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Revista da Escola de Enfermagem da USP

Print version ISSN 0080-6234

Rev. esc. enferm. USP vol.48 no.3 São Paulo June 2014

http://dx.doi.org/10.1590/S0080-623420140000300005 

Original Article

Meaning of becoming mother and son/daughter through massage*

Significado de ser madre e hijo/a por medio del masaje

Francisca Márquez Doren1 

Camila Lucchini Raies2 

Soledad Rivera Martínez3 

1Associate Professor, School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.fmarquez@uc.cl

2Associate Professor, School of Nursing, Pontificia Universidad Católica de Chile.

3Associate Professor, School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.

ABSTRACT

Objective: Revealing the experience of mothers when massaging their children to know the phenomenon in the context of a mother-child healthy development. Method: This is a qualitative study with a phenomenological approach carried out with 11 women who massaged their children and answered the guiding question: What did the experience of massaging your child mean to you? Results: The experience of massaging their children meant the development of their being a mother and of being a son/daughter, in addition to developing the attachment relationship between them. The massage can operationalize this integrality, become a tool of communication, stimulation and promotion of secure attachment, by promoting the loving interaction between mother and child. Conclusion: This practice should be considered as an option in the programs that promote the comprehensive health of the mother and child.



Key words: Child; Massage; Mother-child relations
; Child care
; Qualitative research


RESUMO

Objetivo: Revelar a experiência vivida pelas mães ao massagear seus filhos/as, a fim de conhecer o fenômeno no contexto do desenvolvimento saudável entre mãe e filho/a. Método: Trata-se de uma pesquisa qualitativa com uma abordagem fenomenológica na qual participaram onze mulheres que massagearam seus filhos/as e que responderam a pergunta norteadora: O que significou para você a experiência de massagear seu filho/a? Resultados: A experiência de dar uma massagem em seu filho/a significou desenvolver o ser mãe, o ser filho/a e, a relação de apego entre ambos. A massagem permite operacionalizar essa integralidade, se transformando numa ferramenta de comunicação, estimulação e de promoção do apego seguro, ao favorecer a interação amorosa entre mãe e filho/a. Conclusão: Esta prática deve ser considerada na oferta dos programas que promovem a saúde integral da mãe e do filho/a.




Palavras-Chave: Criança; Massagem; Relações mãe-filho
; Cuidado da criança
; Pesquisa qualitativa


Introduction

In ancient cultures like India and China, the massage was an activity that was part of the care routine given by women to their children(1). It has been established that the massage humans give their children, is the equivalent of mammals licking their offspring at birth, which improves their chances of survival(2-3). The touch is the first sense that human beings develop, which allows connecting throughout all their lives, from the fetal period until old age(3). The massage is done from and through the skin, which is the largest and most exposed organ of the body(2).

The technique of infant massage is an intentional tactile stimulation of repeated pats on the surface of the child’s body. In order to do it, one must make eye and vocal contact with the child, who should preferably be naked(2).

Among the many effects attributed to the massage is the mother-child positive interaction(4); improvement in the mood of mothers and prevention of maternal depression(5). In addition, the parents notice a greater understanding of their child because they learn to identify their different types of crying and the level of urgency that requires their attention, hence, they respond better to their children’s needs(4). It also promotes the development of children through the active stimulation of the neurological system through the skin(6), allowing for example, an early discharge in hospitalized children because of diseases due to their premature condition(7). This latter, thanks to the stimulation of better gastric motility, that would be associated with improved digestion and absorption of food, and therefore, the stimulation of growth(8).

Finally, the massage helps to improve the patterns of sleep and relaxation, due to the muscle relaxation produced, plus the adjustment and regulation of the circadian rhythm(9-10). Another important effect of the massage is reducing the level of the ‘stress hormone’ (cortisol), and increasing the serotonin levels, which allows the release of the growth hormone and is responsible for the feelings of pleasure and happiness(11). Also, longer periods of alert are recorded without manifestations of stress(10), and a lower stress reaction in face of painful stimuli(12).

