Edible, or plant-based oils are an ideal working medium for baby massage. However an edible oil has the potential to cause an allergic reaction – just as any food would do. The molecular structure of plant-based oil, ensures it only absorbs into the uppermost surface layers of the skin [Zatz] unless the skin is broken [Lack 2003].
To make a decision of what oil to choose, it is best to consider cultural/national preference, availability, skin type and also how and where (the environment) you are going to use/store it. Check the highest allergy risks in your country – peanut (also called groundnut/arachis) and sesame are high allergy risks in the UK for example [The Anaphylaxis Campaign]. Do a web search on the oil you are using, to check for any contra-indications – The safety of Safflower oil [Miller] and Mustard oil
[Darmstadt 2002] has been questioned. Baby massage oil should act as a good medium for carrying out massage movements without causing drag or friction. Massaging without oil can be irritating, especially for a sensitive newborn [Field ‘96].

The way the oil is processed will determine its true value as a baby massage medium; it is important to use good quality oil from a trustworthy manufacturer.
True organic oil can be expensive and may not be freely available, as strictly speaking, not only must the seed be organically grown, but also the production process should exclude the use of chemicals. The quality of the starting material - nuts, seeds, fruits - will also determine the quality of the oil.
True cold pressed oil is more costly. Beware of claims made by oil manufacturers that may be untrue e.g. ‘cold pressed’ grapeseed oil is thick and treacle-like; grapeseed oil that looks clear in colour and thin in texture, has been subjected to a high temperature, high pressure process, or may have been treated with steam and solvents.
Cold-pressed oil is obtained from:
1. the raw material being pressed with a hydraulic press to squeeze out the oil –soft, oily seeds such as olive, and sunflower are suitable for this.
2. harder seeds such as almond, which require more force and a large, powerful screw device (expeller) to crush the plant material. This process generates a certain amount of heat, which may alter the oil. After pressing, the crushed shells etc are removed from the oil by a series of filters and the oil is left with its nutritional properties intact.
3. a cold-pressed oil, which may well then go on to be refined - a step not often mentioned to the supplier!

Refined oil is obtained from the vegetable pulp (which may be left after cold pressing) that still contains a reasonable amount of oil. It may then be subjected to a high temperature, high pressure process, or may be treated with steam and solvents. The refining process alters the whole character of the oil. It can also render the oils hypoallergenic and safe for consumption by allergic individuals [Hefle]. However allergy of oils is a subject that is constantly subjected to controversy and the bibliography does not cease to give contradictory examples [Fremont].

l.

• Mineral oil (paraffin oil), which is used for some commercially produced oil/gel, is not an ideal medium for baby massage. This oil/gel does not absorb into the outer layers of the epidermis, leaving a greasy film on the baby’s skin. This pore-sealing effect can hamper the natural functions of the skin (excretion, heat regulation etc.). Mineral oil is a highly processed by-product of petroleum; it is not broken down by the body or used in our diet, so the safety of babies sucking their fingers after application is an unknown risk factor.

• Most mineral-based baby massage oils/gels have an added scent, which may not be appropriate for a sensitive newborn who relies on the normal smell of their parent for bonding, feeding and instinctive sense skills.

• Some brands of baby massage oil contain a mixture of several oils. This can make spot testing difficult when trying to isolate the cause of possible skin reactions or allergies.

• Some baby massage oils have essential oils added. These are known to have therapeutic effects, which may not be appropriate for the immature system of neonates. For safety reasons they should be avoided.

• Essential oils are sometimes added to baby massage oil, claiming therapeutic benefits such as that they are “relaxing” or “soothing” for babies. All babies are unique human beings and should be valued as having their own personalities and physiological traits; we should not try to use a ‘blanket’ sedative to mask their emotional dialogue. If the parents wish to use essential oils as a treatment, they should consult a qualified aroma-therapist who is used to treating babies and their individual specific needs.

• Some manufacturers produce a whole ‘baby range’, that contain essential oils. There is a concern that parents may unwittingly use them all together (on the skin, nappy area, hair, in the bath and for inhalation), which could be intensely overwhelming for the infant’s sensitive physiological system.

• A scented oil, whether it is a natural or chemical scent, should be avoided as the fragrance can MASK THE OBVIOUS ODOUR OF RANCID OIL.

• There is no research to validate the safety of using essential oils for infants; those advising or prescribing these oils are advised to check their insurance cover.

