, the importance of skin to skin time with their parents and how it benefits sleep, heart rates and oxygen level, and how massage can benefit sensory integration issues that kids who are born premature often face…

And so much more!

Hi Tracey and welcome to First Time Mum’s Chat, I’m delighted to have you here and I’m looking forward to chatting with you about the importance of touch, particularly with premature babies, and also hearing your pearls of wisdom about sensory integration. So can you start by telling us about what you do and your background?

Tracey Kondrasuk-Brander: Great well, thank you having me on your podcast today. My name is Tracey Kondrasuk-Brander. I am a neonatal and early intervention, occupational therapist. Been so for about 27 years. I’ve worked with a multitude of children from birth to three and our premature infants, and I am a licensed massage therapist and a certified sleep consultant for infants and toddlers as well.

Helen Thompson: You said that you worked for premature infants. I also know that you work with sensory integration and how we adapt to that. So, as you mentioned premature infants, I thought I’d ask you that first. So how do you work with premature infants.

Tracey Kondrasuk-Brander: Well, it’s a great topic to get started into the sensory integration, autism spectrum disorder children. Because a lot of these babies are born premature, their nervous systems, which we have seven different sensory systems, that have to be integrated and a lot of the maturation actually occurs the last trimester of the pregnancy and a lot of these kids are born before that time or somewhere in that time. So their sensory systems don’t necessarily mature like yours and mine do. So, I used to do a lot of Infant massage to the kids to start helping them integrate, especially tactile and proprioception and different kinds of things in their sensory system so they wouldn’t be overwhelmed in a very harsh NICU (newborn intensive care) environment that they’re exposed to.

Helen Thompson: I know infant massage is very good for that because that’s what I do and I’ve never actually worked with any premature infants, but I am aware of how important touch is for premature babies.

Tracey Kondrasuk-Brander: Yeah, mine was basically to get them from these kids in the NICU. I mean, they could be anywhere from a pound to, I think my oldest one was probably 13 pounds but a lot of these kids have so much negative touch when they’re in the NICU, that infant massage and our skin to skin or kangaroo care are one of, two of the positive things that parents can do for their babies. So I would teach a lot of the massage to the parents so they could show them some positive touch because these kids are constantly poked and prodded, under the armpits, they get heel sticks, they’re getting tests all the time, they’re having a lot of obnoxious, negative stimuli.

You know, for oxygen and CPAP (continuous positive airway pressure), and some of them are intubated, so they’ve got tubes going down their throat. So, people don’t realize how much negative touch that they get as premature infants or sick infants at that point, so they start to have a lot of sensory integration issues as far as tactile. So we try very early on to do massage in the NICU when they are medically stable to get started. And I used to do a lot of teaching that way.

Helen Thompson: I think that’s so good. It actually brings a point of how important touch actually is, a natural touch and as you say, positive touch. We just think of babies as a tiny little thing, but they pick up on what’s going on. If they’re going through all that, it must be quite a hard thing for the baby as well as for the mother.

Tracey Kondrasuk-Brander: Yes and is something for the dad to be able to do as well because a lot of times the mother gets more of the interaction than the dads do. So, I used to love when the dads would show up at the bedside because they’d be petrified, very scared to touch their own babies. But once these babies are stable and you can give them the cues that, your baby’s okayed for some massage, then that’s what I would teach them because their touch is very, very important for that bonding that they don’t get when they’re born so premature that they have so much medical equipment around them and they’re getting so much medical care that they’re doing hands on, basically to keep them alive and fed and to make sure that they’re okay, not so much for that bonding with the parents, because some of these babies don’t get that.

Helen Thompson: When you’re stimulating and giving them touch, doesn’t that help circulate the blood supply to get it, get it moving, to warm the blood supply up?

Tracey Kondrasuk-Brander: It helps with circulation but some of these babies are so medically unstable that they cannot tolerate very light touch. So we show them things like the premi hold and just to be able to give them some firm pressure because some of these kids can’t even tolerate infant massage at that point.

So we’re just showing them some very nice holds so the parents can get some tactile with their kids if they’re not ready for kangaroo care and not true massage. I think some of the smallest kids I’ve ever massaged are a little over two pounds and that’s small and just to be able just to do a little bit of foot massage and a little bit in the hands, because a lot of times they can’t tolerate things to their faces and other parts of their body yet. It’s just too overwhelming.

Helen Thompson: I can understand that. Yeah. You said kangaroo care, what’s kangaroo care?

