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Responses to 'Rethinking Swaddling'

My December 3 post, “Rethinking Swaddling,” attracted more than 7,000 hits—a new record—and triggered many strong reactions.  For some, this post met a need; for others, it struck a nerve.  After reviewing the research, its central question was:  Does swaddling really calm babies, or does it stress them to the point of shutting down?

Readers responded with more than 50 comments here and on Facebook.  One wrote: “My paradigms are shifting at an alarming rate!”  Many understood the concern: “As a hospital lactation consultant, about 50% of my time is spent unswaddling and derobing babies and placing them on their mothers’ bare chests…Parents marvel at how I supposedly got a baby to latch who wouldn’t before.”  “I would like to see the readouts of blood pressure, brain patterns, heart rate, temperature, etc.” And: “I remember a professor telling me she used a certain DVD to teach what ‘shut down’ looked like in a newborn.”

Many disagreed strongly.  Some believed—despite the research findings—that because swaddling appears to calm babies that babies “like” or “prefer” it.  “It’s not me who insists on the swaddle, but it is really my baby who wants it.”  “Some [babies] prefer swaddling, others prefer to be free to move.” Many referred to swaddling as a way to “make babies happy.”  But returning to the question: Are swaddled babies really “happy” or are they shut down?  One thoughtful writer suggested: “it might be a great experiment to swaddle newborn puppies and kittens and see what happens, but probably animal rights activists would have my hide!”

Although avoiding swaddling right after birth made sense to most, some discounted the findings that swaddled newborns lost more weight and had lower temperatures.  They believed that because their swaddled newborns breastfed without problems or because the baby they didn’t swaddle lost more weight initially than the one they did swaddle, the research must be “wrong.”  Of course, there are many factors at work, and swaddling is just one of them.  It takes many more than one or two babies to accurately measure the effects of any practice.

Some were concerned about “the consequences of not swaddling.”  Without it, one wrote, “we would be seeing infants who are fussier, sleep less, and wear parents out more in the weeks following birth.  Temptation will be to put them onto their tummies to sleep, increasing their risk for SIDS significantly.”  Another wrote:  “My guess is that swaddling has saved many infants from shaken baby syndrome (after extended crying bouts) and also allowed babies who have never been willing to sleep on their backs before to accept this practice (if they are not co-sleeping and bedsharing families).”

Swaddling and sleep was the subject of many comments.  Several who were not bedsharing said their babies “needed to be swaddled to go to sleep.” One wrote that the biggest benefit of swaddling was “to encourage a baby to sleep on their back as per the AAP’s recommendation.  It is unfair to me to give parents a recommendation for safety, and then not offer them tools to help them follow those instructions.” Another wrote: “If parents didn’t have unreal expectations or believe infants are meant to sleep all night in their own space at a few weeks old…they would cope much better.” 

One wrote: “Swaddling helped immensely with putting him down to sleep after his needs had been met.”  Biologically speaking, though, body contact is not just an optional “nice to have.” Like milk, it is one of a baby’s needs.  Breastfeeding Made Simple explains that of the four categories of mammals, humans are considered “carry mammals.”  Like the other carry mammals—such as the great apes and marsupials—constant holding and feeding during the early months are the biological expectations of our young.  Has swaddling become a culturally acceptable substitute for the body contact our babies expect?  One writer suggested that swaddling can be okay if parents are alert to their baby’s cues, but another responded: “Swaddling suppresses the baby’s no amount of responsive monitoring can see cues that aren’t there.”  Or as one so succinctly put it:  “Humans are meant to be close to mum, not at arms length being shushed at.”

One considered the article a “blanket statement against swaddling” and an “all or nothing” approach “based on opinion and not actual facts.”  Another thought the post attempted to “take away a tool that many parents find so helpful and needed.” She contended that most parents only use swaddling as last resort after trying many other things first.  However, more than a few popular books and DVDs suggest swaddling as a first strategy to calm a fussy baby. 

Most would agree with the comment “We need to empower parents to read the research second and to read their babies and their own intuition first.”  However, if parents are told repeatedly that swaddling makes their baby “happy,” this colors their interpretation of their baby’s response.  Shouldn’t parents know that swaddling may be stressful for their baby?  Anything less than full disclosure is patronizing.  Only by hearing both sides can they make informed choices about this practice.

Another writer defended the post, noting “I don’t think the purpose of the article was to say swaddling should be thrown out altogether….It reads, ‘when babies get fussy, it may be best to limit swaddling and suggest instead parents consider alternatives, such as skin-to-skin contact and baby carriers.’”  This seems like a logical approach until we learn more about swaddling’s effects on babies.