• The oil used in supermarket-type cooking oils should not be used for massage, as colour enhancers, preservatives and other ingredients may have been added

 

For vulnerable premature or sick babies, who have unique skin problems [Hoath], and may have a poorly functioning immune system, it is safer to use a highly purified/refined oil. Refined oil, has no smell, is thin in texture, has a longer shelf-life (check the oil’s Safety Data Sheet), and is less likely to contain any unwanted toxins, high lead levels, yeast moulds, fungal spores, or allergens, which can be present in cold pressed oils. When choosing an oil for in-patient use, check with the hospital’s Paediatric Allergist, the ward Consultant and Manager, the Pharmacist and the latest Nursing & Midwifery Council recommendations.

SAFETY ISSUES
• Bacteria are not supported by oil, there is no evidence that application of refined oil to neonatal infant skin causes any increased bacteria or fungal cultures [Darmstadt 2004, Kusmireck].
• Oil application on premature infants has been shown to decrease the incidence of dermatitis by restoring the epidermal barrier. Thus application of oil may improve outcome in neonates who are at risk with compromised barrier function [Darmstadt 2002].
• Edible oils are not absorbed into the systemic circulation, as the molecular structure of these oils is not conducive to trans-dermal transfer [Lee].
• Vegetable oil has not been found to be degraded by phototherapy, and there is no substantiation of burning of preterm skin under lights or heaters after oil application [Lee/Nooper].
• There is no researched evidence to warrant the use of essential oils on infants in a NICU. Section 39 of the UKCC Act 1992, documents standards for the Administration of Medicines which states that practitioners who use substances such as essential oils must recognise the importance of consent from the client (we should consider this to be the baby, as well as the parent); also the practitioner must be accountable for their own professional practice.

ALLERGIC PROPERTIES OF EDIBLE OILS.
Any product that is edible has the potential to trigger an allergic reaction [Crevel].
• The allergens in oil are bound to protein molecules, which are too big to enter the blood stream via the skin route if the skin were healthy and intact. If the skin is inflamed or broken there is a risk that this could sensitize the baby, increasing the risk allergy in the future [Lack].
• When oils are highly purified (refined), allergen-bound proteins are destroyed, so there is a greatly reduced risk (some say no risk) of the oil causing an allergy. [Hourihane‘97].
• Nut and sesame allergies are common and on the increase, the highest risk is peanut allergy which can be life threatening [Ewan]. Allergenic proteins may be found in the refined oil due to cross contamination with other oil products [Olszewski]. Check the Anaphylaxis Campaign website for more information.
• To have an allergic reaction one must first be sensitized. A newborn infant may already be sensitized to allergens transferred in utero (during the last trimester) from the mother via the placenta. The breast-fed infant may be exposed to human milk-borne allergens derived from foods the mother has eaten during lactation. [Lovegrove ’94]

 

(Botanical name - Cocos Nucifera)
Supplied by Essentially oils Ltd.
The oil used in the Neonatal Intensive Care Unit,
St. Mary's Hospital, London W2 1NY

The coconut palm is grown in many tropical areas, with the Philippines and Indonesia being the most important regions in terms of international trade.
Coconut oil is extracted from the white flesh of the coconut, which when pressed yields an odorous solid fat that has therapeutic properties. The white flesh of the coconut has an oil yield of up to 65%, making it the highest yielding of traditional oil-bearing materials, and contains over 90% saturated fatty acids [NEODA].
To extract the fractionated oil, this fat is subjected to heat and the top liquid fraction is removed [SCOPA].
• This fractionation process purifies the oil removing the fungal spores, pesticides and yeast moulds that are present in some oils.
• Fractionation produces perfume-free oil that stays in liquid form.
• Fractionated coconut oil does not oxidise (‘go off’) as quickly as other oils. The stabilization quality of this oil is particularly advantageous when used in a warm environment such as the NICU.
• The coconut is not commonly associated with the extreme allergic reactions triggered by peanuts and tree nuts. It is rare for coconut to cause an allergic reaction and should a reaction occur it is usually mild [Dr Lack]. The process of fractionation removes most of the proteins to which the allergens are attached.

We use this oil as a medium to facilitate the Positive Touch Programme on the Winnicott Baby Unit. The programme is designed to encourage safe, loving contact between parents and baby. Positive Touch is part of our family centered approach to infant care. The oil is mainly used by parents, giving them a precious opportunity to make an active contribution to their infant's well being.
The main function of the oil is to act as a lubricant so that movement over the skin is not abrasive. Stroking the skin without oil causes friction and can stimulate an adverse reaction in babies [Field ‘96]. Fractionated coconut oil is an ideal medium for massage as it is a pure, light, non-greasy emollient [Watt].