Tracey Kondrasuk-Brander: Kangaroo care is skin to skin. So here in the United States, I think we’re kind of behind in that kind of phase when newborns are born now in regular delivery rooms and there’s no problem, they’re full term. They’re literally putting them right on the mom’s chest for up to an hour after they’re born to get that bonding and giving them off to the dads, so they can get that bonding right away. Whereas our premature infants are quickly whisked away to the neonatal intensive care unit because they’re performing life saving procedures on them. So when they get older in the NICU at the bedside, the nurses and sometimes myself, would place the baby on the mom and you have to be able to hold them anywhere from one to two hours at a time. And literally the baby would be just in a diaper and the mom would have a hospital gown on and they would slide the baby on the chest and tape down, like if they’re on a vent or if they have IVs and things like that, they would tape them to the parents and then they cover them just like with a nice blanket and they’re reclined in a chair and they’re literally getting that positive touch.

If we can’t give them a massage, the best thing we can do for our babies is let them do skin to skin care with their parents. So that’s what that does and it helps regulate sleep, it brings down their heart rates, it brings oxygen levels up. So it has such a positive effect, just like the massage would, but this is even something even more primitive but more effective for our babies to have that skin to skin with with their moms and dads. And sometimes their siblings, older siblings are doing it too now.

Helen Thompson: I think skin to skin, it all links in with the importance of touch and how important it is.

Tracey Kondrasuk-Brander: It’s very important and that was my job initially in letting parents do things like that because besides changing diapers and checking their temperatures and things like that, doing the massage and positioning their babies and skin to skin was some of the first kind of parenting some of these people had had, since their child’s been in the NICU.

Helen Thompson: And that must be so nice for the parents to be able to actually feel and touch their own baby.

Tracey Kondrasuk-Brander: Oh yeah and just showing them the right kind of touch. So they’re not stressing them out and that’s the biggest thing is, is teaching them what is, positive touch and what’s obnoxious or negative touch for our babies.

Helen Thompson: So, how can we adapt and support them with sensory integration?

Tracey Kondrasuk-Brander: Well, as I said, a lot of our kiddos when they’re born premature tend to have a lot of sensory integration issues, meaning their sensory systems do not mature like yours and mine do and working in early intervention, birth to three here in the states, I’m finding more and more children are having a lot of sensory integration issues. They are bombarded by different kind of external stimuli in their environment. Tactally, visually they’re over stimulated.

A lot of our computer kids that wanna do a lot of technology. You know, we’re finding the more technology these kids have access to, the more it’s overstimulating their brains as far as their sensory systems and so I do a lot of education to our families about that. The blue light, so visually, auditorily, just all different types of sensory systems are starting to be more and more involved with our kiddos and, and they’re getting younger and younger in age with these issues. So we just need to adapt what we’re doing. You’re a massage expert as well, so we know what the positives are for our regular kiddos.

We’re trying to get our kiddos with sensory issues out of that fright flight, when you have that adrenaline pumping through their system. So they’re in a fright flight, their whole body is in that kind of mode in that they can’t focus, they can’t sit still, they don’t like people touching them so they run away. They kind of self spin, you’ll see them spinning in the room by themselves or climbing, so they’re looking for different kinds of things that their sensory system’s looking for. And tactally, as I said, some of our kiddos do very well with massage if it’s done properly and not overdone.

Helen Thompson: Yeah, cause I know some kids who are autistic and I don’t like labeling. I know those are some of the stigmas that people say that kids have, but if you can catch that they’ve got those issues at an early age, whether they’re premature or not premature, what you are saying, you can help them at an early age to find out all about this in sensory integration and give them the support to learn how to do that. Is that right?

Tracey Kondrasuk-Brander: That’s correct. That, massage is one good avenue to use as me as an occupational therapist, when I’m treating my kids that are showing red signs for autism. So I’ll go through a whole gamut of different things. A lot of our kids with sensory integration issues love deep pressure, whether it’s to the head, through the whole body, shoulders, arms, trunk, legs, their feet. So that’s what I kind of start at, is their tactile system. Tactally, what can they tolerate? A lot of these kiddos don’t like light touch and that’s like our premature babies. They can’t handle light touch that actually gets their nervous system all wound up, so to speak, but for our kids that might be on the spectrum, that deep pressure will help with eye contact, but it’ll also help that nervous system to calm down.