The available studies on this subject, address mostly the effects of massage from a quantitative perspective. There are few studies addressing the issue from a qualitative point of view, and its results are focused mainly on the development of the mother-child link in social and physical situations of disadvantage, showing that when mothers give their children a massage, this improves bonding between them(13-14). There is a gap in the knowledge about what mothers experience by massaging their children. From this observation, raised the interest of carrying out a qualitative research of phenomenological design, in order to reveal the experience of mothers when giving their children a massage, and knowing the phenomenon in the context of a mother-child healthy development, and this way, contribute to the construction of knowledge in this area and strengthen the role of clinical nurses, nurse-midwives and midwives. For this reason, the following research question was raised: what is the experience lived by mothers when massaging their children?

Method

This is a phenomenological qualitative research, which seeks to understand the perception of the experience from its description in depth, and from the consciousness of those who live it, in this case, mothers when massaging their children. As a process, it includes revealing the essence of the phenomenon, and the use of an intuitive process that comprises the structure of the essences of the experiences lived by the person in day to day, according to the principles proposed by Streubert based on Husserl(15). Husserl’s phenomenology is understood as ‘back to the things themselves’, meaning what is inside the conscience of individuals, with no causal explanation(15).

The study participants were women, who had learned the technique to massage their children in a nursing consultation designed for that. The location was a private outpatient health center that belongs to the Hospital Clínico Universitario de Santiago de Chile, as part of a program to support the monitoring of development and growth of children under two years (EPAS)(16). It was a convenience selection through intentional sampling, in search for people who had lived an experience that was interesting to unveil(15). The selected women were those who attended the massage consultation and continued performing it after their children were one year old, with a frequency of 4-7 times per week. In total, 15 women were invited to participate, among which 12 accepted. Finally, 11 women were interviewed, since one of them declined, despite having initially accepted, as in the time of the interview she was living in another city. The interviews were carried out by the main researcher, who was part of the nursing massage instructors of the health center, and for this reason some of the participants already knew her. The interviews took place at a location previously agreed between the researcher and each of the participants. The criterion used to determine the number of participants was the saturation of meaning. Data collection was carried out until the researcher ensured to reach the theoretical saturation(15), which occurred in the eleventh interview. The interviews lasted 45 minutes on average, and were fully included in the analysis.

After the first interview, its phenomenological analysis was done to initially identify the units of meaning that emerged from an intense reading of the interview, and that responded to both the research question, as to the concerns of the researcher. From this, the rest of the interviews were carried out, always analyzing each one before moving on to the next.

The technique of in-depth interview was used to collect the testimonies. The interviews were conducted between November 2006 and August 2007, recorded with the consent of participants and then verbatim transcribed, word for word (verbatim). The research question was: What did the experience of massaging your child mean to you?


It is noteworthy that the units of meaning unveiled through the process of interpretive analysis account for aspects of the interviews that make sense for researchers and respond to the guiding question made to participants(15).

For the construction of categories that respond to the phenomenon of massaging children, was used the interpretive method of Streubert based on the phenomenological analysis process proposed by Husserl, who postulated that phenomenology is the study of the human experience as revealed to consciousness, free of presuppositions, considering only the act itself in its purest essence(15). Thus, similar meaning units were regrouped, giving rise to the three central comprehensive categories that account for the studied phenomenon.

The ethical principles that protect participants in their dignity were guaranteed throughout the investigation with the process of informed consent. Such process complies with the universal ethical principles for research involving persons: respect, beneficence and justice(17). The anonymity of participants was ensured by numbering the recordings of interviews and replacing the real names by fictitious names. Similarly, transcripts were reviewed and analyzed by the researchers only. This study was approved by the Ethics Committee of the School of Nursing of the Pontificia Universidad Católica in Chile, in September 2006 (N°CEEEUC09/2006).

Results

The experience of massaging a child means the development of being a mother, through a relational dynamic in which she is constituted and recognized as such. Meanwhile, the child, will develop their being a son/daughter and between both the attachment relationship becomes stronger. The development of being a mother, being a son/daughter and the attachment relationship constitute the central comprehensive categories, which have shown to be dynamic and interrelated dimensions among each other. This is depicted in Figure 1.

Figure 1 'Meaning attributed by mothers to the experience of massaging their children' 

The massage contributes to the constitution of being a mother as a psychosocial construction, from where emerge two subdomains that relate to the transitional process of becoming a mother: the process of moving from insecurity and fears that arise from the birth experience, breastfeeding and caring for your child/a newborn, until feeling confidentin performing the role of mothers.