A small, brown glass bottle of oil is supplied to each baby with batch number, baby’s name, and expiratory and opening dates on the label. This avoids any risk of contamination from shared containers or the practice of decanting oil into unsuitable containers (which is an illegal practice). Supplying the oil in small quantities and in dark glass bottles also reduces the risk of becoming stale/rancid (the process of oxidation). We take regular samples of the oil for bacterial analysis

(Helianthus Annuus)

This oil is being used in the Neonatal Unit at Queen Charlotte’s Maternity Hospital, London

The flower originated in South America, where it was worshiped by the Aztecs as a representation of the sun; the seeds were eaten toasted or turned into meal and the plant was brought to Europe at the end of the 16th century. The seeds are still eaten today just like nuts, and the buds used like artichokes [Kusmirek]. Sunflower seeds contain an oil yield of 30% (although some modern varieties contain 50%).

Sunflower oil is the most widely grown edible oil crop.
• Sunflower oil is produced and sold in large quantities so it likely to be fresher than a more infrequently sold product, which may be sitting on the shelf waiting to be sold for a long period of time.
• It has a lovely light texture, which is very pleasant to use, leaving the skin with a satin-smooth, non-greasy feel.
• Given its high content in essential fatty acids, sunflower oil presents restructuring, regenerative and moisturizing properties.
• Studies by Sechi demonstrate evidence that the properties in sunflower oil have an anti-microbial effect [Sechi].
• It is not commonly associated with allergic reactions. However some refined sunflower oil, may contain minute trace elements of allergen, therefore highly sunflower seed-sensitive people, may be at risk of allergic reactions to the refined oil [Zitouni].
• Plant-based refined oil should not be stored in extreme temperatures. Do not store in a fridge as it can cause clouding and separation of the oil, as the oil’s natural waxes have been removed.

Oil extracted from organically grown plants and cold pressed, is dark yellow in colour and has a ‘nutty’ aroma. Cold-pressed oil should not be used at high temperatures, as in cooking, as it brakes down and produces toxic elements when heated.

The oil used at QCCH is food grade (can be ingested) and meets BP (British Pharmaceutical) and food federation standards. It is obtained from sunflower plants, which are grown in several European countries; supply depends on the yearly climate. It is manufactured in the UK [William Hodgson Co.]. The sunflower oil is produced by an alkali refining process i.e. it is refined, deodorised and heat treated . This oil is clear pale yellow in colour and has no odour. The oil is bottled by Huddersfield Royal Infirmary Hospital Pharmacy and bought in 50 ml bottles by QCCH.

Studies in a Neonatal Unit in Cairo, showed that using sunflower oil resulted in a significant improvement in skin condition and a highly significant reduction in the incidence of nosocomial infections and mortality [Darmstadt 2004]

(Olea europaea)

The oil used at Northwick Park Hospital (London) at the postnatal Baby Massage classes

The olive tree dates back several thousand years. In ancient Egypt the tree was called the bak, whereas to the Romans it was the olea, derived from oleum meaning oil. It has always been portrayed as a token of peace: the dove messenger to Noah, the wearing of olive leaf garlands by the Greeks, the use of olive branches in the Jewish Feast of Tabernacles, the symbol of the United nations flag etc.

The olive tree is a cultivated evergreen tree, gnarled with a grayish bark and silvery green olive leaves. The fruit is small and green, becoming black when ripened. It is the flesh that is used to obtain the oil, not the stone or seed. The oil is slightly green owing to the retention of trace amounts of chlorophyll. It is prone to congealing when cold, thus it is usually filtered in the warm countries where the tree is grown. It is known as Florence oil or Lucca oil, named from the towns in Tuscany that are important trading centers for olive oil

Many people enjoy using olive oil for massage use; however, it can be a little heavy and sticky with a strong odour. It is a good general emollient and has anti-inflammatory properties and has been known to be used for treating burns, bruises, insect bites, itchy and sensitive, chapped skin [Price],

Contact allergy to olive oil is rare [Isaksson].
Olive oil may not be ideal for use on dry skin - cradle cap [Malmkvist Padoan].
In animal studies, olive oil application was not found to improve epidermal barrier function. In the same study sunflower oil showed significant skin barrier recovery [Darmstadt 2002].

The author has not provided a policy for this oil, if using it in hospital/NNU you would need to check the Safety data Sheet and ask your pharmacy about storage. If you have any additions to these guidelines please contact me, they will be gratefully received.

(Prunus dulcis)

The almond tree is indigenous to the Middle East, and is now cultivated in the warm climates of the Mediterranean countries and California. It is an ancient tree, which has been cultivated for thousands of years. Almonds were prized by the Greeks, who introduced them to southern Europe. The trees were grown in Italy for hundreds of years before they spread to France in the 8th century and on to Britain some 800 years later.