Finally, a writer cautioned against limiting swaddling because it is an “age-old practice” that has been “used for centuries.”  However, the same could be said of discarding colostrum as “dirty,” an age-old practice in many cultures. We have since learned better.  And if we discover with further research that rather than calming babies, swaddling actually does stress them, we may need to rethink this practice as well as many of our own assumptions about it. 


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Reader Comments (19)

This is just as--or even more--problematic than the first blog, because it even more so conflates swaddling immediately after birth with swaddling later on. The research doesn't, I don't think, cover both. And if it conflates the two as well, then it is just as misguided. There are two totally different things going on here, and they really deserve separate treatment.

December 22, 2010 | Unregistered CommenterKara

I don't know what I think about this. My first was not swaddled. She hated it (and until she was three or so would kick any covers off. She was heck to sleep next to). My second was and is swaddled (she's 15 months). At this point she DOES appreciate it. She will climb onto bed, onto her blanket, and try to self swaddle. As a newborn? I don't know. I would think in moderation it can be helpful. For a baby who startles every 20 minutes, laying next to mom or not (and therefore mom startles) it can be nice to have whatever little transition they're going through a little smoother for them. Everyone still wakes up for the big one. OTOH, excessive swaddling removes skin to skin contact, it removes the ability to move freely.

However, when humanity was born we lived in the tropics. Skin to skin was the default, there was no clothing. Here, in order to stay warm a lot of the year, even in our houses, skin to skin must be reduced just so we aren't cold constantly. There's lots of face touching, hand holding, and back rubbing under the shirt, but there's not as much skin to skin as probably baby humans are genetically and evolutionarily accustomed to, just because humanity is not where our genes think we still are.

I guess, use it as little as possible for your baby to be comfortable, watch your baby, and make sure there's a lot of skin to skin contact (we're a BFing, ECing, babywearing, no infant seat using family, so there is a lot of skin to be touched here. LOL).

December 22, 2010 | Unregistered CommenterWendy

My daughter wasn't swaddled immediately after birth, due to a birth defect, and actually wasn't able to be swaddled until she was a week old because of the defect (we weren't able to hold her until she was 8 days old for the same reason). So, while I can't speak for whether or not swaddling right at birth would have stressed her, I can say that swaddling once she was able to be swaddled DID calm her, and DID NOT stress her.
Because she was hooked to monitors in the NICU, it became quickly apparent which things stressed her and which calmed her. Her numbers were all better when she was swaddled, similar to how they were when I was holding her. I continued swaddling her after she came home, until she was probably 9 months old, because of the consistency and the fact that it was actually soothing for her. I also practiced babywearing, both while she was in the hospital and after coming home, however being in a carrier actually stressed her out more than it calmed her, so that unfortunately wasn't something we were able to do as much as I would have liked. Having had the amount of sensory overload that she experienced in the NICU, I think swaddling really was soothing for her, whereas the constant touch of babywearing was stressful.
It would be interesting to see research on normal, healthy babies and swaddling, to determine whether it is soothing or stressful, but at least from my experience, for my sick daughter, it was one of the few soothing, calming things that worked.

December 22, 2010 | Unregistered CommenterRK

My first response is yes, skin to skin is a basic need for an infant and baby. No one would dispute the benefits of skin to skin vs swaddling, especially during the newborn phase. However, the first article does, in my opinion, vilify swaddling. It is said to be dangerous, even contributing to Sids. I would like to point out first that the research clearly stated it contributed to SIDS in the prone position. Certainly, we can all agree that stomach sleeping has proven dangerous. So, does swaddling a back sleeping baby contribute, especially when compared to a back sleeping unswaddled infant? This a question unanswered by the research. I do believe cosleeping to be the biological norm. However, it is not trated as such by the studies. In a situation where an infant would sleep in a crib, swaddled or unswaddled, which is safer? The article implies unswaddled, though the evidence really doesn't support (or disprove) the claim.

The question in my mind is what is the control group? In one study, the babies that thrived the best were skin to skin. In another, cosleeping babies were not involved. None of the studies involved the same control group, or the same circumstances, and I don't believe they can be thrown together to make a statement about swaddling, especially swaddling just the upper body and arms. I think that before a widely used baby calming technique is implied to be bad, we first need to clarify what it is being compared to (back sleeping, cosleeping, etc) and then address what alternatives can be used in its place. Certainly cosleeping is one of them. But I would like to see more alternatives because whether we like it or not, most families do not cosleep on a regular, intentional ongoing basis, and in our culture, it isn't happening anytime soon.

