This guest was written by Sheena Hill. We encourage mothers to express themselves and make their own educated choices. The views and opinions expressed here may or may not be the opinions of “I Am Not the Babysitter”.
Section III
Why Do I Care So Much About Swaddling?
Given all the confusion created by myths and misreading research, the important thing I want you to take away from this piece are to follow best practice every time you swaddle! This means: swaddle correctly and safely (for sleep only), swaddle early and rely on your baby’s preferences (not your own). Because of all the fancy swaddling paraphernalia and products available on the market today, there is really no excuse to swaddle incorrectly. I know it can feel like swaddling requires a day at the house of the three bears, but products like the Halo or Woombie make it easy to swaddle with just the right amount tightness.
Best Practice
So what is best practice? Best practice does not mean I think I know everything, nor should it make you feel guilty if you chose to do something which falls beyond what is considered best practice. Best practice does not translate exclusively to what the law requires (or allows) and it might not even be what most of the people you know currently do. Best practice is what parent educators teach and hope that all caregivers adhere to. Best practice consists of perimeters which are considered the safest way to use a product or apply a technique. Best practice is always about safety and is not hung up on parenting style, preferences, fads, or agendas. Swaddling best practice means only swaddling infants until they can roll over,
Reserve Swaddling for Sleep
Though some experts advise parents to use swaddling to help settle babies who are overstimulated, I am confident that removing your baby from a lot of stimuli (such as going into a quiet room together to reconnect, nurse, sing, snuggle) will have the same effect. You can also hold your baby and make sustained eye contact in order to offer comfort and provide the tightness and security of the womb with your presence and physical touch. Additionally, swaddling is seen as a wonderful intervention for excessive crying, but I always recommend to my clients to hold your baby when they cry (unless you need a break), so you communicate with them that you are not afraid of their big emotions. Consistent nurturing response to crying teaches even the youngest infants that they can trust you to identify and meet their needs. I know that colic and crying are intense for parents! I’m not suggesting that swaddling should never be used to soothe a crying baby, instead I am advising that you try other soothing methods first, and move swaddling as an intervention for crying to the bottom of your tool box.
Even though some well-respected people suggest swaddling at any time during the first month of baby’s life in order to recreate the womb, I am not yet comfortable viewing it as the exclusive “cure” for fussiness or colic. To make it easier for everyone, best practice promotes swaddling for sleep only. Reserving swaddling for sleep in infants until 4-6 months (or when baby can start to roll over), allows you to recreate the womb with your attentive care to your baby’s needs. If baby needs a womb-like environment during waking hours (make sure they are not hungry, wet or tired), then try holding them, relying on sucking (a baby’s only self-soothing skill), side-laying, swinging, and “shhing”. Wearing your baby will also provide the comfort they needs and help them to associate you–a loving parent–with the comfort of the womb. The movement, noise and sensory (including smell, touch, sound and taste) stimulation of baby-wearing recreate womb-like sensations merely with your closeness. As you may recall from our cultural examination, swaddling was never intended to replace baby-wearing. Both are viable tools for parents and can be used in tandem with each other.
While we are on the topic of swaddling for sleep, I want to take a moment to address it’s role in co-sleeping. It is true that if you plan to co-sleep (in the sense that you plan to exclusively bed-share with your infant), you may not need to swaddle. However, even bed-sharing infants can benefit from the soothing sensation of being swaddled, since the practice merely recreates the closeness and security of the womb. Swaddling will not hinder co-sleeping in any way, and even co-sleeping parents may choose to put children to sleep without them at times. For example, if you nurse to sleep and then leave your baby in your bed to go to the kitchen to finish the dishes, your baby may still startle and wake. So co-sleeping only replaces the need for swaddling if you plan to stay in the bed with your baby for the entire duration of their sleep. In fact, swaddling may make co-sleeping a more positive experience for the whole family, since swaddling has been correlated with better quality infant sleep overall.
Start Early
If you are going to swaddle, you should start the practice as soon as possible in baby’s young life (if not at the hospital, then at least within the first week). Research has shown that delaying swaddling until after baby is eight weeks old can lead to obvious resistance. This struggling is clearly related to a low tolerance for immobilization, since by that point babies have already grown accustomed to dealing with life beyond the womb. Because delayed swaddling waits too long to recreate the security of the womb, the benefits of practice will be greatly diminished30.
Swaddling and Preference
Probably my biggest pet peeve when talking to parents is when they project their own preferences onto their children. For instance, when I talk to parents about leaving kids rear-facing (in car seats) as long as possible, a common retort that I hear is, “He looks squished” or “She doesn’t seem comfortable.” This reflects the key ‘feeling” which has dominated the anti-swaddling belief throughout the generations: that it can’t possibly be effective because it simply looks uncomfortable1. Misunderstanding of what children need and misinformation have sadly led to this persistence of such a philosophy.
In reality, the child (rear-facing or swaddled) is quite comfortable and doesn’t mind being “squished”. Many parents do not agree with swaddling because they think it looks uncomfortable and imagine that baby will agree. Of course these parents are just trying to protect their sweet newborns, but never “trying” swaddling–based solely on a projected emotion–denies parents and babies a meaningful tool to ease the transition from womb to world. Remember, that as an adult, you are much farther removed from the reality and experience of a womb. You have most likely been walking relatively upright for at least a few decades. You may even spend your day simply going from vertical to horizontal and back again. In this adult body awareness, it is sometimes hard to imagine how a person could feel comfortable all curled up. But the truth is that the womb is pretty small. And as baby grows, while the uterus does expand to accommodate it, the best way to maximize space is to spend most of the time curled up. Even toddlers love to sleep with their legs tucked underneath them and their arms curled to their chests. This position is soothing because it is snugly and cozy. Most babies respond well to being swaddled and don’t appear to experience discomfort at all. If you still think swaddling “looks uncomfortable”, please take some time to measure your belly from hip to hip and consider the length of your baby. Imagine how they fit in there not so long ago.