This popular oil is:
• Pale yellow in colour, odourless and easily absorbed into the skin.
• It is used in many cosmetics such as moisturising and emollient hand and facial creams.
• It is widely used and appreciated for its excellent handling characteristics for massage.

Oils derived by nuts like almonds are more protected from drifting chemical sprays and pollution than are more exposed seeds.

Cold pressed almond oil is obtained by pressing the Almond kernel, which contains up to 50% oil, and then clarifying by filtration. It then gives a yield of 35% oil.
It is more often available as a refined oil, which has been chemically extracted by the use of solvents.

Most Almond oil available has been solvent extracted.

This nut oil would not be recommended if there were a history of nut allergy, if the baby had broken skin or eczema and if the mother had decided not to eat nuts while pregnant or breast feeding.

If mothers are not consuming a nut-free diet, they may already be exposing their infant to nuts (via the blood-steam, breast milk or placenta).

The author has not provided a policy for this oil, if using it in hospital/NNU you would need to check the Safety data Sheet and ask your pharmacy about storage. If you have any additions to these guidelines please contact me, they will be gratefully received

This oil was first produced in France but is now mainly produced in Spain, Italy and California. It originally became popular for aromatherapy use because, being a by-product from waste, it was cheap.
Grape seeds are available as by products of the raisin, wine and juice industries. Grape seeds are very hard (if you have ever tried to crush one in your mouth you will have found out!), so a great deal of pressure and heat is needed to generate the oil from the seed: they only contain 5% -20% lipids depending on the grape variety. Despite this low figure the total quantity of grapes produced is so huge there is a considerable potential for the production of the oil. It needs a lot of refining to make it acceptable for massage use.
The oil from crude, first pressing is thick and dark-coloured, not an oil one could use for massage. The refinement process involves the use of solvents, deodorizing by distilling at high temperatures, bleaching, and alkali refining.
The refining process produces oil:
• With little or no odour.
• which keeps fairly well.
• that has a good ‘slip-factor’
• that leaves the skin with a nice satin finish without being greasy.

In recent years grape seed oil has become rather a nutritional speciality, it is recommended to be included in diets designed for lowering serum cholesterol (Godin)

The Anaphylaxis Campaign. PO Box 275, Farnborough, GU14 6SX. Tel: 01252 373793. Helpline: 01252 542029. Fax: 01252 377140. http://www.anaphylaxis.org.uk/diet.html
Crevel RW, Kerkhoff MA, Koning MM. (2000) Allergenicity of refined vegetable oils. Food Chemical Toxicology, 38 (4): 385-393. Darmstadt GL, Badrawi N, Law PA, Ahmed S, et al. (2004). Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infant in Egypt: a randomized, controlled clinical trial. The pediatric Infectious Disease Journal, 23(8):719-725.

Darmstadt GL, Mao-Qiang M, Chi E, et al. (2002) Impact of topical oils on the skin barrier: Possible implications for neonatal health in developing countries. Acta Paediatr, 91 (5): 546-554.

Ewan P. (1996). Clinical study of peanut and nut allergy in 62 consecutive patients. British Medical Journal Vol.312; 1074-1077.

Essentially Oils Limited, 8-10 Mount Farm, Junction Road, Churchill, Chipping Norton, Oxfordshire, OX7 6PN. UK. Web: http://www.essentiallyoils.com
Tel: 01608 659544. Fax: 01608 659566. E-mail: sales@essentiallyoils.com

Fremont S, Errahali Y, Bignol M, Metche M, Nicolas JP. (2002) Allergenicity of oils (Article in French). Allergie et Immunologie, Mar; 34 (3): 91-94.

Field T, Schanberg S, Davalos M, and Malphurs J. (1996).
Oil Versus No Oil Massage. Pre and Perinatal Psychology Journal, 11 73 – 78

The Fragrant Earth Co. Ltd. Orchard Court, Magdalene Street, Glastonbury, Somerset. U.K. BA6 9EW. Tel:01458 831216 Fax;01458 831361 www.fragrant-earth.com E-mail: all-enquiries@fragrant-earth.com.

Hefle SL. (1999) Impact of processing on food allergens. Advances in Experimental Medicine and Biology, 459: 107-119.

Hoath S, Narendran, (2000). Adhesives and emollients in the preterm infant. Seminars in Neonatology, 5: 289-296.

Hourihane J. Bedwani S. Dean T Warner T. (1997). Randomised, double blind, crossover challenge study of allergenicity of peanut oils in subjects allergic to peanuts.

British Medical Journal 314; 1081-1088.

