While mortality rates for preterm infants have decreased with the advances in neonatal care, morbidity rates have not (Wilson-Costello, Freidman & Minich et al., 2006). There is no single etiology for neonatal morbidities; however, emerging evidence suggests that an interplay exists between Neonatal Intensive Care Unit (NICU) environmental factors (e.g., noise, handling, pain, separation from families), existing medical diagnoses, and the maturation of the developing neonatal brain may influence overall development, especially in the smallest of infants (Symington, & Pinelli, 2003).
Admission to the NICU is a crisis for the infant and the family that has long-lasting effects. Parents often feel out of place and incompetent in the care of their infant. These feelings of incompetence can lead to increased stress for parents and decreased attachment with their infants that may last well past the infant’s discharge, ultimately having the potential for long-lasting harmful effects on the child’s development (Gage, Everett, & Bullock, 2006; George, & Solomon, 1996; Ginsburg, 2007; Merritt, Pillers & Prows, 2003). Decreased parental confidence and, ultimately, competence is often related to decreased skill proficiency and lack of experience (Franklin, 2006; Kristensson-Hallstrom, 1999). Providing parents with increased opportunities to participate in their infant’s care through the provision of touch and massage has the potential to provide positive experiences for the parent and the infant and to improve the infant’s developmental outcomes (George, & Solomon, 1996; Ginsburg, 2007; Vandenburg, 2000).

Studies have demonstrated that positive human touch and massage are safe for preterm infants; however, whether routine use in the NICU is warranted is less clear. Several studies have evaluated preterm infants' responses to various types of touch and massage techniques. Although benefits have been reported including improved feeding progression, weight gain, and shortened length of hospital stay; moreover the safety of massage within a human social interaction has been repeatedly documented, the underlying mechanism(s) of these benefits have not been determined. Therefore, massage associated with parental social interaction remains under-subscribed in the NICU. Although the studies by Aly et al. (2004) and Glover et al. (2002) suggest potential benefits of massage, these studies had methodological flaws and failed to consider the physical and social effects of massage in the same study. The conclusions of the recent Cochrane Review (2006) that not enough evidence exists to support the routine use of massage in NICU also provides evidence of the need for further research in this area (Sizun & Westrup, 2004). Additionally, previous preterm infant massage interventions have not been routinely provided in synchrony with the infant’s developmental maturation and behavioral cues. Preterm infants have the ability to communicate their stress and physiologic status through their behavioral cues as well as their needs for rest and/or stimulation, thus providing the caretaker with information about the appropriate duration and intensity of interventions that can be tolerated (Loo et al., 2003). Caregivers who mindfully use this information provide interventions that the infant can tolerate. This type of intervention has the potential to provide mothers with an active role in the care of her infant and has the potential to affect both short- and long-term outcomes (Franklin, 2006; Holditch-Davis et al, 2003).