Massage Therapy for Kids: What Parents Need to Know – PediaCast 597
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Description
Jessica Waller and Dana Shoff visit the studio as we consider massage therapy for children and teenagers. Massage therapy is not just for grown-ups… and it helps with more than relaxation. It can play an important role in helping kids manage pain, stress, and complex medical conditions. Tune in to learn more!
Topic
Pediatric Massage Therapy
Guests
Jessica Waller
Licensed Massage Therapist
Nationwide Children’s Hospital
Dana Shoff
Licensed Massage Therapist
Nationwide Children’s Hospital
Links
Message Therapy at Nationwide Children’s Hospital
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast is brought to you by the Pediatric Massage Therapy Program at Nationwide Children's Hospital.
[MUSIC]
[Dr Mike Patrick]
Hello everyone, and welcome to another episode of PediaCast. We are a pediatric podcast for moms and dads.
This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 597.
We're calling this one massage therapy for kids and teens. What parents need to know. I want to welcome all of you to the program.
We are so happy to have you with us today. Massage therapy is of course popular among adults for lots of good reasons. And I suspect many of you out in the audience have reaped the benefits of massage therapy in your own lives.
Well, it's not just for grownups. Massage therapy benefits children as well. It's also for more than simple relaxation.
Much more. In fact, massage therapy can play an important role in helping kids and teens manage pain, stress, and complex medical conditions. In this episode of PediaCast, we will explore pediatric massage therapy, what it is, who it helps, and all things parents need to know.
Of course, in our usual PediaCast fashion, we have a couple of terrific guests joining us in the studio to discuss the topic. Jessica Waller and Dana Shoff are both licensed massage therapists at Nationwide Children's. Before we get to them, I do want to remind you the information presented in every episode of PediaCast is for general educational purposes only.
We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast terms of use agreement, which you can find at pediacast.org.
So, let's take a quick break. We'll get Jess and Dana settled into the studio, and then we will be back to talk about massage therapy for kids. It's coming up right after this.
[MUSIC]
[Dr Mike Patrick]
Jessica Waller is a licensed massage therapist at Nationwide Children's Hospital. Dana Shoff is also a licensed massage therapist, and she serves as the evidence-based practice coordinator for the massage therapy program at our hospital.
Both have a passion for incorporating massage therapy into the treatment plans of young patients and supporting families whose children would benefit from their services. That's what they're here to talk about. Massage therapy in pediatric patients who benefits what treatment looks like and expected outcomes for families.
Before we dive into our conversation, let's offer a warm PediaCast welcome to our guests, Jess Waller and Dana Shoff. Thank you for stopping by the studio today.
[Jessica Waller]
Thanks for having us.
[Dana Shoff]
Yeah. Thank you for the invite.
[Dr Mike Patrick]
Yeah. We are so happy that you guys are both here today. Jess, let's start with you.
What exactly is pediatric massage therapy and how did the program get started?
[Jessica Waller]
So pediatric massage therapy is a gentle age-appropriate massage for infants and children, including like light, moderate touch adjusted to their needs that day. Our program was started in 2001 with a grant funded working with cystic fibrosis patients. And that kind of expanded into physician support and pediatric massage therapy and we had physician champions.
And so, the program just slowly grew. It was really well received. And so, it's grown over the last long time.
[Dr Mike Patrick]
Yeah. It really just started with one massage therapist. And so now you have full time staff, and you see more than just cystic fibrosis patients, I would imagine, through the hospital, correct?
[Jessica Waller]
We have grown throughout the whole hospital, and we now have 20 massage therapists on staff, including one clinical leader and one evidence-based practice coordinator. And five out of that 20 are contingent massage therapists, meaning that we use them as a call-in basis. So, when census is high or someone's off work, we can use them to come in and help us get all the kiddos seen.
[Dr Mike Patrick]
Yeah. Yeah. And as I think back to when I was a resident, this didn't even exist.
And to think that it grew from one massage therapist coming in two days a week to all the staff that you guys have now and all the different patients that you see. And it really is a lot of inpatient units that you guys are on. So, it started with cystic fibrosis, but you're all over the hospital.