So you don’t wanna do anything very fast when you’re touching these children, because that just puts them into flight. Their adrenaline will just kick in and you’ll see them get all wound up. But if you do things very slowly, very slow rocking with the kids, so you can tactally have them on your lap or holding them and just doing some deep pressure with them, just to get them calm down so they’re going for that sympathetic and that fright and flight to a parasympathetic, which is a different sensory system and a different nervous system that goes. Like, you can hear that breath literally come out because they’re starting to relax and their sensory system tactally is starting to calm down. It’s like you and I getting massaged, we’re on the table for, 30 minutes, 60 minutes or 90 minutes, but it takes us a while to really feel that relaxation. Same thing with our kids on the spectrum that, you can’t expect automatic quick one to two minute. Sometimes my whole session, like 45 minutes just to get the child to calm down. So that’s when I’ll teach some of our parents very, very simple massage strokes. Very simple and every child’s different, so that parent’s gotta figure out what part of that body is very calming for them.

A lot of our kids are very hypersensitive on their heads, so we don’t wanna touch their heads or their hands or their feet, or orally, so that facial massage is usually not a thing we start with or the head, hands or feet, but a lot of times you can do their backs, you can do their arms and their legs.

And that’s where I tell my parents to start. Have you worked with children like that?

Helen Thompson: I have when I was a childcare worker and that was a while ago, but I never knew about massage then, I never knew about the sensory touch thing but I sensed that they didn’t like to be touched on the face and they didn’t like to be touched in certain areas.

Tracey Kondrasuk-Brander: Yes, so I tell my parents find somewhere else and a lot of times it’s their back. Like my son is on the spectrum, he’s very high functioning Asperger’s so he’s in a regular classroom, he got therapies for years for speech, apraxia, but he’s very tactally defensive, but if you would rub his back and go on either side of his spine in one direction, you’ll find him just calm down, right before bedtime.

So yes, my son is a great example. He had a lot of sensory integration but found that using the massage with him before bedtime was very calming for him and he just turned 12 this weekend and I still massage his back. Not a true massage, just rubbing, stroking his back, getting his little knots on his shoulders, cause he’s very athletic so he’s always doing sports, but that’s what calms him down. That’s what brings him down, even though he is wound up, if I do that, that just brings his system down so he turns over and passes right out. So I’ve been doing it for years. Since he’s been a baby to help him with sleep at nighttime.

Helen Thompson: Yeah, that’s what I always say to parents if they ask me how to help the baby to sleep, that’s what I say. Give them a massage on the back or just gently on the legs and it really does calm them down.

Tracey Kondrasuk-Brander: It does and a lot of the kids love their legs. As I said, I have one mom whose child has not been tested yet for autism, but we’re pretty a hundred percent sure she’s moderately autistic. The one thing that calms her down is massaging her legs cause she’s moving constantly. So when mom’s trying to calm her down, she’s found that just doing a few massage strokes with her on her legs, just kind of brings her down for a certain amount of time and kids need to be able to calm and focus in order to play and to interact with their environment.

And if you can’t get them in that state of calmness, they can’t learn, they can’t process things around in their environment and I just tell them, if we can’t get them in a state of calmness, they’re not gonna be able to interact with you well, they won’t be able to follow simple commands for you.

They will literally tune out everything around them, their whole environment. They won’t be curious about, oh, what’s in the bookcase and I think I’m thirsty, let me go over to the refrigerator and mommy will get me a drink when I walk over there. So just your basic types of things that people don’t think about just with that touch is actually key, to our kids on the spectrum.

Helen Thompson: Yeah there’s so many keys and values to touch, and I think a lot of us are very unaware of it and I think it’s so valuable.

Tracey Kondrasuk-Brander: Right, so with you educating your parents do you normally teach just the infants?

Helen Thompson: Yes and I actually massage on a doll. I’d love to massage the babies, but I don’t for two reasons, because I want the mom to get the sense of the touch and to get the bonding experience and because I think it’s important for the mom to do it.

Tracey Kondrasuk-Brander: I have two certifications in infant massage and I am a licensed massage therapist for adults as well. One of them was literally me teaching them without me touching them, where the other one is a lot more like a trigger release where I did have to show them first. I would show them exactly where to be touching them, to do some trigger point release, for some of our kiddos that had some postural things going on and were just so tense from all the over stimulation in the NICU, but yes, they’re like, well, we can’t do it as well as you, so I’d always get that. You do it so well. I said, I’m not taking your baby home. So just giving them that encouragement, get on in there, you know, these dads with the big hands, they are petrified touching their three, four pound babies, but once they they did it a couple of times and they started getting a lot more confidence and then they really enjoyed it. So we really started seeing the parents really get more engaged with their babies and feeling more control of their own infant, even though they’re in the NICU.

And a lot of them would say to me, I don’t even feel like their parent. Everybody else is doing everything for them. So these are small positive and very crucial things that we can give to our parents, to empower them with their small ones.