In early pregnancy, women feel insecure and afraid because they see it as a great responsibility and wonder if they will be able to perform the multiple tasks they have seen their own mothers and other women around them perform. Therefore, and especially those who are first-time mothers, face the process of birth and embracement of their child with uncertainties and fears.

I think sometimes you have many fears. Will I be able to feed him/her? Will I be able to take care of him/her? … Endless questions you have! (Rosa).

… because in the first three days I felt like a bad mom, I do not know, I could not breastfeed him/her and in between there was the massage, which in truth calmed me down. I really believe that if I haven’t had the help and protection of the EPAS, I would be hysterical (Petunia).

When massaging their children, mothers begins to feel competent and acknowledge this has become a medium that allows experiencing a process that enhances the loving intimacy with their children, achieving security and confidence in their roles of mothers.

it makes me feel like a more capable Mom, more like … with the right to be called Mom! it is one thing that validates me as a good mother as well (Margarita).

the massage has helped me to have the necessary confidence to say ‘Yes, I’m doing well!’ and realize that my daughter is perfectly happy (Tulipán).

An important aspect that mothers highlight as benefits of the massage is that it allows their children to develop their being a son/daughter. When massaging their children, they feel involved in enhancing their development and contributing with it in a positive and decisive way. Thus, three subdomains are raised in the statements of mothers, which contribute to the overall development of their children: the healthy psychological development, the healthy biolological development and the promotion of a healthy caring behavior. Mothers report that through massage, they contribute to achieve a healthy psychological development of their children, as it strengthens their self-esteem, affection, security and independence. They describe their children as more sensitive and perceptive, because they feel loved during the massage experience.

Well I notice in his personality, he’s independent … feels safe to do things, always has the initiative to do things. He doesn’t want his Mommy doing everything for him, He stands and pulls the shirt alone, puts his shoes on, gets dressed practically alone, and he’s just 2 years and 1 month old. He tries to eat alone, is an autonomous child and of course that surprises me! I also feel he is a more self-confident child (Rosa).

The other benefit, that is more subjective, is that they are more emotional and demonstrative with their body … Until today F…goes and hugs me, kisses me, tells me she loves me, cuddles my back. An atmosphere was created, an emotional environment, and that is an important benefit because it is not easy to do that, sometimes, for some people (Margarita).

They also perceived that the massage has significantly contributed to the adequate biological development of their children, because they have normal growth, have managed to have a peaceful sleep, good digestion, without the presence of serious illness.

Because of that, since I gave her a massage, she was always well, slept great and was happy … Almost did not wake at night. Every time I gave her a massage she slept peacefully, if I ever came home too late and didn’t catch her for giving the massage before going to bed, I felt it was an uneasy sleep and she woke up more often at night (Tulipán).

It came a time when P… she could not poop and I talked to the nurse in the consultation, who advised me to continuously massage her stomach, then every time she ate, I gave her a tummy massage and rubbed it until she pooped. It worked, worked really well! (Cala).

In relation to the promotion of a healthy caring behavior, mothers believe that the massage helps them to be closer to their children, lovingly communicating, discovering each other in an intimate and fulfilling experience of love.

Well I think that touching means something special to me, I feel that touching is like reconciling the affection. … a gentle and warm touch in a rich environment makes me feel that one can reconcile all those rough patches that you may have had, including with this same baby, to create a more emotional bond, more fulfilling (Rosa).

If both have the complicity of having passed those great moments, it is not so easy to reach violence. It is not so easy because there is a deeper and more emotional experience, and I think that in general. You no longer allow yourself to hit your child if you’ve been massaging him/her in the previous night, also because you learn to respect him/her ….you’re being generous and respectful to your child when you give him/her a massage, you saw him/her in absolute surrender, trusting you, then you learn to respect him/her (Margarita).

The massage creates a powerful bond of intimacy between the child and his/her mother, in an active and reciprocal connection that they recognize as the attachment relationship. Participants highlighted that the massage promotes intimacy between them and their children, which allows establishing a deeper understanding between the two. They emphasize the skin-to-skin contact (SSC) between them when massaging their children, the experience of happiness and joy, the development of a special connection, expression of mutual affection and a relationship of deep understanding between both, which arise as the subdomains of the third unit of central significance.

During the massage, mother and child establish moments of total and mutual surrender, looking in the eyes and communicating through touching and the SSC. The child is the protagonist that asks for the massage in his/her own way, and the mother learns to identify her child’s needs through the loving touch. In this interaction, they feel that one is part of the other, as when the child was in the womb.

Normally they look me in the eyes, then it is a very deep, non-verbal communication, really intimate … do not know how to describe it, because it is through touch … I think the act of touching your son and that touch being soft and nice … I always had the feeling that it reminded him a little like the womb (Rosa).

… In his own way he asks me, because he will not tell me, ‘ Mommy will you give me a massage?’, but he takes my hand and puts it on his face for me to touch him the way he is used to, that I normally do, that is simple (Cala).

The moment of the massage is recognized as an action that opens space for the experience of happiness and joy, of harmony between both, of great tranquility and mutual acceptance. Through contact, mothers will strengthen and deepen attachment with their children, in a deep closeness they perceive as a strong bond that will last forever, creating a special connection between them and their children. It is a moment when time stands still, in a connection so pure that the intimate relationship creates a bond that brings happiness to both.

Deep down, at the time of the massage, I also have seen that we are both happy, it does us well … it’s like, we get happy when that time comes … It makes me happy when I touch her, and she gets happy when I massage her, touch and cuddle her, it kind of helps in the mood! (Rayo de Sol).

There is a connection, these are very special moments of pure connection. When you start touching and cuddling, you basically get into a system where the rest of world stops for a while and it’s just you and your baby. I notice that he looks me in the eyes, laughs, starts imitating me, moving his little hands the same way I do, as if verbalizing: there’s a connection point here! I would say it’s that, a connection where obviously the relationship gets stronger (Erika).

The massage is also a moment of total attention, where mother and child are fully embroiled in a moment of absolute presence giving each other affection and communicating with love through intentional touching. The massage is then an active interaction in which mother and child mutually express affection building a circle of love. The mother gets to know her child through this relationship, and discovers new forms of contact that emerge from the experience. They accept each other, and this closeness provokes a unique relationship between them both.

It is a circle of love, I always saw him like that because P … also cuddled me. As he was loved with the massage, he was always very pleased. He is a happy boy, with easy laughter (Rosa).

It was a basically affective communication, because I realized what my baby felt at that time, I understood it by putting the hands on him. So, it was a bond of caress for love, not so much for comforting…. (Diamelo).

In moments of mother-child interaction, is established a relationship that allows both to know each other deeply. The mother learns to enjoy the relationship with her child, because a dynamic is developed, where both are active when the encounters take place. The relationship becomes closer as the mother does the massage, what leads her to an understanding of her child, accepting him/her in his/her wholeness. The knowledge is constructed step-by-step and the mother will recognize the different ways by which her child expresses his/her feelings. Thus, if she sees that her child is pleased, she will continue with the massage, and if her child seems annoyed, she will stop.

We have a good relationship, maybe the massage helped me to know him better, I know what he wants or needs. We have a close relationship, I understand him (Magnolia).

First, I feel fully responsible for the growth of M … if I know her better, I feel more confident when making decisions if something happens to her. By knowing my daughter better, I get less concerned about her, because I know how she is developing and I do not get nervous about what she does. I am aware of her needs, we can guide her growth better and I control myself better when she does things that make me angry, because what she does is not a surprise to me (Laurentina).

The experience of massaging a child showed to be an experience in which mothers feel complete, because it allows them to have moments of effective presence with their children. A relationship of mutual love is built, identified as generating a healthy and happy child, and a woman that becomes a mother.

I feel in real surrender, to be doing something honest, something real. Because sometimes you’re with your children, but in fact you’re not, you are also doing other things … and massaging is absolute presence. Those little 10 minutes are absolute, that’s what comes to my head, what a pleasure it was that I could give myself those moments of absolute presence with my kids … it’s a super human thing (Rayo de Sol).

Discussion

In order to organize the results of this study in the context of the knowledge already built on this subject, it is necessary to separate the processes that occur integrated in the living experiences.