Dana, what other areas do you guys work in?
[Dana Shoff]
So, we cover all of the inpatient areas, which includes the HemOnc and bone marrow transplant floor, neuro rehab, general medicine, pulmonary, complex care, NICU, like post-op general kind of surgery as well. If the kiddos end up inpatient after that, GI, the cardiac floor trauma, orthopedics, the PICU. So essentially everywhere as well as our newer program with the fetal medicine unit.
[Dr Mike Patrick]
Yeah. Are there particular age ranges that you're looking for? Is this only for like preteens and teens or are younger kids and even babies?
I heard you mentioned the NICU. So, babies can get massage therapy too. Is that correct?
[Dana Shoff]
Yeah, that's correct. So here at Children's we see patients throughout life. So, if they have something congenital, we can see, you know, adults as well, but the babies are included.
So, we can see babies at day one, which is I've done that myself and that's like a really exciting kind of cool thing that not a lot of people can say.
[Dr Mike Patrick]
Yeah. Yeah. I'm sure that the parents are often like, hey, can I get a massage too?
But I know, you know, you guys can't do that in the hospital, but gosh, I think that that would be so relaxing for the, you know, there's a lot of stress when your child's in the hospital. Do you get, do you get asked that from time to time?
[Jessica Waller]
We get asked that all the time and our family resource center does have a massage therapist on staff. So, they work, I think it's Monday through Thursday and they offer free 10-minute chair massages to parents and caregivers. So, we can just direct them down there.
[Dr Mike Patrick]
Yeah. Yeah. Now become a licensed massage therapist.
How then do you get special training or certification to take care of kids? Jess?
[Jessica Waller]
So, in order to work here, you don't really have to have any special certifications or trainings. The hospital does support continuing education but does not require it to be hired on. So, our team has a wide variety of skillsets from pediatric massage therapy to certified infant massage instructors, lymphedema training, myofascial release, trigger point, neuromuscular.
We have scar tissue training, oncology training, Kinesio taping, and a couple of us are certified aromatherapists.
[Dr Mike Patrick]
That is really, really fantastic and services that you don't think of traditionally in the healthcare environment, but at the same time you can really understand why this would be helpful not only for relaxation, but really therapeutic. You'd mentioned folks who have issues with lymphatic drainage. So, in that case, it's really therapeutic for the disease condition, correct?
[Jessica Waller]
Absolutely.
[Dr Mike Patrick]
And Dana, then what does a typical day look like for a pediatric massage therapist? I'm sure that each day is a little bit different depending on the clients that you're seeing. In general, what does a typical day look like for you guys?
[Dana Shoff]
Yeah. So easy answer is there's no sort of typical day because you plan your day and then it changes and you know, you're just kind of on your toes and you have to be adaptable all day, every day. But a typical day if it was to go exactly how I planned it is, you know, in the morning I'm doing my chart review, I'm looking at my patient lists, kind of seeing, you know, do my patients have things on their schedule already?
Are they going to the OR? Kind of trying to plan like who I can see at what time and maybe when I would try. So it's a lot of coordinating with that, but also with the chart review, you know, kind of checking, you know, how they've been doing since the last time I saw them or if this is a new patient, you know, what can I potentially expect from what's listed as their, you know, principal problem as well as other things that might be affecting the way that we want to approach, you know, treatment.
But then you show up to the room, and it could be a hundred percent different than what you thought it was. So, you really just have to, you know, we do that in-person interview every time too with the kid or the family, just kind of checking in to see. And then we really decide on our approach in the moment, you know, what does this patient need right now?
And what can I help with? What can I offer with? But so that's the treatment kind of portion of it.
And then, you know, we finish up our day typically by doing all of our charting and all of that good stuff. So, we can kind of reflect on, you know, also I charted this and then I'm able to kind of look at, you know, the results. What did I record for my outcomes?
