Monthly Archives: December 2012

Swaddling: Boosts Baby Sleep, Stops Colic & Reduces Infant Risks – By Harvey Karp, MD, FAAP


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Swaddling is one of the world’s oldest baby care traditions. For thousands of years, parents have wrapped infants to carry, soothe and protect them and to promote sleep. Until, in the 1700’s, parents started shunning infant wrapping as unnecessary, overly restrictive and even barbaric.

As swaddling was phased out, it was replaced by medicinal calming aids. In fact, doctors prescribed sedatives (like Valium) and even opium!! for infant crying until the 1970’s.

But, in recent years, the ancient practice of swaddling has undergone a renaissance as parents search for a way to calm fussy babies…and get more sleep. Newborns cry/fuss an average of 2.5 hours/day. And, 10-20% babies have colic, meaning that they cry for over 3 hrs/day.

Infant irritability – and the parental exhaustion it provokes – is much more than a nuisance. It is a primary contributor to numerous serious/fatal problems including marital stress, depression, breastfeeding failure, child abuse, SIDS/suffocation, over treatment for acid reflux, maternal smoking and even mom and baby obesity.

Swaddling can help reduce all these problems, especially when used as part of the comprehensive calming intervention, including sound, motion, and sucking.

Swaddling Reduces the Risk of SIDS/Suffocation

In 1992, the “Back to Sleep” campaign was launched in the USA; since 1992, the “Back to Sleep” campaign has reduced SIDS deaths by ~55%. But, over 2000 infants still die from SIDS in the US each year. And according to the CDC, suffocation deaths of babies in bed have risen 4 times during this period.

Two important studies (one in Australia and one in New Zealand) have shown that babies who sleep on the back – swaddled – have about 33% less SIDS than unwrapped back-sleeping babies!

Correct swaddling does not overheat babies as long as parents don’t overdress their baby, cover the head or overheat the room. Blair noted that, “the infant head is the site of 40% of heat production and for an infant up to 85% of total heat loss is through the face or head.” It is important to note that over chilling a baby is just as much of a SIDS risk as overheating!

In fact, rather than increasing SIDS, there are several ways supine (back sleeping) swaddling might actually reduce SIDS and accidental suffocation:

  • Boost baby sleep so parents aren’t tempted to place baby in the dangerous tummy sleep position
  • Boost baby sleep so parents aren’t tempted to bring baby into the adult bed. Exhausted adults are like drunk drivers! 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) or overlay the infant.
  • Keep 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. Swaddled babies are less able to roll onto stomach.
  • Promote breastfeeding. Swaddling reduces infant crying and boosts sleep, factors known to lead to early breastfeeding cessation from depression, exhaustion, lack of confidence in milk and reduced family /physician support.
  • Reduce cigarette smoking by reducing maternal exhaustion and frustration.

There are other concerns and questions to consider.

Does Swaddling Enhance or Interfere With Nursing?

A Russian study found no drop in milk production (four days postpartum) or reduction in “nearly exclusive breastfeeding” (averaging 4 months) between the swaddled and skin-to-skin babies.

On the other hand, excessive crying (and the exhaustion it triggers) can interfere with nursing via: reduced milk production; poor let down; mastitis; damaged confidence; lost family support; more depression; more cigarette smoking; and pressure from doctors to stop nursing or try very difficult diets.

Two CDC studies (over 30,000 nursing women) found the top reason mothers wean (over one month of age) was because they thought their infants disliked the milk or were not getting enough. Wrapping may boost nursing rates by reducing crying and boosting a mom’s confidence and increasing her sleep.

Does Swaddling Lead to Pneumonia?

A 1990 study reported a rise in lung infections among wrapped babies. But, a newer study of 1000 tightly swaddled babies found no rise in lung infection. Swaddled babies have been shown to have normal oxygen levels.

Does Swaddling Cause to Hip Dysplasia?

All reports that associated swaddling and hip dysplasia (DDH) come from cultures using antiquated wrapping techniques (knees and hips rigidly bound with cloths or ropes).

