Swaddling was an almost universal child-care practice before the 18th century. It is still tradition in certain parts of the Middle East and is gaining popularity in the United Kingdom, the United States, and the Netherlands to curb excessive crying. We have systematically reviewed all articles on swaddling to evaluate its possible benefits and disadvantages. In general, swaddled infants arouse less and sleep longer. Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled. When compared with massage, excessively crying infants cried less when swaddled, and swaddling can soothe pain in infants. It is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions. It can be helpful in regulating temperature but can also cause hyperthermia when misapplied. Another possible adverse effect is an increased risk of the development of hip dysplasia, which is related to swaddling with the legs in extension and adduction. Although swaddling promotes the favorable supine position, the combination of swaddling with prone position increases the risk of sudden infant death syndrome, which makes it necessary to warn parents to stop swaddling if infants attempt to turn. There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling. Furthermore, swaddling does not influence rickets onset or bone properties. Swaddling immediately after birth can cause delayed postnatal weight gain under certain conditions, but does not seem to influence breastfeeding parameters.
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October 2007
Review Articles|
October 01 2007
Swaddling: A Systematic Review
Bregje E. van Sleuwen, MSc;
Bregje E. van Sleuwen, MSc
aDepartments of Medical Psychology
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Adèle C. Engelberts, MD, PhD;
Adèle C. Engelberts, MD, PhD
bDepartment of Pediatrics, Maaslandziekenhuis, Sittard, Netherlands
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Magda M. Boere-Boonekamp, MD, PhD;
Magda M. Boere-Boonekamp, MD, PhD
cDepartment of Science, Technology, Health, and Policy Studies (STeHPS), School of Management and Governance, Twente University, Enschede, Netherlands
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Wietse Kuis, MD;
Wietse Kuis, MD
dImmunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
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Tom W.J. Schulpen, MD;
Tom W.J. Schulpen, MD
ePaediatric Association of the Netherlands, Utrecht, Netherlands
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Monique P. L'Hoir, MSc, PhD
Monique P. L'Hoir, MSc, PhD
aDepartments of Medical Psychology
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Address correspondence to Bregje E. van Sleuwen, MSc, Wilhelmina Children's Hospital, University Medical Center Utrecht, KA.00.004.0, PO Box 85090, 3508 AB Utrecht, Netherlands. E-mail: [email protected]
Pediatrics (2007) 120 (4): e1097–e1106.
Article history
Accepted:
March 03 2007
Citation
Bregje E. van Sleuwen, Adèle C. Engelberts, Magda M. Boere-Boonekamp, Wietse Kuis, Tom W.J. Schulpen, Monique P. L'Hoir; Swaddling: A Systematic Review. Pediatrics October 2007; 120 (4): e1097–e1106. 10.1542/peds.2006-2083
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Limit swaddling and massage to colicky babes
Dr. Patricia Franco (1) and her co-authors reported in Pediatrics in May of 2005 that their study on swaddling of infants revealed that it was associated with increases in the infants' sleep efficiency and in the time spent in non–rapid eye-movement(NREM) sleep . When swaddled, the infants awakened spontaneously less often.
Both swaddling and prone placement have traditionally been employed in countering the effects of infant colic. Additionally, childcare advocates are currently being quoted widely in the various news media and on Internet websites in regard to the many benefits of employing infant massage techniques ... and not alone in regard to bringing relief to colicky infants, but also as being beneficial to all infants in general. The claimed benefits are widespread and comprised in a lengthy list of well researched and worthwhile outcomes; included are claims of massaged infants experiencing improved sleep efficiency and sleeping more 'soundly'. In short, there is no reason to suspect that the claims being made concerning the benefits of infant massage are other than being entirely valid.
Nevertheless , while all three approaches, namely prone placement, swaddling, and massage, may be employed beneficially in treating infant colic, it should be understood that the infants are to be fully awake and crying, and when sleep eventually initiates they should be placed in the supine position.
Prone sleeping is recognized as being contributory to the overall incidence of SIDS fatalities, and since we do not know which infants may be individually vulnerable, it becomes necessary to recommend that all infants be placed to sleep in the supine position.That being the case ( vis-à-vis prone placement during sleep increasing the possibilities of SIDS outcomes) and since both infant massage and swaddling have been recognized as 'improving' the duration and depth of sleep, the following observations may merit consideration:
There appears to be the assumption that if massage brings relief to victims of infant colic, and has all kinds of benefits for infants generally, not least of which is that sleep becomes longer and deeper, then it should be employed 'holus bolously' with all infants without exception. Therein, may rest a danger paralleling that of prone placement during sleep, inasmuch as increasing the duration and depth of sleep may likewise possibly result in the elevation of the overall incidence of SIDS.
Possible vulnerability to SIDS once again has to be considered, and unless infants have been diagnosed professionaly as experiencing colic, or until such time as research data and/or study outcomes tell us otherwise, namely that infant massage is not contributory to increasing hazard of SIDS, it might be useful to weigh claimed benefits against the possibilty of tipping the scales in the directly opposite direction. Similarly the above considerations can be also applicable to swaddling, and, therefore, consideration once again might be given to restricting its use solely to professionally diagnosed cases of colic.
A search of the Internet will reveal that there are numerous unsupported claims being published concerning the effectiveness of swaddling in reducing the incidence of SIDS. It did not take too long before Franco's and her colleagues' study was being cited on the websites as being supportive of these purely speculative claims, despite the fact that the authors were careful to avoid making any such conclusions.
Dr. G. Manci (2) in an editorial in the New England Journal of Medicine back in February,1993 wrote : "....assuming that the adverse consequences of sleep are limited to the REM phase and considering slow- wave sleep to be invariably beneficial may be unwise. ..."
The bottom line? Swaddling and massage should not be employed with infants under the age of 6 months,unless in cases of professionally diagnosed colic.
(1) Pediatrics. 2005 May;115(5):1307-11. Influence of swaddling on sleep and arousal characteristics of healthy infants. Franco P, Seret N, Van Hees JN, Scaillet S, Groswasser J, Kahn A. Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium.
(2) Autonomic Modulation of the Cardiovascular System during Sleep; NEJM, Volume 328: 347- 349,February 4,1993; Number 5
Conflict of Interest:
None declared