December 22, 2010 | Unregistered CommenterGinger

I will also point out that my individual children do not matter. I had one who coslept, one who coslept part time and crib slept unswaddled, and one who crib sleeps swaddled. Where my children sleep has no sway on my opinion of swaddling. I choose cosleeping first, as I believe research has proven it best.

December 22, 2010 | Unregistered CommenterGinger

One thing I think should also be looked at are the stats on swaddled babies and hip displaysia (dislocated hips.) My daughter has had 2 surgeries (one on each side) to put her hips into her sockets. She is barely 2. There is reason to believe (and some research that shows) that an increase in swaddling has increased the number of this type of surgery. The reason being that you have to pull babies legs down and straight to swaddle. This can pull the still developing hips out of the socket. Just a thought. And something to be looked into further. If it can save more families from going through this surgery it's worth it.

December 22, 2010 | Unregistered CommenterAF

For a baby in NICU swaddling might well reduce stress as opposed to being alone in an incubator, but this presents a situation outside of the biologic norm, where such tools might well prove useful. I think the question is whether swaddling is simply another way of compensating for not giving babies what they really need. In a NICU situation kangaroo mother care would be the preferred approach to meeting a baby's needs, but as so many NICUs use it incorrectly if at all, then another tool might provide some benefit to the baby. In my mind I always think about the biologic norm and that all humans seek homeostasis. There are ways to achieve homeostasis that are nurturing and health-supportive and there are ways that are less so. I consider these to be compensatory, because they substitute for that which is most beneficial. When there is compensation, then something is forsaken or lost in the process.

As a very simple example that many moms have experienced, when a nursling cannot feed properly due to a structural injury (such as birth trauma) or anomaly (such as tongue-tie), when given the opportunity to remain at breast, the infant will typically compensate for his inefficiency by doing things like sucking in his lips or clamping on his mother's nipple or feeding non-stop as a way to get fed. There is clearly much that is lost here, but in the moment, the compensation may mask the underlying problem and baby may even seem to be happy.

I would be really interested to see what happened if mothers did not routinely swaddle any babies and only those who seemed to "require it" for some reason were sorted out. I think we would find that those babies have an underlying problem that needs to be solved, such as a feeding problem, neurologic disorganization, birth trauma, a need for constant maternal presence, co-sleeping or the like. Many of the "problems" I have seen mothers resort to swaddling for are resolved fully when babies receive structural care such as chiropractic or cranial-sacral therapy, which restores homeostasis at the neurologic level. And of course, if swaddling is used to make isolated sleep more acceptable to the baby, then it is clearly compensatory, as shared sleeping is the biologic norm.

So, while swaddling may appear to calm babies and they may appear to like it, IMO it is simply a compensatory tool that often masks an unmet need or physiologic problem. I think if parents are aware that this is the case and choose to use it anyway well, that is one thing, But, I see it being offered without ever addressing these others issues and without offering other approaches that might bring greater benefit to the baby.

December 22, 2010 | Unregistered CommenterJennifer Tow

My first born nursed for comfort, nursed to sleep, co-slept and was a very easy baby. My second child rocked my world. She would not nurse for comfort. I had oversupply and even after it was regulated, she would nurse quickly and then would not take the breast to go to sleep. She was constantly in the sling. She did not like co-sleeping and the only way for her to sleep was to be swaddled. I watched her cues and this was the only way to calm her down. Eventually we took her to an Occupational Therapist who diagnosed her with Sensory Processing Disorder. She was still swaddled at the age of 9 months and needed weighted blankets. She was addicted to her pacifier and used that for comfort, rather than the breast. Can you imagine how embarrassing this was for me, as a La Leche League Leader?

I don't think it is a one size fits all approach, but swaddling helped us meet her needs.

I really hope this doesn't add to the Mommy Wars. The WOHM/SAHM/WAHM debate, vaccines/nonvaxxers, co-sleepers/crib sleepers, crying it out/rocking to sleep, FF car seats/RF car seats debate can now add swaddlers/non-swaddlers. :(

December 22, 2010 | Unregistered CommenterNH

This article upsets me more than the first. The biggest thing I have learned since I had my daughter was that you can pick up a book or read an article and every author out there believes what they say is "right." I followed my daughter's cues, she liked to be swaddled and she liked skin to skin and has thrived since day one....interesting....These types of aricles on Kellymom are making me not like the facebook site as much as I used to.....