Like how could I maybe modify that tomorrow or the next time I see this kid? Like, you know, maybe seeing them in the morning didn't work out as great as it would be to see them in the evening. So, there's a typical day is a lot of jumbling to be point blank.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. And like I said, each day is a little bit different than the previous one for sure.
So, when you're looking at a patient population, are you just looking through the charts to see who you think might benefit or do you guys get consulted to come see a particular patient or family?
[Dana Shoff]
So, the way that our therapists kind of function is mainly by area. So, we have like a therapist who's kind of, you know, a primary on a floor. So, they're familiar with the staff and you know, the physicians are aware that it's something that's offered.
So they can either place a consult or, you know, we like notice there's a patient on the floor when we're kind of looking at the whole floor of like, Oh, we haven't seen this patient, but you know, based off of their diagnosis, maybe it's something that we often do see that's helpful. So, we can kind of offer as well.
[Dr Mike Patrick]
Yeah. Yeah. I would imagine that the nursing staff is probably another place where you get recommendations to see kids.
Sometimes the physicians are so focused in on the management plan from a, from, you know, the minute details that sometimes you miss the big picture of things that can help kids therapeutically and also from a mental health standpoint. And those nurses are always advocates for their patients. So, you probably get some recommendations from them too.
Right, Dana?
[Dana Shoff]
Yeah.
[Dr Mike Patrick]
Jess, what is a typical massage therapy session look like? And this is a thing too, where I bet it's a little different depending on the, the particular patient, their age, their disease, the, you know, your goals. But if you had a typical therapy session that you're explaining to parents, hey, here's what's going to happen.
But what does that look like?
[Jessica Waller]
Absolutely. Definitely age and diagnosis plays into it, but we follow like the hospital precautions and do whatever PPE is needed. And then we enter the room and introduce ourselves to the patient and the family and what massage therapy is.
And then the doctors have ordered this for them to help. It can be from stress, relaxation, pain, muscle tension and anxiety. So, we just kind of talk to the family and introduce our role.
And we ask some questions to determine what their needs would be that day because day to day can differ. So, we might ask them if they're having any pain or if they're having any muscle soreness, you know, hospital beds aren't always the most comfortable thing to sleep in. So sometimes, you know, it's just how did they sleep last night and is there any pains from that?
And then we, once the child is agreeable in the family, we can help them get positioned comfortably. We typically see them in their hospital rooms. Sometimes we can go into like therapy rooms or playrooms, but most of the time it's bedside.
So, it's helping them get positioned comfortably in bed. And if they want to get out of bed, helping them transition to the couch or chair for the session. Most of our patients remain clothed or in their hospital gowns for the sessions.
And obviously the session length can vary on what we're there for that day. And how the patient is liking the massage and if it's helping them with their comfort. We also have options to co-treat with other therapists.
So, we can work with therapeutic recreation, physical therapy, occupational therapy, music therapy, anybody too. That kind of looks different with each discipline. But if it's physical therapy, helping a patient get out of bed and they're having back pain, then we might be able to sneak in with them so we can get to their full back more comfortably.
Sometimes with therapeutic recreation, the child might not be as comfortable one on one with massage, but when they're distracted with an activity, they can be more engaged, and it helps them relax better. Music therapy is also another great co-treat where they can come in and play like relaxing music that just helps the massage session along.
[Dr Mike Patrick]
Yeah. Yeah. Are there situations where you would need to sort of modify what approach you would normally take or when massage therapy ought to be avoided entirely?
[Jessica Waller]
So, we don't have any contraindications for massage therapy in the hospital. As long as the patient and family are agreeable, we can adjust our pressure and our positioning to that patient's needs that day.
[Dr Mike Patrick]
And then, Dana, if you know, when you look at a patient's overall care plan, massage therapy, we've kind of talked about what needs that those that the massage therapy meets. Is there a role for education of the clinicians in your world? You know, explaining, you know, how this is going to help, why you're here.
Do you give talks to the residents and attendings from time to time?