Helen Thompson: Well, that’s what I like to do, help the parents build their confidence to be able to communicate and touch their own baby. So that’s one of the reasons, another reason why I don’t want to touch the baby is because it’s not my baby and as you quite rightly say, I’m not taking the baby home, they are.

It’s their child, so that therefore it’s important that they build up their confidence and they build up their touch skills and they build up the bonding experience with the child.

Tracey Kondrasuk-Brander: Oh, I totally agree with you. So, yes and when COVID hit, I was teaching some, all virtual. We were doing all virtual. So I did have a doll and going through some of this stuff because we weren’t allowed into houses for 14 months when COVID hit in 2020, so we were doing all virtual, early intervention, just like you and I are doing on Zoom.

So for me, it was a great coaching model and I still do teach if I can’t get down or I’m not in the area, I can still teach and this is the model that we’re using and I’m doing a good job in teaching what they need to know.

Helen Thompson: Virtual is better than nothing!

Tracey Kondrasuk-Brander: Correct and we found here in the United States, we’re still using virtual. It’s not gone away, so we can do both. We can do online and we can be in person.

Helen Thompson: Yeah is there any tips that you’d like to give to moms that we haven’t already mentioned?

Tracey Kondrasuk-Brander: I guess, they know their kids more than anybody and I talk about this as a sleep consultant. You’ve gotta watch your kids’ cues for when they get overstressed and that positive touch may be needed, is to really hone in on your kids. You’ve gotta find their cues.

We may not see it, you and I, but they know. They can start seeing those very subtle cues that like this might be a good time for some tactile intervention. And you know, it doesn’t have to be 15 minutes, it could be one to two minutes, but that one to two minutes of the right kind of touch, could mean a very positive experience for not only the child, but the mom and the dad, knowing that they know how to help calm their child with touch.

They don’t have to use words and other means or other sensory systems, but you know, their skin is their brain, cause it formally is a part of the brain that comes forward, outward. So I always tell a lot of the parents, when you touch your child’s skin, you’re touching their brain. There’s a direct link, it used to be part of the brain. So your skin covers your child. So what you do with them is very powerful. When you do touch children you are actually touching their brain. So you want to definitely make it positive when you’re interacting with their child.

I think that’s the biggest thing that I can give to a parent, is just remember when you’re touching their skin, you’re touching their brain. So what kind of touch do you really wanna give your child?

Helen Thompson: I knew that but it’s something I’ve never actually said to parents, but I think I might add that when I do my baby massage classes, that when you’re touching your child, you’re actually touching their brain.

Tracey Kondrasuk-Brander: It’s the truth. It is and it’s a sensory system that these kids are constantly having contact with because it’s covering their whole body, whereas your ears are right here, your eyes are here, but tactally, it’s everywhere. Very powerful sensory system.

Helen Thompson: Oh definitely, both as massage people, we understand that.

Tracey Kondrasuk-Brander: Oh, you better believe it!

Helen Thompson: If anybody wanted to get in touch with you and find out more about what you do or come, come onto one of your virtual classes, or how would they go about doing that.

Tracey Kondrasuk-Brander: Sure, I have a website, it’s a telehealth website, but they can leave me a message there. That’s EarlyDevelopmentTherapy.com. My friend and I have a podcast and that is NICU and Beyond With Tracey and Stacey. A lot of people seem to find it on Spotify, even though we have it on the four major, Spotify seems to be the place to find it. As a sleep consultant you can find me at tracey@tinytransitions.com. So those are probably the main places to catch me.

Helen Thompson: Okay, well thank you Tracey, I’ve really enjoyed talking to you. I’ve actually learned a lot more about what I do by talking to you. I’ve actually learned a lot more about touch for premature babies, which I knew about through my training, but I’ve never actually ventured to do it. So you’ve now given me a little bit more confidence to actually encourage mothers to do it when they’re premature.

Tracey Kondrasuk-Brander: Oh, for sure please do encourage these moms and dads to be touching their baby because it really will help them in the long run with bonding and that sensory integration piece as the babies get older.

Helen Thompson: Okay, well, thank you so much, Tracey, it’s been a pleasure talking to you.

Oh, thank you, Helen. I appreciate being on your podcast.

Wow, Tracey shared some great tips and insights and I learnt a lot from her. She certainly has a lot to offer parents with her many years of experience with babies and premature infants. I’ve included links to Tracey’s podcast, as well as the websites she mentioned in the episode in the show notes, which can be accessed at MyBabyMassage.net/podcast/084.