This guest post 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”.
The purpose of this post is to clarify the vast amount of misinformation on swaddling which is currently circulating. Across cultures and throughout history, a wide variety of swaddling methods have occurred and its prominence highlights its relevance in infant care. The bottom line is that most infants do respond well to swaddling and it addresses a real need for them. If the campaign against breastfeeding infuriates you, the debate over swaddling should stir an equal degree of frustration, since swaddling is unfairly under attack. Today, pervasive myths, misinformation and misinterpretation of research have left parents and health care providers confused about what constitutes safe swaddling practices, leaving people wondering if swaddling should be used at all. I want to address the cultural and historical evidence, pivotal research and the top three specific dangers related to swaddling. I also intend to discuss best practice in safe swaddling and my biggest pet peeve, projected preference. Since that could take awhile, let’s start with looking at how we got here.
The swaddling debate dates back to the 18th century, and has experienced a resurgence due to a few unfortunate news-worthy incidents. Recently, swaddling in daycare centers has been deemed illegal in Minnesota due to the higher numbers of in-home daycares being established there. Though this preventive measure appears unwarranted, I was even more shocked when I read the Minnesota law, which officially states that blankets should not be used in any way for sleeping, including swaddling. Legislation makes it illegal to use any blanket during sleep in all daycare facilities, however, it also recommends swaddling to calm a child until age two. Despite the fact that swaddling is mentioned specifically, it appears to be included in the no-blanket law by default. Given that swaddling is advised for use on children so old, the policy makers clearly do not understand what swaddling is or how it should be used.
Additionally, the practice is now strongly discouraged in California and Pennsylvania, after experienced childcare workers in California swaddled babies older than 6 months so tightly that it caused harm to the children and was considered “abusive’. In this case, seven infants between the ages of 7 and 11 months old were tightly swaddled during nap time in an effort to completely immobilize the children. Worse yet, the owners of the home daycare allegedly covered the children’s faces in order to prevent crying. By all accounts, the police at the scene, the police spokesperson and the public can all agree that this is not a case about swaddling; it is an unmistakable case of abuse and neglect. There is no doubt that swaddling in both of these examples was misunderstood and misused.
I know that it can be confusing. Unsafe and incorrect swaddling can indeed create risk for young babies. However, there is nothing inherently unsafe about swaddling. Safe swaddling, used correctly and with the appropriate intentions, is the best way to address the Moro (startle) reflex in newborns. Safe swaddling can help infants achieve fewer startles, lowered heart rate and reduced motor activity1 which can lead to more total daytime sleep2 and more extended sleep periods overall. In essence, with decreased arousal3 and fewer spontaneous awakenings4 safe swaddling enables babies to sleep better, sleep longer and experience more sleep continuity. Furthermore, parents who swaddle are much more likely to place infants to sleep on their backs which is believed to be a major factor for SIDS risk reduction5.
It is easy to see why swaddling leads to more sleep6 in infants. Early research in muscle relaxation demonstrated that it is a necessary requisite for sleep in children and adults7,8,9. Through their own continued movements, infants may prevent muscle relaxation by maintaining a state of alertness and responsivity10. If you have ever witnessed an infant startle themselves awake, you know that they can easily keep themselves from fully resting. So swaddling induces muscle relaxation while it minimizes startles; greater relaxation means better sleep.
In order for sleep to be restorative and fully refreshing–for all the reasons our bodies require sleep–it is the deep sleep which is most important. Many babies struggle to achieve this state of deep sleep when they startle themselves awake regularly. The benefits of deep sleep could use their own post; but it should be underscored that a consequence of self-stimulation is a reduction of the deepest stage of sleep. Without this, infants are not able to get the rest they require to grow and regulate their own bodies. Moreover, babies who do not get enough REM suffer from being poorly rested. Without restful sleep, babies are likely to be more fussy and irritable in their waking hours due to prolonged sleep deprivation (and possible mounting frustration over unmet needs). What’s more, parents of babies who don’t sleep “well” often find themselves more sleep deprived and stressed, often complaining that baby wakes after only a few minutes of sleep or that it takes a long time to finally get baby to sleep. (If you are thinking about co-sleeping as an option right about now, don’t worry, we will get there in a bit).
Sleep aside, Dr. Harvey Karp informed us that babies experience a 4th trimester of neonatal development, in which newborns are particularly vulnerable to the external stimulation in their new lives. Considering the infant’s true physiological need for extra comfort and sensory recognition during the transition from womb to world, swaddling remains a valuable option to provide a baby with the stimulation and security they legitimately require. For this reason, it is crucial to remember that swaddling is only intended to simulate the comfort of the womb and should be only used in ways which provide (and not jeopardize) well-being.
The important things to remember about safe swaddling are:
- Swaddling is for sleep only. Babies should always be placed to sleep on their backs. A swaddled baby should never be placed on their belly to sleep.
- Always swaddle in a way which allows the infant access to their hands. This does not mean that the arms are free for newborns, but hands should be positioned near the top of the swaddling blanket so they can stick out and be accessed by the baby’s mouth.
- Don’t swaddle too tightly. Baby’s legs and hips should be able to move a little. Remember that swaddling should minimize movement, not restrict it completely.
- Do not use any extra blankets with swaddled babies. If they appear to be overheated, remove a layer of clothing or try swaddling baby naked.
- Stop swaddling once your baby can roll over (around 4-5 months)
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.
1 Lipton EL, Steinschneider A, Richmond JB. (1965). Swaddling, a child care practice: historical, cultural and experimental observations. Pediatrics, 35: 521– 567.
2 Çağlayan S, Yaprak I, Seçkin E, Kansoy S, Aydinlioğlu H. (1991). A different approach to sleep problems of infancy: swaddling above the waist. Turk Pediatrics, 33: 117– 120.
3 Gerard CM, Harris KA, Thach BT. (2002). Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics, 6: 110.
4 Franco P, Seret N, van Hees JN, Scaillet S, Groswasser J, Kahn A. (2005). Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics, 115 :1307– 1311.
5 Gerard CM, Harris KA, Thach BT. (2002). Physiologic studies on swaddling: an ancient child care practice, which may promote the supine position for infant sleep. Pediatrics, 141 :398– 404
6 Giacoman SL. (1971). Hunger and motor restraint on arousal and visual attention in the infant. Child Development, 42: 605– 614.
7,8,9Sidis, B. (1908). An experimental study of sleep. J. Abnorni. Psvchology, 3, 63.
Coriat, I. H. (1912). The nature of sleep. Abnormal Psychology, 6: 329.
Kleitman, N. (1939). Sleep and Wakefulness as alternating phases in the cycle of existence. Chicago: University of Chicago Press, 40.
10 van Sleuwen, BE, Engelberts, AC, Boere-Boonekamp, MM, Kuis, W, Schulpen, TWJ, L’Hoir, MP. Swaddling: A Systematic Review. Pediatrics, 120: 1097-1106.