Pediatric orthopedists note swaddling is safe as long as it allows ample hip flexion and abduction. The International Hip Dysplasia Institute says swaddling is safe as long as the infant’s knees can flex and the hips can flex and abduct.

Does Swaddling Impair Development?

A study of 1279 babies (half tightly swaddled almost continual for 2-3 months), then gradual less, found no differences between the swaddled and unswaddled babies’ development at 11-17 months.

Is Swaddling Stressful to Infants?

Throughout the day, babies shift through different levels of arousal, or “state,” moving back and forth between deep sleep, drowsiness, quiet alert and crying.

Swaddling helps fussy babies have greater state stability: soothe faster, stay calmer and sleep longer. But is this tranquility a good thing? Some have worried that, rather than being serene, less movement from swaddling might “stress” infants and make them neurologically “shut down.”

But, the key clue that swaddling actually reduces stress is the finding that swaddling lowers a baby’s heart rate (exactly as is seen in babies who are calm and relaxed).

Other Benefits of Swaddling:

Beyond the fact that swaddling can help reduce the risk of SIDS, there are other important benefits of swaddling.

Prevent and Reduce Shaken Baby Syndrome

Over 1300 US babies suffer Shaken Baby Syndrome (SBS) each year. The average age is 3.5 months and the #1 trigger is infant crying. One report found 89% of parents who shook their babies visited a doctor seeking baby calming help before the assault occurred. According to recent reports the incidence of AHT has almost doubled since the current recession began.

Today, numerous SBS prevention programs teach swaddling, as part of their cry reduction intervention.

Prevent and Reduce Postpartum Depression

Postpartum depression (PPD) affects 10-15% of all new mothers (and 25% of their partners!). Several studies have found that infant crying and maternal fatigue are common PPD triggers.

Swaddling (and white noise) have been demonstrated to increase infant sleep and increased sleep has been shown to reduce PPD. For this reason, swaddling has been taught in PPD prevention and treatment programs at Duke University and Virtua Health (in the setting of Happiest Baby classes).

Reduced Crying

By itself, wrapping often fails to calm a fussy baby. But, once a baby is calmed the swaddling keeps them calmer longer – and sleeping better. Virginia doctors found swaddling – as part of the 5 S’s – very quickly calmed crying after baby vaccines.

Other Health and Health Care Related Benefits

Swaddling may also reduce unnecessary doctor visits, unnecessary medication, moms overeating and overweight,…and exhaustion-related car accidents.

Conclusion

Babies benefit from the soothing effects of many ancient practices including nursing, massage, sling use and skin-to-skin contact.

Swaddling deserves a place among these time-honored techniques as a valuable tool to promote sleep, soothe crying, boost parental confidence and prevent a broad range of morbidity and mortality. However, parents need to be educated to understand how to swaddle correctly and safely and use a swaddle blanket that is made from breathable cotton.

The heightened pressures so common in today’s families (e.g. work demands, lack of baby experience and reduced family support) have led groups like the American Academy of Pediatrics to promote correct swaddling.

Over the past 20 years, parent education programs have successfully modified various parent practices, including prone sleeping; cigarette smoking and improper use of infant car restraints. We have learned that through education we can save lives and help parents use the techniques that reduce risks. When used correctly, child safety seats save lives (reducing fatalities among young kids by 53-71%). But, improper car seat installation (which still occurs 73% of the time, most often with infants) can accidentally increase injury and death. For this reason, we work hard to teach correct car seat installation.

Similarly, we need safe swaddling classes. Correct swaddling (among other techniques to reduce fussiness and promote safe sleep) has been taught since 2005 through The Happiest Baby program. Happiest Baby educators now teach safe swaddling in hospitals, clinics and military bases in ten nations, including over 1000 working for state and local health departments in the US (e.g. Connecticut, Oklahoma, Massachusetts, Minnesota, Pennsylvania, Wyoming).

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