I want to clarify that swaddling is not a torture device or a way to control your baby. It is not intended as a punishment or a way to control your baby. If you plan on using it in this way, please refrain from swaddling. Swaddling is meant to be a tool, a way to provide babies with an extra source of sensory stimulation which mimics the security and warmth of the womb. Period.
It is true that some babies do not prefer to be swaddled. If your baby seems distressed when safely sleep swaddled, by all means, you should loosen the swaddle or discontinue use. But if your infant does not prefer to be swaddled, it does not mean that it is unsafe for other parents to use. As good as it is, swaddling is not a ‘magic cure” and may not get “immediate results” (as in, you swaddle a crying baby and they stop crying instantly). Swaddling for sleep should be performed on a calm baby. Can you swaddle a slightly upset baby to help them calm down once you know respond to being swaddled? Yes! But if your baby is crying excessively (or you would describe them as “fussy”B) you should soothe them until they are more relaxed before you swaddle. (Soothing can include holding, talking, or singing to them, make a “shhh” sound or humming while holding them close, allowing them to suck, holding them side-laying, and swinging them gently.)
While newborn preference can influence a family’s use of swaddling, parental preference should never be the top factor deciding not to swaddle. Many parents use of swaddling is not about preference, it is about what is safe for babies and helpful to families. I have found that many parents who do not prefer swaddling came to that conclusion after getting discouraged from a lack of immediate results or after only trying swaddling a few times. This does not mean that your baby does not prefer it, it just means they are learning along with you! Most babies do prefer swaddling and respond well to the technique. While we want to encourage our babies to explore, we have to remember that they genuinely need the security of the womb. My hope for future swaddling debates is that they steer away from parental preference and focus on best practice. Preferences aside, what is paramount is the safety of families. We know that safe swaddling is the best way to minimize startling in transitional sleep phases and encourage the most restful sleep for infants, but what is often forgotten are real dangers of not swaddling.
Risks of Not Swaddling
Mothers who choose not to swaddle are actually at higher risk for post-partum depression and their babies are at higher risk for shaken baby syndrome or being left to cry-it-out. The trouble is that un-swaddled infants will sleep less soundly, and may also cry more in the first 3-4 months of life. Babies who cry more and sleep less are likely to be more “challenging” for caregivers, who will also likely be tired and cranky. This truly puts infants at higher risk. Research has found that excessive crying preceded incidents of child abuse in 80% of cases examined30. Since swaddling is a tool for sleep, exhausted parents can easily become frustrated with infants who are “difficult” to settle or who cry excessively. This frustration obstructs bonding and can even cause parents to over-feed, which is a contributing factor to childhood obesity. Dr. Karp has also suggested that excessive crying in infants can interfere with breastfeeding and cause marital conflict. It seems pretty obvious that these risks should make parents realistically consider the benefits of swaddling.
Conclusion
Swaddling is not a cure-all. Are there dangers to it? Of course. There are dangers to everything which has a margin for human error. But it is important to remember that all research which showed negative implications of swaddling examined maladaptive, incorrect variations of the practice which means the conclusions drawn from unsafe swaddling cannot be applied generally to safe swaddling methodologies. But if you look at the tradition longitudinally, swaddling has clear dominance as an effective tool in infant care. While it does not replace the nurturing arms of a responsive caregiver, extensive international research has confirmed that swaddling infants effectively addresses the startle reflex, helping babies attain more restful sleep. The long history and cultural applicability of swaddling also strongly suggests that swaddling helps keep babies warm and calm while they transition to life outside of the womb. When it is used incorrectly, it can indeed be an unsafe practice. But the cases of improper usage do not make all swaddling a lost cause. It is possible to swaddle safely with appropriate information and education. Swaddling is a reliable way to help babies get the most restful sleep and empowers families with an effective tool for parenting. I hope this helps to put all the myths and misinformation to bed, once and for all, and I trust this post encourages you to recognize the real dangers of swaddling and make a truly informed choice about keeping the practice at the forefront of infant care traditions.
Sheena M. Hill is a single mom who understands the stresses of balancing parenthood with all the other responsibilities in life. She is an educator who specializes in parenting and family life. Its easy to be an expert, but in order to truly serve families, you must also be an excellent teacher who can respond to the complex needs of adult learners. She developed the Purposeful Parenting Philosophy, which helps parents make the most of parenthood. Read more at ParentingWorks.org.
References
1 Lipton EL, Steinschneider A, Richmond JB. (1965). Swaddling, a child care practice: Historical, cultural and experimental observations. Pediatrics, 35: 521– 567.
30 B.E. van Sleuwen, M.P. L’Hoir, A.C. Engelberts, W.B. Busschers, P. Westers, M.A. Blom, T.W.J. Schulpen, W. Kuis, (2006). Comparison of behavior modification with and without swaddling as interventions for excessive crying. The Journal of Pediatrics, Volume 149, Issue 4, Pages 512–517.e2
31 Weston J. The pathology of child abuse. In: Helfer R, Kempe C, eds. The Battered Child. Chicago, IL: University of Chicago Press; 1968
B It doesn’t matter if your friend, MIL or neighbor doesn’t agree that the baby is ‘fussy”, if you consider your baby “fussy” your time together should focus on soothing rituals.
