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Adverse events associated with paediatric massage therapy: a systematic review
Mohhamad Karkhaneh1, Liliane Zorzela2, Hsing Jou1
1Medicine, University of Alberta, Edmonton, Alberta, Canada.
Insights
Massage therapy (MT) in children can lead to adverse events (AEs), ranging from mild to severe. Caution is advised, particularly with abdominal massage in preterm infants due to potential risks like volvulus.
Area of Science:
- Pediatric Medicine
- Complementary and Alternative Medicine
- Patient Safety
Background:
- Massage therapy (MT) is a common intervention for children.
- The safety of MT in pediatric populations has not been systematically evaluated.
- Adverse events (AEs) associated with pediatric MT require systematic assessment.
Approach:
- Conducted a systematic review of seven electronic databases.
- Included peer-reviewed primary studies involving children aged 0-18 years receiving MT.
- Classified AEs based on severity and association with the intervention.
Key Points:
- Out of 60 included studies, 51.6% did not report AEs, 21.6% reported no AEs, and 26.6% reported AEs.
- Identified 20 mild, 26 moderate, and 18 severe AEs.
- Severe AEs included 17 cases of volvulus in premature infants, with 4 fatal outcomes.
Conclusions:
- Massage therapy in children is associated with a spectrum of adverse events, from mild to severe.
- A significant proportion of studies failed to report AE occurrence, potentially skewing safety data.
- Findings suggest caution with abdominal massage in preterm infants due to a potential association with volvulus, warranting further investigation.
Introduction:
Massage therapy (MT) is frequently used in children. No study has systematically assessed its safety in children and adolescents. We systematically review adverse events (AEs) associated with paediatric MT.
Methods:
We searched seven electronic databases from inception to December 2018. We included studies if they (1) were primary studies published in a peer-reviewed journal, (2) involved children aged 0-18 years and (3) a type of MT was used for any indication. No restriction was applied to language, year of publication and study design. AEs were classified based on their severity and association to the intervention.
Results:
Literature searches identified 12 286 citations, of which 938 citations were retrieved for full-text evaluation and 60 studies were included. In the included studies, 31 (51.6%) did not report any information on AEs, 13 (21.6%) reported that no AE occurred and 16 studies (26.6%) reported at least one AE after MT. There were 20 mild events (grade 1) that resolved with minimal intervention, 26 moderate events (grades 2-3) that required medical intervention, and 18 cases of severe AEs (grades 4-5) that resulted in hospital admission or prolongation of hospital stay; of these, 17 AEs were volvulus in premature infants, four of which were ultimately fatal events.
Conclusion:
We identified a range of AEs associated with MT use, from mild to severe. Unfortunately, the majority of included studies did not report if an AE occurred or not, leading to publication bias. This review reports an association between abdominal massage with volvulus without malrotation in preterm infants; it is still to be defined if this is casual or not, but our findings warrant caution in the use of abdominal massage in preterm infants.