December 22, 2010 | Unregistered CommenterSarah

Unfortunately, Kangaroo Mother Care doesn't work for all babies. I would have loved to kangaroo my daughter 24/7 in the NICU (I was there that often anyway), but there were many times in her first month where we couldn't even hold her, and in the next 3 months of her stay she spent more time NOT allowed to eat than she did able to eat... and when she was getting feeds, they were through a tube to her stomach, very slowly. However, instinctively she KNEW that she should nurse, and so every time I tried KMC with her, she rooted and got desperate to nurse, and it was torturous for both of us. So yes, KMC would be the preferred first option for NICU babies, but it is definitely beneficial to have another option when KMC isn't one.

December 22, 2010 | Unregistered CommenterRK

I don't know what to think of this piece - while I agree that skin to skin is THE BEST thing for babies, I can't say that this article swayed me to believe swaddling stresses a baby. The purpose of the swaddle is to mimic the womb - the tight, secure feeling our little ones become so accustomed to. It's not to pin them down, restrict them, or control them.

Our little Jack was swaddled since birth - I had an unexpected csection and he was swaddled when he was handed to me. I immediately unwrapped him and did skin to skin/breast feeding for hours but he was so strong and would flail so much that he would wake himself up every 20-30 minutes and was clearly wanting to stay asleep. We would swaddle him and he would calm down immediately, concentrate on BFing, and sleep soundly. We did focus on lots of skin to skin time as well but he spent a lot of time swaddled while sleeping. He is 4 months now and still prefers to be swaddled - if we try to lay him down without it he screams and the only things that makes him stop is to be wrapped up, nursed, and then rocked to sleep.

December 22, 2010 | Unregistered CommenterT

I have swaddled all 4 of my boys...and expecting a girl in two has been a great tool in my parenting in those first months...but I also do a lot of skin on skin contact...breastfeeding in bed and 6 months probably most of my kids are at least bedsharing most of the time and no longer swaddled...but I greatly encourage its use intitally...none of my kids seemed "shut down"...and they slept much better than cousins who were never swaddled.
Also in my husbands culture...their cradle, which I used last baby, swaddles the baby in, and my son loved it and would sleep very good in it.
I think maybe the fact that we swaddle, breastfeed, cosleep, and also are very affectionate...all together make for a good combo...but this works for our family, and in the end I think that's the most important thing...finding what will meet the needs of your family.

December 23, 2010 | Unregistered CommenterEva Abdullah

I agree with commenter #1 here: "This is just as--or even more--problematic than the first blog, because it even more so conflates swaddling immediately after birth with swaddling later on."

I didn't comment on the original post but that's what struck me then. You were talking about babies that had been taken from mom, examined, washed, and then swaddled, before breastfeedng initiation. That's very different from swaddling later.

December 23, 2010 | Unregistered CommenterJen Mueller

Where is the research that says swaddled babies are shutting down? The research in the article was about weight loss, temp loss, and less breastfeeding success. Where is the connection to the author's assumption that swaddled babies are only using a coping technique?
We all want what is best for babies and mothers. I think before our paradigms shift, we need to see more than just one assertion that babies are truly not being comforted. So far it seems like a stretch and only an opinion.
I respectfully disagree Nancy, and although it is good to question practices that don't seem evidence based, I would like to see some specific evidence on this topic before we start telling parents not to use swaddling or that it is dangerous for their babies.

December 23, 2010 | Unregistered CommenterABC DOULA

We didn't swaddle at first because we didn't know how to do it effectively. When we did start swaddling (at about 5 weeks), our son seemed relieved. Really relieved. Once he knew what we were doing he would relax his whole body into it. Perhaps, like other parenting practices, there is a right time and a wrong time for it.

December 23, 2010 | Unregistered CommenterMelinda J

So - honest question - does anyone know how other infant carry mammals sleep? In their mother's arms?

December 23, 2010 | Unregistered CommenterDanielle

Can parents tell the difference between a "happy relaxed" baby and a "shut down" baby?

December 24, 2010 | Unregistered CommenterJen

I think we all are awaiting the answers about where the evidence ends and opinion begins.

December 26, 2010 | Unregistered Commenterrose

Wow. I am a newborn nurse and practice swaddling all the time. The last thing I want to think is that I am actually harming babies. However, I am open to the research and certainly want to practice based on evidence. Our NICU has actually stopped swaddling babies that are close to discharge stating the risk for SIDS as their reason. I will be on the lookout for more info on this subject.

January 23, 2011 | Unregistered Commenterrvpmomof3
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