Thus, the interviewed women recognize to have undergone a transition process, initially facing motherhood with fear and insecurity due to the feeling of incompetence to assume the responsibilities implied in what it means to be a mother. They report having experienced a process marked by internal demands and those from the environment, feeling challenged to fulfill maternity successfully. The interaction lived by mother and child through massage strengthens the maternal self-esteem by developing skills that benefit the overall development of their children and their own. In this context, mothers need to feel that they are doing well with their children, what becomes a positive reinforcement to develop and affirm their act of being a mother.

This agrees with the results of studies carried out since 1977(18), that originated a nursing theory on the process of becoming a mother: Becoming a mother, which emphasizes the transition lived by women when becoming mothers. In this theory, the process of becoming a mother is defined as

the movement towards the personal state in which the mother experiences a sense of harmony, confidence and competence in performing the role, thus developing her maternal identity(18).

The development process of being a mother is complex and depends on many factors, among which the parity, the child’s temperament, the self-esteem, the union of the mother with her child, the maternal sensitivity, among others. All these factors influence the transition process lived by mothers, from the uncertainty about motherhood, until achieving the necessary security to feel comfortable(19).

This process is significantly influenced by the cultural and social environment and the mother’s self-demands. Thus, pregnancy and the arrival of the child become a process that is part of the lives of women, especially for first-time mothers. This process is characterized by a sense of insecurity about motherhood, which is strongly determined by demands self-imposed by women, by social demands and the models experienced during their own childhood that add the fear. Therefore, it is essential to recognize, during pregnancy and the postpartum period, the impact produced by the arrival of a child in the woman and her family, supporting new mothers to understand this is their child and they are perfectly capable to look after their needs(20).

From this perspective, the child massage is one of the practices that mothers can use to reach an approximation and understanding of their children, which will help with their confidence and the development of being a mother(21), along with practices such as breastfeeding, daily care, stimulation of psychomotor development, among others. Thus, infant massage is conceived as a nurturing touch to the newborn baby, that becomes a way for parents helping their children going through an easy transition from the womb to the world(3).

Mothers highlight that children were able to develop their being a son/daughter through the interaction between them both generated during the massage. They also revealed that the massage stimulates the healthy psychological and biological development of children, and that through the loving touch it was possible to promote a healthy caring behavior with them. These results are consistent with those reported by the literature on this issue(4,21).

In their statements, women also emphasized that the massage promoted a good relationship with their children, because they connected with them in a loving way and in such a deep level that made the coexistence of any form of violence impossible because the massage helped to reconcile affection and respect that child who fully surrenders. This is confirmed from the postulation that a secure attachment between mother and child contributes to a healthy and non-violent interaction(22). This type of link promotes a contact of deep love, which allows children to grow and develop in the safety of their mothers’ love(4,10). Therefore, encouraging practices of health promotion(23) such as the massage could help to reduce violence and child abuse, a fact which is especially important in Chile, considering that violence towards children in all its forms reaches more than 70% in all socioeconomic levels(24).

On the other hand, mothers discovered that their children developed confidence and trust with them, and that their needs were met and they felt understood. They recognized that through massage and skin to skin contact with their children, they were closely related to them, having sensations of joy and pleasure that stimulated them to continue. This is consistent with the reports on the process of establishing attachment, which states that between mother and child is established a relationship that reduces the distance to reach the state of security and protection. The attachment relationship develops through the prolonged time that children and their mothers or caretakers spend together, which is facilitated by proximity and skin contact(22). The process of establishing attachment(22) is determined biologically and by the environmental stimuli provided by the caregiver. At birth, children remain in contact with their mothers, guided through smell and skin to skin contact. As children grow, they conceive the figure of their mothers as entities apart from themselves, who remain through time and produce feelings of pleasure and safety(22). In this study the interviewed women confirmed that the massage favored the attachment relationship.

It has been established that during the attachment relationship, mother and child connect and create a special bond which, when living with joy, pleasure and tranquility, allows establishing a style of secure attachment(22,25). In the reciprocal interaction, mother and child know each other and know what to expect from each other, which is a very important factor, because in case this does not occur, the attachment style developed may be insecure(24,26). This same author states that the attachment style developed by mother and child during childhood may be determinant of the adults these children will be in the future(26).