[Dana Shoff]
Yeah. So, we do some like in-service presentations, if you will, to different residents and things like that with people kind of more so like on the floors, if we're like newly getting established or they have a new group of residents just to kind of like bring awareness. So, we do some of that and we can kind of modify like, you know, hey, this is the floor that you're working on and this is the populations.
And these are kind of the more targeted benefits, to be a little bit more specific. But, you know, we always give that general knowledge as well.
[Dr Mike Patrick]
Yeah. Yeah. And then do you give reports back to the clinical staff on like how the session went or like insights into the family?
I would imagine that you probably see the family at a time when they've got their guard down and are a little bit more relaxed and they have some insight into family dynamics and that sort of thing. So, does that interaction and communication piece of you being in the room also helpful to the to the other clinical staff?
[Dana Shoff]
Yeah. So, I think that just kind of speaks with our involvement of the whole care team. We are all established in the patient chart.
So, we write our note. And then, you know, if there's some like interactions, as you speak on with the family that we think are, you know, pertinent or somebody needs to know, like, hey, this is something they told us. And I think like going forward, like it's something to keep in mind.
You know, the communication is key. So, we do communicate a lot with the other members of the team.
[Dr Mike Patrick]
Yeah. Yeah. So being an emergency medicine physician, I am not aware of massage therapy down in our area.
But if there's a room for expansion, I can imagine there are a lot of kids who would benefit, especially as you think about. I mean, it's pretty stressful being in the emergency department. There are probably folks who'd benefit down there, too.
So anyway, just a little just a little idea there for you. Research within massage therapy. So, Dana, you are the evidence-based practice coordinator.
How does research play into the work that you guys do?
[Dana Shoff]
So, as you can probably imagine, there's not a lot of research out there currently with, you know, pediatric massage and specifically, but massage in general doesn't have as much as, you know, some of the other clinical therapies. So, we really do try to look at what we're doing and be able to reflect and, you know, spread that and share awareness of these are potentially, you know, beneficial things that we can add to other people's care. So we do that in order to try to expand on our field, as well as, you know, we look at the research that is out there to try to build up our evidence based models and, you know, make sure we're doing what's just and what's safe and trying to, you know, continuously like modify and reflect and make sure we're doing what we can.
[Dr Mike Patrick]
Yeah. Yeah, absolutely. Do you find that because, you know, this is there is some evidence and the body of evidence is slowly growing that there may be a place for massage therapy as outpatients?
So especially kids with chronic illnesses, other kinds of stress in their life. Is there a push at all to kind of move from inpatient to also offering these services on an outpatient basis?
[Dana Shoff]
Yeah. So, we actually do have some certain clinics that we do have a presence in for outpatient. It's just not quite as, you know, big and robust as our inpatient program.
Just with like, you know, their scheduling. And I think there's a lot of probably more time restriction on it, depending on what program or clinic they're going to, those kinds of things. But then we also do have home care.
So that's another big one. It's a little bit it's not under the same kind of like therapist staffing. So, they're a little bit of their separate own entity.
But we that's another thing through Children's that is offered for, you know, hospice and palliative at home.
[Dr Mike Patrick]
Yeah. Yeah. Now, are the are the services covered by most insurance or by Medicaid?
Or is this something that the families are going to get billed in addition to their other hospital bills? Or is it just kind of covered by the hospital as a service? Or how does the how does the financial structure of it work?
I think some families would be interested to know that.
[Jessica Waller]
We do bill insurance, but it's kind of absorbed into the hospital bill. So, it's not an additional bill that they will see. But we do massage therapy does have insurance codes.
[Dr Mike Patrick]
Yeah. Oh, that is fantastic. And then how can parents support massage therapy for their kids, maybe be an advocate for it happening in the hospital?
And also from a parent standpoint, when they go home, you know, are they able to provide some massage therapy to their kids by learning what you guys are doing in the exam room, Dana?
[Dana Shoff]
Yeah. So, I think that the biggest part is the advocation and just kind of encouraging kids to participate and, you know, something that they probably have never done before. I think like new and scary is valid here.
