Pro-Con: Swaddling for Newborns

The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.¹ Still popular in Europe, there appears to be a resurgence of swaddling in North America among the holistic movement, making it an important topic for patients, particularly those expecting a child or blessed with a newborn.

The purpose of swaddling is to calm the infant and promote sleeping. This technique is often grouped with the traditional soothing techniques of nursing, massage, skin-on-skin contact and baby carrying. One benefit of swaddling may be that babies cry less: "The movements of the arms and legs cause the baby to startle. This is upsetting to the baby and causes over stimulation. When they are over stimulated, newborns cry in an attempt to block out the stimuli. When they are swaddled, the jerky arm and leg movements are kept to a minimum, resulting in less crying."² Another benefit noted by Hughes is that swaddled babies are less likely to scratch their faces with their fast-growing nails.

Holistic medical physicians Feder and Neustaedter both recommend the practice of swaddling in their respective books, Natural Baby and Childcare and The Holistic Baby Guide.^3-4

Why Consider Swaddling?

In The Happiest Baby on the Block, pediatrician Harvey Karp, MD, suggests a newborn needs the imitation of the womb during their first three months of life. The "five S's" that help replicate that environment are swaddling, side or stomach position, shhh-ing sound, a swinging motion and sucking.⁵

How to Swaddle^3,8

• Place a blanket flat on a level surface; fold one corner down.
• Place baby on their back, neck along the fold, arms to their sides.
• Lift the left corner of the blanket over the right arm and chest, and tuck it behind their back on the left side; then lift the bottom corner over the feet and body, and place over the chest.
• Lift the right corner and wrap it over the baby's left arm and chest; tuck it as far as you can around the back on their right side.
• Wrap both arms; always keep baby's head and face exposed.
• Make sure the blanket is not too tight. You should be able to fit two fingers under each fold.

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Is Swaddling Safe?

Thach addresses the issue of safety in his article, "Does Swaddling Decrease or Increase the Risk for Sudden Infant Death Syndrome?" He notes: "Fortunately in the present study, as noted previously, swaddling does not appear to impair sub-cortical arousals that are essential for adequate pulmonary function and appear to be the primary mechanism in terminating obstructive apnea in infants."⁶

In an extensive review, "Swaddling: Boosts Baby Sleep, Stops Colic and Reduces Infant Risks," Dr. Karp notes two studies that have shown babies who sleep on their back and are swaddled have a 33 percent less risk of SIDS than unwrapped back-sleeping babies. He suggests swaddling might actually reduce the incidence of SIDS and accidental suffocation, in addition to providing other benefits to both mother and child:¹

• "Boosts baby sleep so parents are not tempted to place baby in the dangerous tummy sleep position.
• Boosts baby sleep so parents aren't tempted to bring the baby into the adult bed. Parents' profound slumber could be hazardous if they fall deeply asleep while holding their baby, especially if they sleep in a dangerous location (e.g., couches or beds).
• Keeps babies from accidentally rolling onto the stomach. Babies who always back sleep – but accidentally roll to the stomach – have an 8-37 times increased SIDS risk than swaddled babies, who are less able to roll onto the stomach.
• Promotes breast-feeding. Swaddling reduces infant crying and boosts sleep, factors known to lead to early cessation from depression, exhaustion, lack of confidence in milk and reduced family  /physician support
• Reduces [maternal] cigarette smoking by reducing maternal exhaustion and frustration."

Addressing Other Concerns

Does swaddling enhance or interfere with nursing? It appears not to create an interference; in fact, a calmer baby may enhance breast-feeding and improve maternal well-being.

Does swaddling cause infant hip dysplasia? The International Hip Dysplasia Institute states it's safe as long as the baby can flex, and the hips can flex and abduct.⁷

Can swaddling prevent or reduce shaken baby syndrome (SBS)? According to Karp, the No. 1 reason for SBS is infant crying, and one study found 89 percent of parents who shook their babies visited a doctor prior to assaulting their babies, seeking advice on how to calm their infant. He comments that if maternal well-being were improved, it could reduce possible stressors leading to SBS.¹

Suggested Safer Protocols

• Never place a swaddled infant in a prone position.⁶
• Do not swaddle too tightly – this may limit pulmonary function or overheat the baby.⁶
• If the infant is ill (viral pneumonia) or coughing, do not swaddle.⁶
• Do not flatten (extend) baby's hips.⁷

Divided Opinions

Opinions remain divided on the issue of swaddling, and just last year, new guidelines from the Registered Nurses Association of Ontario (RNAO) addressed the possible unsafe practices of swaddling, since there is no evidence on a "safe way."⁹ The guidelines note the following concerns: 1) Swaddled babies placed on their stomach may increase the risk of SIDS; 2) There is a risk of overheating or the blanket suffocating the infant; 3) Swaddling may lead to hip abnormalities.

The RNAO concluded the safest approach is for infants to sleep on their backs, alone, in a crib that meets national safety standards. The guidelines also recommend avoiding the use of blankets, pillows and other types of sleep aids.

References

1. Karp H. "Swaddling: Boosts Baby Sleep, Stops Colic & Reduces Infant Risks."
2. Hughes P. "Benefits of Swaddling Your Baby." Available on Baby.more4kids.info.
3. Feder L. Natural Baby and Childcare. Hatherleigh Press, 2006.
4. Neustaedter R. The Holistic Baby Guide - Alternative Care for Common Health Problems. New Harbinger Publications, 2010.
5. Karp H. The Happiest Baby on the Block: The New Way to Calm Crying and Help Your Newborn Baby Sleep Longer. Bantam, 2003.
6. Thach B. Does swaddling decrease or increase the risk for sudden infant death syndrome? J Pediatric, 2009 Oct;155(4):461-462.
7. International Hip Dysplasia Institute position statement on swaddling for pediatricians and primary care providers.
8. Cannon B. Grow Healthy. Grow Happy. The Whole Baby Guide. Genki Press, 2004.
9. Leung M. "New Guidelines Reopen the Great Swaddling Debate." CTVNews.ca, March 5, 2014. Reporting on the 2014 RNAO guideline: Working With Families to Promote Safe Sleep for Infants 0-12 Months of Age.