Is Swaddling Your Baby a Good Idea?

 

 

 

 

 

 

 

 

 

 

“Is swaddling my baby a bad idea?” asked a mom, just the other day, “Or should I be doing it?” Great question. For the parents of sleep-proof or fussy newborns, finding ways to improve their infant’s shuteye—longer? better? –may be their highest priority. Is swaddling safe? (yes, if done right) Does it work for all babies? (Not always) Until what age is it appropriate? (Read on!)

Contrary to what certain claims may suggest, swaddling isn’t new.  Rather, in Europe and North America, the practice has been rediscovered as a way of soothing crying infants or promoting better sleep. Wrapping infants snugly in cloth has been done worldwide for centuries. Recall the swaddling clothes used at Christ’s birth? Consider also the variety of approaches to swaddling used around the world: from the papoose-style cradleboards in rural China (35 days) and the Navajo (for 5-6 months), to the use of cloth wraps in Holland (12 weeks), Mongolia (5-6 months) or rural Turkey (up to a year). In warmer climes as in Africa, babies require less clothing, and may be placed in a sling instead.

In the US, interest in swaddling intensified, with the 2002 book by Dr Harvey Karp, The Happiest Baby on the Block. What has followed has been a fascinating resurgence in this practice, with a raft of studies to assess anew swaddling’s effectiveness and safety. And here’s the thing: for some younger infants, swaddling seems to work, and when done right, it can be downright beneficial. Tuck in, and I’ll explain.

Proper swaddling technique is key.  Babies need to be properly wrapped (nice video here)—not too tight!–with the snugness of the blankets as one article suggests, just under that of the elastic band on a pair of gym shorts. Lastly and most importantly, a swaddled babe can be placed in her crib in the supine, or face up position. Why? Babies placed on their backs to sleep have substantially lower rates of Sudden Infant Death Syndrome (aka SIDS, or crib death).

Research has confirmed some clearly positive aspects of good swaddling on sleep. Properly swaddled infants generally have fewer startles and arousals during sleep than their unswaddled peers, allowing them (and their parents!) to sleep longer.  That’s pretty sweet. What’s more, swaddling helps infants who seem to prefer prone or face down position do better in sleeping on their backs. That’s a good thing, too.

Other studies have shown that swaddling decreases fussiness and crying for infants, at least in the first couple of months. Much in the way a pacifier can soothe an infant who is upset or in distress, swaddling exerts a calming effect on most young and premature infants. For example, research and practice demonstrates swaddling proves effective in decreasing crying time after babies get stuck for blood draws. Premature infants who are routinely swaddled demonstrate improved neuromuscular development, and soothe more easily than their unbundled peers.

In a more profound example, infants born to narcotics-using mothers often undergo treatment for withdrawal. These babes do far better—with less irritability and crying–when swaddled snugly. So much so, in fact, that bundling these infants thus has long been considered a cornerstone of their care, and helps them recover faster.

For the first several months of life, swaddling helps babies do what neurologists would describe as “organize better,” and decompensate less with the stresses of newborn life: eating, sleeping, waking, and pooping. Before we start swaddling our inattentive adult co-workers to see if it helps them any, let’s consider a few more issues.

Are there downsides to swaddling?  A number of studies have attempted to answer this question, but only a few have had convincing results. Investigators have posited unconvincingly that swaddled babies may have higher rates of chest colds, or issues with rickets and vitamin D deficiency. For most babies, I don’t see this as a problem.

However, tight wrapping of some babies may contribute to higher rates of abnormal development of the hip, called developmental hip dysplasia (DDH).  This is less a concern for healthy babies. However, for parents whose children have been identified with DDH, or to those who are at risk for having it (e.g. children born in breech position), I recommend that they discuss if/how they swaddle their babies with their child’s primary care provider. In general, better techniques involve bundling that is snugger on top, and permits some leg and hip movement on the bottom.  Clinical pearl here: if you need a live demo in your doctor’s office, ask a nurse. They do it SO much better than the physicians.

I advise parents to use a bit of common sense, as well. On hot days, or in stuffy, unairconditioned homes, swaddling can overheat babies. Increased ruddiness, fussiness or sweatiness on the babies face or hands or feet may suggest it’s better to refrain from using clothing or heavy blankets, and that a light cotton blanket will do, if at all.

Otherwise, the other, more concerning downside of swaddling is a moot point for the watchful parent following healthful bedtime procedures. In short, swaddled infants should NEVER be placed prone (face down) to sleep. For reasons not entirely clear, this setup places these infants at a substantially higher risk of SIDS. ‘Nuff said.

And so: how long should someone swaddle their baby? As noted above, experts, studies, and world cultures differ on this point. Here’s my bottomline: I encourage parents to swaddle their infants for as long as it seems to work. For most infants, this seems to run about 2-3 months. Some babies seem to want to wean from it sooner, and will let you know by fussing more when wrapped. For other babies, swaddling becomes a trusty part of the glidepath to bedtime, and helps them relax before they cork off for the night, up to 4 or 5 months. In my case, I’ll tell parents it’s probably time to wind down their child’s swaddling when the baby is consistently busting out of the wrap like some teeny Incredible Hulk, or when they are able to flop from their back to their front.

And lastly, there is the Truth that keeps we parents and pediatricians humble. Kids vary. Some infants never take to swaddling, finding it neither relaxing nor enjoyable. These parents will come to this conclusion quickly, as evidenced by the crescendo of fussiness when these kids are wrapped snug as a bug in a rug. And, that is ok. There’re still kisses, hugs, and binkies!

That’s a wrap.

 

Photo above by tsdelvis; cartoon below by me

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