They're going, you know, in a very stressful time with being ill. But, you know, the advocation really works wonders. And it's not just that the therapies like need that.
It's sometimes other things. So honestly, the advocacy just really helps across the board. But yes, we do a lot of education with the family as well.
If they're present at bedside when we're treating. And I've had like parents that I've taught, like a lot of different things that they want to, you know, they will go out of their way to try to say, like, I would love to continue doing this at home. Can you show me what you're doing?
And give like an explanation as to why. So that's kind of like one of the more exciting things as well is when the parents are engaged. We get to share that, and everybody gets a little excited.
And, you know, it's something that's beneficial and should be relaxing and should be easy.
[Jessica Waller]
These kids are, you know, busy getting like poked and prodded from medications given to them. And so sometimes when we walk in the door, they're like touch. No, thank you.
But once we can show them that there is positive touch in the hospital, then they like kind of become more relaxed in their environment.
[Dr Mike Patrick]
Yeah, I would imagine that support from the parent is also going to be important for teenagers who may be like, oh, no, I don't want a massage. But, you know, if their parent explains and encourages them, do you see some hesitancy on the part of in particular teenage patients?
[Jessica Waller]
We do. It's very rare. Actually, most people are willing to try it.
And once they try it, they end up liking it. We always tell them, like, this is one positive thing you can get while you're in the hospital. So, some people are definitely hesitant.
You definitely have the people that are like, I do not like being touched. No, thank you. And that's OK.
We always let them tell us what will help them. We never want to increase anxiety or stress. Always want to meet them where they're at.
[Dr Mike Patrick]
Do you ever use other objects other than your hands? So, I'm thinking like, you know, you can go get a hot stone massage, for example. Are there other techniques than just what folks are thinking?
Just hands on massage, if that makes sense.
[Jessica Waller]
Yeah, not typically in the hospital. It's typically just very light pressure. And we do offer aromatherapy so that we can either mix that in their lotions if they like that, or we can give them like inhaler sticks or diffusers to just kind of promote that relaxing environment.
[Dr Mike Patrick]
And then, Jess, is there anything else that that providers and clinicians and parents should know about massage therapy in kids and teens?
[Jessica Waller]
So, it's a safe and beneficial. Like option for people when provided appropriately and tailored to each child's specific needs. We're there to support the kids, not replace their medical care.
It's widely viewed outside the hospital as a luxury, but we're really working hard to expand the awareness on all the different medical benefits that massage therapy has to offer. It's been really well received here, and we really look forward to working with more patients in the future.
[Dr Mike Patrick]
Yeah. And as you guys grow, are you currently looking for a massage therapist? And I only mention it because if they're folks listening in the central Ohio area that may be interested in pediatric massage therapy, are there career opportunities?
Are you guys kind of firm in your numbers right now?
[Jessica Waller]
It always fluctuates. You never know day to day what's going to happen. So, we typically are always hiring a contingent massage therapist.
And then with the opportunity to come on full time, most of our contingents end up joining us full time. So, then we have to backfill and hire more contingents. So, it's definitely been a great place to work.
And there's definitely opportunity here, especially with the new tower going up. And as patient census grows, there's definitely opportunity.
[Dr Mike Patrick]
Yeah, yeah. Well, this has been a really fascinating conversation again in the emergency department, since we don't see you guys there. I wasn't really aware that we even had massage therapy service, but it sure makes sense.
And I'm sure that families really do appreciate the great work that you guys do. We will have a link to the massage therapy program at Nationwide Children's Hospital in the show notes. That's going to be over at Pediacast.org.
It's episode 597. And we'll have that link there for you. So once again, Jessica Waller and Dana Shoff, licensed massage therapists at Nationwide Children's Hospital.
Thank you so much for stopping by and chatting with us today.
[Jessica Waller]
Thank you.
[Dana Shoff]
Yeah. Thank you for having us.
[MUSIC]
[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. We really appreciate your support. Also, thanks again to our guests this week, Jessica Waller and Dana Shoff, licensed massage therapists at Nationwide Children's Hospital.
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[MUSIC]
