SWADDLING - YEA OR NAY
Understanding the practice
I think it's worth to consider why swaddling is practiced so much. It recreates the womb experience, provides warmth, soft tactile sensation, the environment that mimics the warmth and softness of a mother. But the moments after birth are so important. Infant behavior is wired by the mother's presence, it allows for infant neurological system maturation. I have witnessed many deliveries and observed infants feeding readiness cues such as rooting, hands to mouth activity and lip smacking minutes after they are born.
When this happens, I often I hear nursing staff or family say, "he must be so hungry, he needs to eat." What most people don't realize is that infant's are hard wired to initiate breastfeeding within the first 1-2 hours following their birth. This behavior is not hunger driven. Infants can't rationalize hunger and look for breasts that provides food. Feeding behaviors are involuntary, sequential and automatic, sort of like breathing. Most mammals follow a similar pattern. Moments after birth, offspring finds it's mother teat and begin nursing. For these early reflexes to develop well infant needs freedom to move their body in the instinctive and reflexive way.
Keep the mother and baby together
But what happens when we separate a infant and their mother? Nils Bergman the father of kangaroo care said "A baby taken out of this habitat will behave in a way which is protective and defensive in order to maintain and conserve its energy and preserve its life." The first few days after birth is a crucial period when an infant is trying to learn to life outside of a human body, which means leaning how to breath, suck, swallow and digest food. These are basic survival skills. Anytime an infant is away from their mother their natural instinctive behaviors are also disrupted. This can lead to difficulties with establishing breastfeeding and that's why the advantages of skin to skin contact after birth are discussed time after time in studies and literature.
Throughout my years working as a lactation consultant in the hospital settings, I have noticed that infant's who nurse frequently in the first day of life spend much of their time in their mother's arms, skin to skin, free to move and interact with parents. Mother's are responding to infant hunger cues and don't try to nurse on schedule. These infant's most often have little problems with breastfeeding and do not loose too much weight. Contrary to infant's who spend a lot of time away from their parent, swaddled in a crib, become very sleepy and hard to wake for feedings. This is seen most frequently on the first day of life. They might have more trouble keeping their blood glucose up and it takes them longer to learn to transfer milk well. We know swaddling encourages sleep, that's why it's so widely practiced, but the questions remains is it because the infant is trying to preserve energy? Is it because swaddling reminds them of the womb were food was provided via umbilical cord?
What about older children
Swaddling is helping mothers get more sleep. All tired mothers dream of an extra hour of sleep. There is much to say about changing culture of an infant sleep. From co-sleeping, bed sharing, to back to sleep campaign, experts are divided on the subject for many different reasons. Every mother deserve the right to understand the physiology of infant sleep and decide which option is right for her. Some mothers claim swaddling is incredibly effective way of helping their babies sleep.
So is swaddling always bad and should be avoided? Not necessary, but perhaps first days after delivery is the most vulnerable time when this practice can have the most negative impact. If infant feeding is going well and mother is following back to sleep recommendation, swaddling can be very helpful if used appropriately. If that's the case it would be important for parents to incorporate a lot of activity time like tummy time throughout the day to offset times when movement is restricted to help infant with neuromuscular development. It would also be helpful to know swaddling techniques that is less likely to cause hip displasia and will allows for greater freedom off movement. Clink here to view helpful video.
James McKenna once said "We can no longer talk about the baby without talking about him in the context of his mother. The mother baby dyad are a single unit and must be seen and studied as one."
Franco, P., et al. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 2005;115(5):1307-11.
Yamauchi, Y., & Yamanouchi, I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Pediatrics 1990; 86(2):171-75.
Moore, E. R., & Anderson, G. C. Randomized controlled trial of very early mother-infant skin-to-skin contact and breastfeeding status. J Midwifery Womens Health 2007; 52(2):116-25.
Bystrova, K., et al. The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling. Early Hum Dev 2007; 83(1):29-39.
Ferber, S. G., et al. Massage therapy by mothers and trained professionals enhances weight gain in preterm infants.Early Hum Dev 2002; 67(1-2):37-45.
Galligan, M. Proposed guidelines for skin-to-skin treatment of neonatal hypothermia. MCN; Amer J Matern Child Nurs 2006; 31(5):298-304; quiz 305-296.
Ludington-Hoe, S. M., et al. Safe criteria and procedure for kangaroo care with intubated preterm infants.JOGNN 2003; 32(5):579-588.
Sahin, F. et al. Screening for developmental dysplasia of the hip: Results of a 7-year follow-up study. Pediatr Int 2004; 46(2):162-66.
van Gestel, J. P., et al. Risks of ancient practices in modern times. Pediatrics 2002; 110(6): e78.