After six months of life, it is possible to identify signals in the children that account for the interaction and closeness with their mothers, such as their search, the crying when the mothers disappear and the gaze direction to their source of security (the mother)(25). The interviewed women highlighted the deep knowledge about their children they achieved through massage, with dimensions described above. This knowledge would give them security to meet the needs of their children, which would further enhance the development of attachment. Knowledge and understanding of the children’s needs has been identified by various authors as maternal sensitivity, a factor that largely determines the development of attachment(4).

Studies suggest that mothers of our days have difficulty to bond with their children due to multiple reasons such as lack of knowledge, lack of support, time spent at work, and caring for their other children, among others(27). The contribution that the massage means for these mothers in the aspect of developing the attachment is a knowledge that needs to be disseminated as a powerful strategy for health promotion(23). It is suggested to consider it for the policy of comprehensive early childhood development Chile Grows with You(Chile Crece Contigo)(28), which since 2006 has implemented a reform in the programs of prenatal care and monitoring of growth and development of children. This reform is focused on the perspective of health determinants and proposes a reformulation of the philosophy and practice of health care of mothers with their children, considering it since pregnancy(28).

Conclusion

The experience of mothers when giving their children a massage, from the newborn period until they were about eighteen months old had multiple meanings for them. The quality and intensity of the relationship they establish with their children stimulates the development of their being a mother because they are certain it gives them the experience of actively participating in the comprehensive development of their children, strengthening the emotional bond between them.

During the development process of their being a mother, women require a comprehensive, systematic and ongoing support to achieve a sense of competence and confidence to care for their children. Until nowadays, the care for pregnant women, puerperal women and their children has been carried out separately and by different professionals, and is focused on the control of the biological aspects of the process, both of the mother as the child. The challenge for the health team; especially for nurses and midwives, is to understand what the arrival of a child means for that mother and what she experiences in this transition process, especially for first-time mothers. This comprehensive care is built with the mother and the father, based on their experiences and needs during the whole process of pregnancy, childbirth, puerperal period and the child’s infancy.

The approach driven by national policies aims to rethink the practice of health care for the mother and child, considering it from pregnancy, childbirth and early attachment, during the puerperal and the child’s early childhood. The massage is one of the strategies that proved to be effective and can help achieving the objectives of the program, as it aims that mothers gain confidence to care for their children, are best linked with them and stimulate their integral development.

Incorporating practices such as the massage in programs of child health care, involves creating methodologies to empower families from the period of pregnancy, in every step of the massage, to ensure that once the child is born, they can put it into practice from the first days of life. Such strategies should be integrated to programs such as the monitoring program of growth and development of children under two years, which allows putting the family care in a privileged and protected place, with follow-up to reinforce it and feed it back throughout the process. It is essential that parents can express their doubts, problems and concerns, and incorporate the necessary changes on due time, in order to continue giving massages as their children grow.

The massage can operationalize this integrality, become a tool of communication, stimulation and promotion of secure attachment by promoting loving interaction with their children. This practice should be considered in the options of programs that promote the comprehensive health of the mother and child.

Developing an integral and comprehensive nursing care aimed at supporting and meeting the needs of the mother and father in the care of their children is an imperative that is possible to specify nowadays by incorporating practices such as the massage combined with breastfeeding. The present study contributes to the construction of knowledge in this area, strengthening the clinical role of nurses and midwives in a national context that is giving special emphasis on promoting the healthy growth and development of children from pregnancy, and especially in the early childhood.

On the other hand, the understanding of this phenomenon from the perspective of a particular social context limits the results of this study, which prevents the generalization of its data. However, the importance of this research lies in the experience of mothers massaging their children, their feelings and perceptions, regardless of the social group to which they belong.

*Extracted from the master’s thesis “Develando la experiencia vivida por las madres que realizan masaje a sus hijos/as”, Master of Nursing, School of Nursing, Pontificia Universidad Católica de Chile, 2008.

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Received: November 07, 2013; Accepted: March 28, 2014

Correspondence: Francisca Márquez Doren. 
Escuela de Enfermería, Pontificia Universidad Católica de Chile – Departamento de Salud del Niño y Adolescente
 Vicuña Mackenna, 4860
7820436 - Santiago, Chile

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