Question: If a client told you not to swaddle because the hospital
told them not to, what would you say?
This is a fairly new recommendation employed
in some, but not all, hospitals. My research on the subject seems to point to
this recommendation being more prevalent in the UK than in the US. The reason
that swaddling is being advised against appears to be because of a link to SIDS
and hip dysplasia/stunted growth. The fear being that incorrect wrapping leads
to loose bedding in the crib, overheating from over dressing, too deep of a
sleep that baby is unable to awaken from, and wraps that are tied too tightly.
Parents have other reasons for eschewing swaddling too. Some worry about baby
rolling over in a swaddle and being unable to save themselves from suffocation.
Others want their baby’s to be able to suck their thumbs while they sleep.
Swaddling and SIDS
There have been conflicting studies
in regards to how swaddling effects SIDS. Some studies have shown that babies
whom are correctly swaddled show lower rates of SIDS, other studies say that swaddling
can contribute to SIDS. The truth is hard to know, especially since the causes
of SIDS are still unknown. We only have statistical evidence on what lowers the
risk. Everything can be done right, and babies still die of SIDS.
One of the main reasons that
swaddling has been linked to SIDS is the fear of loose bedding in the crib.
However, swaddling done correctly leaves no loose bedding in the crib. A tight
swaddle is the only swaddle that should be used. Teach the parents how to
correctly do a tight swaddle to alleviate this fear. Hospitals have to play to
the lowest denominator. They can not assume that a parent will try to learn how
to correctly and safely swaddle a baby. Thus, they are forced to recommend no
swaddling in case someone does it wrong. If their child is breaking out of the
swaddle, recommend a ready made swaddler like a Woombie, Miracle Blanket,
Loving Baby Swaddle, etc.
Overheating is another problem
associated with swaddling and SIDS. The blanket is another layer. Keep the
blanket in mind as baby is being dressed for sleep. According to the American
Academy of Sleep Medicine, the optimal room temperature for sleep is a few
degrees cooler than room temperature, somewhere around 65-70 degrees
Fahrenheit. If you are not lowering the temperature or turning on a fan, than
take a layer off before putting baby down. Babies can not control their own
body temperatures anyway, and they certainly can’t take a blanket off if they
get too hot. Using a breathable swaddle blanket like the ones made be Aiden
& Anais that are made out of muslin or bamboo is a good way to keep baby
from overheating. These blankets are exceptionally breathable, allowing for
dissipation of heat near baby. As far as swaddlers go, Woombie is coming out
with a breathable swaddler later this spring.
The lack of the ability to arouse
from sleep when in respiratory or cardiovascular distress in some infants has
been a factor in what many experts believe cause SIDS. The deeper a baby
sleeps, the harder it is for them to wake up if in distress. Anyone who is
familiar with swaddling knows that swaddling helps babies sleep better. Where
though is the line drawn between helping a baby sleep better to promote growth
and letting a baby try to sleep according to when they drop off to prevent too
deep of a sleep? The job of the sleep trainer is to teach the infant how to
self soothe to settle down after a natural arousal as happens in normal infant
sleep patterns. If a baby is not showing signs of problems like sleep apnea,
and is following the natural patterns of sleeping and feeding in an infant,
than the addition of a swaddle should
not cause harm to the infant. However, according to a study published in the
Journal of Pediatrics 2010, introducing a swaddle to an infant who was not
routinely swaddled for the first few months has been shown to decrease
arousability in infants, thus sleep trainers should avoid introducing a swaddle
if a baby has not been routinely swaddled in the months since birth.
Hip
Dysplasia
Infant’s hip sockets are not fully
developed at birth; much of the hip joint is made up of pliable cartilage that
can be more easily forced out of place. Before birth, a hormone comes into play
that makes mother’s ligaments stretchier to make it easier for baby to pass
through the birth canal. Some babies are sensitive to this hormone, causing
excessive stretchiness in their ligaments. In such cases, hip dysplasia becomes
more prevalent. Hip dysplasia is also more likely in first born children
(particularly girls), a baby born breech, and if there is a family history.
Incorrect swaddling can lead to hip
dysplasia when the swaddle is too tight around the infant’s hips and thighs.
While it is important to have a tight swaddle, tying a baby into a blanket is
not recommended (Think of the Native Americans who tied their babies into
papoose carriers. They had a 33% rate of hip dysplasia). The International Hip
Dysplasia Institute teaches a method of swaddling that is hip-healthy (see
hipdysplasia.org for more information). A swaddler like the Halo SleepSack,
Woombie, and TrueWomb that allows for freedom of movement in the legs can help
prevent hip dysplasia in infants. Also be aware of the effects that carriers
like the Baby Bjorn have on infant hip health. If hip dysplasia is a worry for
a family, than encouraging them to keep baby out of a swaddle during waking
hours may be best.
Other Objections
I have heard before of parents who
fear that their baby will roll over while in a swaddling blanket and be unable
to roll back because their arms are strapped down. Newborns have no control
over their muscles. If they were able to roll over even without a swaddle, they
would not know how to roll back anyway. Once they are old enough to roll over,
they will have more control of their muscles, and at that point it will
probably be time to move them to a sleep sack or arms free swaddle anyway.
Some parents talk about how their
baby prefers to have their hands nearby their face for comfort or sucking. In
this case, suggest a one arm or arms free swaddle, but explain how the Moro
(startle) reflex works to startle baby from sleep because of baby’s lack of
muscle control. A swaddler like the Woombie or TrueWomb, that lets baby move
their arms or have them across their chest rather than at their sides may be a
better option here.
Conclusion
Swaddling done correctly is a safe
practice. The risks associated with SIDS are circumvented by a correct swaddle,
and hip safe swaddling can be done with infants who are at risk for hip
dysplasia. A light breathable blanket that is tightly wrapped, or a ready made
swaddler can be used to safely swaddle a baby. Keep in mind the risks associated
with overdressing and do not start swaddling a baby who was not swaddled in the
first few months of life.
Author: Katherine, Certified Newborn Care Specialist, Certified Professional Nanny.
Recommended for Safe
Swaddling:
1. Aiden
& Anais Swaddle Blankets: large, breathable, light-weight, easy to get a
tight swaddle with
2. Woombie:
Allows for freedom of movement, easy to use, breathable version available this
spring, convertible version available for an arms free swaddle
3. TrueWomb:
A lot of Velcro makes this a noisier swaddler, but it allows for freedom of
movement, especially when concerned with hip dysplasia
4. Halo
SleepSack: Freedom of movement, convertible to a regular sleep sack, allows for
freedom of movement
5. Loving
Baby Swaddle: No Velcro, snaps, or zippers, this is a wrap and tie/tuck method
that creates an easy tight swaddle
6. Miracle
Blanket: Similar to the Loving Baby, simply wrap around baby for an easy to use
tight swaddle.
Sources:
