I absolutely love this quote. “I plan to give you love, nurturing and just enough dysfunction to make you funny.” I love it because it’s real- it captures parenting. No matter how many books we read and expert tactics we employ, we will never be perfect parents. But if we come at it from a place of love, compassion and ample humor, we can meet the daunting task of parenting head on. I want this blog to be a resource for parents– I plan to stay current on pediatric topics in the news, evaluate relevant studies and decipher opposing “expert” viewpoints, and present the information in a way that is palatable to you, as a parent.
First up, this debate on swaddling – one of dr Harvey Karp’s famed “S”s- the other four being swinging, side/back lying, shushing and sucking. Basically, all of Karp’s recommendations mirror life in utero where the blood swooshing through the mothers body creates a continuous “shushing” noise, babies are swaying back and forth in the amniotic fluid as mom moves, the space is tight and restricted, and baby is sucking on her thumb. Pretty much every parent has seen their baby’s thumb or fist planted squarely in his mouth on a prenatal sonogram! These strategies are super effective!
But what if a respected entity deems these practices unsafe- how can a parent effectively soothe a crying baby- and let’s face it- often times a crying mom- if the tools that work may harm your child?
The facts- several studies have shown that babies that are swaddled are almost uniformly placed on their backs. We know that back sleeping is markedly safer for babies than tummy sleeping as the incidence of SIDS was reduced by half with the back to sleep campaign in the 90s. We also know that swaddled babies tend to startle less as the waving arms associated with the Moro reflex are restricted with an upper body swaddle- this often translates to better sleep at night- at least one long stretch (4-5 hrs). The concern with swaddling is that an infant may somehow maneveur onto his tummy with arms fixed. If this happens, a baby would be caught face down and immobile. Because of this risk, the National Resource Center for Health and Safety in Child Care and Early Education recommended against swaddling in 2011, citing an increased risk of SIDs. The AAP has been slower to make a formal recommendation, but Rachel Y. Moon, M.D., FAAP, author of the AAP safe sleep guidelines and chair of the Task Force on SIDS, said despite the AAP’s lack of an official stance regarding swaddling, babies should not be swaddled past 2 months of age.
My recommendations- Done correctly and for only a few months, swaddling is very safe and can be a real game changer! Parents sleep in those first few months is so fleeting, that measures like swaddling, or noise machines for that matter, can make a difference by actively providing comfort to a baby when you are exhausted.
Swaddling technique is important! Avoid thick blankets that baby can easily wiggle out of, muslin wraps or swaddling blankets with zippers or Velcro are ideal. Your baby should be able to move his legs and flex at the hips – the tight wrap should be at the upper body only – this will help minimize the risk of hip dysplasia- a finding of greater prevelance among cultures that bind their babies – ie Mongolia. Interestingly, many African communities see a low incidence of hip dysplasia as babies are often worn on parents backs – hips abducted out to the sides- positioning the ball of the femur nicely in the hip socket. Tummy time is important too, even though lots of babies hate it! Continuing to build neck, arm and upper body strength when baby is alert and awake should help baby struggle through ending up on her tummy accidentally. I always tell my patients’ parents even a minute of tummy time multiple times a day makes a difference. It’s definitely ok to pick them up if they are upset — short intervals work too!
The real question is when do we need to abandon the swaddle– 2 months, 4 months.? It really depends on YOUR baby! Is he starting to roll? Is she pushing up on arms with chest raised when on her tummy? Has she ever rolled over accidentally? As previously mentioned, the risk of the swaddle is baby makes it over to his tummy with arms fixed. As parents, we have to anticipate this possibility and adjust our technique. Perhaps we transition to sleep sacks between 2-4 months, we swaddle in a muslin wrap with one arm out then two arms free. Muslin wraps are an awesome choice especially when transitioning from the swaddle because they are breathable. If the baby breaks free of the swaddle, much better to have a light, breathable blanket accidently end up on baby’s face.
I have seen swaddling make a significant difference for many parents of newborns in my private practice. With ideal technique employed, swaddling is a very safe strategy! It can ease the first few months of baby’s life and give parents at least a little respite at night!