Isaksson M, bruze M. (1999) Occupational allergic contact dermatitis from olive oil in a masseur. Journal of American Dermatology; Aug. 41(2 Pt 2):312-5

Kusmirek Jan (2002). Liquid Sunshine: Vegetable oils for aromatherapy. Floramicus ISBN 0-9543295-0-3.

Khakoo A, Lack G. (2004). Preventing Food Allergy. Current Allergy & Asthma Reports, 4:36 -42.

Lack G, Fox D, Northstone K, Golding J. (2003) Factors Associated with the Development of Peanut Allergy in Childhood. The New England Journal of Medicine, 348 (11):977 -985.

Dr. G Lack - Consultant Paediatric Allergist. St. Mary’s Hospital London W2 1NY.
Lane A.T & Drost S. (1993). Effects of repeated Application of Emollient Cream to Premature Neonates’ skin. Pediatrics (92) 3; 415-419
Lee E. Gibson R, & Simmer K. (1993). Transcutaneous Application of Oil and Prevention of Essential Fatty Acid Deficiency in Preterm Infants. Archives of Diseases in Childhood 68; 27-28.

Lovegrove J. & Morgan J. (1994). Feto-maternal Interaction of Antibody and Antigen Transfer, immunity and Allergy Development. Nutrition Research Reviews; 7:25-42.

Malmkvist Padoan S, Petterson A. Svensson A. (1990) Olive oil as a cause of contact allergy in patients with venous eczema, and occupationally. Contact Dermatitis, Aug; 23 (2): 73-6.

Miller DG et al (1987). Cutaneous application of safflower oil in preventing essential fatty acid deficiency in patients on home parenteral nutrition. American Journal of Clinical Nutrition, 46 (3):419-423.

NEODA - The National Edible Oils Distributors Association. 6, Catherine Street, London WC2B 5JJ

Nguyen SA, More DR, Whisman BA, Hagan LL (2004) Cross-reactivity between coconut and hazelnut proteins in a patient with coconut anaphylaxis. Annals in Allergy, Asthma and Immunology, 92 (2):281-284.

Nooper AJ, Horii KA, Sookdeo-Drost S, Wang TH, Mancini AJ, Lane AT. (1996). Topical ointment therapy benefits premature infants. Journal of Pediatrics,128 (5Pt 1): 660-669.

NMC - NURSING & MIDWIFERY COUNCIL: (Replaced the UKCC) It is the disciplinary body set up under the Nurses, Midwives and Health Visitors Act 1992. 23, Portland Place, London W1N 4JT TEL: 0207 637 7181 FAX: 0207 436 2927. www.nmc-uk.org

Olszewski A, Pons L, Moutete F, Aimone-Gastin I, et al. (1998) Isolation and characterization of proteic allergens in refined peanut oil. Clinical and Experimental allergy: Journal of the british society for Allergy & clinical Immunology, July; 28 (7):850-900.

PRICE L. Price S. & Smith I. (1999). Carrier Oil for Aromatherapy & Massage. Riverhead publisher.

SCOPA - The Seed Crushers and Oil Processors Association.
6 Catherine St., London WC2B 5JJ, United Kingdom TEL: 44-171-836-2460; fax: 44-171-379-5735)
or IASC, P.O. Box 252, Haywards Heath, West Sussex RH16 2YG, United Kingdom (phone: 44-1444-483786; fax: 44-1444-484068).

Sechi LA, Lezcano I, Nunez N, Espim M, et al. (2001) Antibacterial activity of ozonized sunflower oil (Oleozon). Journal of Applied Microbiology, 90 (2):279-284.

Vital Touch oils Tel: 01803 840670

WATT M. Medical Aromatherapy Training Services. 7, Elm Court Park, Blackmore, CM4 OSE. UK. Fax: 01277 822563 E-mail: martin@aromamedical.demon.co.uk www.aromamedical.demon.co.uk

William Hodgson & CO., (Keith Mealand)
Alderly Edge, Cheshire, UK, Tel: 01625 599111

Zatz JL (1993). Scratching the surface:rational and approaches to skin permeation. In: Zatz JL (ed) Skin permeation:fundamentals and application. Allured, Wheaton p 28.

Zitouni N, Errahali Y, Metche M, Kanny G, Moneret-Vautrin DA, Nicolas JP, Fremont S. (2000) Influnce of refining steps on trace allergenic protein content in sunflower oil. Journal of Allergy and clinical Immunology, Nov; 106 (5): 962-967.

Cherry Bond – This information sheet is taken from the above resource references and is subject to alteration when new information comes my way, so please feel free to contact me with comments and updates. Tel: 0208 398 6551. Email:cherrybond1@aol.com