Part 2 -
What proof is there that the 5 S's are effective?
There is a robust body of research supporting my observations and
recommendations (over 50 peer reviewed references that I am happy
to send to anyone who wishes). They can be divided into 3 pillars of
evidence:
1) Numerous peer reviewed studies demonstrating efficacy of
swaddling, white noise, rhythmic motion, and sucking on diminishing
infant crying (including the additive effect of multiple modalities
used simultaneously)
2) Field studies of aboriginal parenting and "proximal parenting"
techniques in our culture that significantly diminish excessive crying
3) The Happiest Baby video (essentially a video multiple case study)
Several studies are underway/planned to further validate the 5 S's
approach. An NIH-funded study began this summer at Penn State
using THB educators with healthy primips. Researchers are examining
infant parameters (sleep, cry, weight gain to see if
obesity risk can be lowered) and parental parameters (depression,
feelings of competence, sleep, etc). Researchers plan to replicate
this study at UNC. Other studies are being developed in Boston (with
PCA America and Harvard School of Pub Health and WIC
parents), in New Haven with the CT dept of children and families, and
perhaps at Riley Children's Hospital in Indianapolis.
If a baby is to be swaddled, shouldn't the arms be up?
Swaddling with arms up is fine..as long as the baby is calm. But,
once a baby begins to fuss they miss having the restricting walls
of teh womb to keep them from flailing. In essence, the world is too
big for newborns. All mother's know this and intuitively heir
own arms to "swaddle" their babies and keep them from flailing...the
trouble is that as soon as they are put down any
little jiggle may reawaken them and start the crying again
(especially because we place babies on the back...on the stomach
they can't flail and are naturally more content...but of course this
is a more dangerous position for sleep). Babies who are
loosely swaddled wiggle their arms out and cry even more! (Wolff PH:
The causes, controls and organization of behavior in the
neonate. Psychol Issues 1966;5; 1-105)
Can swaddling raise the risk of SIDS?
Yes. But, in a way, swaddling is like car sar use. Car seats are
dangerous unless they are correctly tethered in and used as
directed. Parents need to be counseled to check that they are not
overheating their baby and that the baby is not in bed with loos
bulky blankets.
Having said that, there is much evidence to suggest that swaddling
might substantially decrease SIDS rates. Here is a compilation of
the information about the 5 S's and the prevention of SIDS:
Swaddling is like continuous tactile stimulation...it is a rich
addition to the sensory milieu that comforts fetuses in the womb
and that gently stimulates sleeping babies postpartum.
In 1975, Brackbill demonstrated that white noise sound (continuous
auditory stimulation) at 60-80dB significantly increases quiet
sleep and decreases active sleep. Most SIDS occurs in active sleep
(nursing promotes quiet sleep and is may be protective against SIDS
via this mechanism). (Brackbill Y, Continuous Stimulation And Arousal
Levels in Infancy: Effects of Stimulus Intensity and
Stress. Child Dev 1975; 46: 364-369)
Swaddling may in fact lower SIDS (and suffocation) incidence 4 ways:
1) Recent research has shown that swaddling makes babies more
arouseable (probably because of constant tactile stimulation).
Increasing arouseability is believed to be associated with a
decreased SIDS risk. (Gerard C et al, Spontaneous Arousals in
Supine Infants While Swaddled and Unswaddled During Rapid Eye
Movement and Quiet Sleep, Pediatrics 2002 110: e70 Franco P, Seret
N, et al, Influence of Swaddling on Sleep and Arousal
Characteristics of Healthy Infants, Peds 115:1307-11. 2005 )
2) Swaddling keeps babies from accidentally rolling from stomach to
back. Babies who routinely back sleep have ~2 times the risk of
back sleeping babies. However, babies who routinely back sleep and
accidentally roll to the stomach have 7-8 times increased risk of
SIDS. (AAP, Task Force on SIDS - The Changing Concept of Sudden
Infant Death Syndrome, Peds 2005; 116: 1245-1255, . Li DK, Petitti
DB, Willinger M, et al. Infant sleeping position and the risk of
sudden infant death syndrome in California, 1997-2000. Am J
Epidemiol. 2003;157:446-455)
Swaddling inhibits a baby's ability to roll into the prone position.
Once infants reach 4 months most of them can roll from
stomach to back easily and thus are less at risk of SIDS and can be
weaned from the wrapping.
3) Many parents know they shouldn't let their babies stomach sleep,
but they do anyway because they are so sleep deprived...and that is
the position in which their babies sleep the best. Van Sleuven
reported that half of all parents who put their babies to sleep
prone do so because they wake up too often on their backs (Van
Sleuven B, et al: Comparison of behavior modification with/without
swaddling as interventions for excessive cry. J Peds 2006;149:512-7).
Gerrard and Thach and Franco demonstrated that swaddled babies sleep
as well on the back as unswaddled babies sleep on the
stomach, so swaddling allows exhausted parents to put their babies to
sleep on the back...and still get a good night's sleep. (Gerard C et
al, Spontaneous Arousals in Supine
Infants While Swaddled and Unswaddled During Rapid Eye Movement and
Quiet Sleep, Pediatrics 2002 110: e70 Franco P, Seret N, et al,
Influence of swaddling on sleep and arousal characteristics of
healthy infants, Peds 2005; 115:1307-11)
4) Swaddling may prevent cases of accidental suffocation associated
with co-sleeping. Recent reports (David Tappin J Peds, et al;
Martin Lahr, et al Peds, etc) recommend bed sharing only after 3
months of age, however, babies at that age can still migrate in bed
and get stuck on a pillow, duvet, or in a headboard. Swaddling keeps
babies who bed share from accidentally rolling around,
getting entrapped...and suffocating.
One other great value of the 5 S's is that they make sense to dads!
These steps are simple, straightforward and men are usually
really good at them...so it helps dads feel more competent, more
needed...and offers the potential of boosting their bonding with
the baby and support of the mother.
This is an approach that has been embraced by parents and
professionals alike. Two years ago, I launched THB Educator
Certification Program to teach baby calming techniques to new
parents. It is an at-home, DVD based training program. Over 1400
teachers have enrolled to date. We have educators at the University
of Michigan, Northwestern, Robert Wood Johnson University Hospital,
Jacksonville Naval Hospital, at teen parenting programs, PPD support
groups, fatherhood classes, and many military bases. All
parents are given a THBOB DVD and a CD of white noise so they don't
faint from hyperventilation when they are shushing! ("The
classes have been very well received and each parent that has
completed the class has been amazed at how well the techniques work
at helping to calm and soothe their babies." Tommi Peterson, RNC,
CPCE, IBCLC Coordinator, Robert Wood Johnson University Hospital)
This goal of teaching parents baby calming is much like the
initiative, begun 60 years ago, to restore the ancient wisdom of
breastfeeding to our culture. Neither skill is rocket science...but
both are ancient skills that parents in our culture
need a little help in getting the hang of...and some need intensive
help in mastering.
Nikki, I am grateful to you for taking the time to look at the book,
but I have to say that the real tool for parents is the
DVD...these are techniques that are much more easily learned by
watching a 30 minute video vs reading a 250 pg book. I strongly
encourage you watch the DVD and try it. I hope you will have an open
mind, and for my part I pledge to be available to respond to
any specific concerns you have. Look, no one is perfect...no
approach is perfect either...there can be and will be improvement
over time....and I welcome your help in suggesting refinements.
Let's be constructive!
Subject: karpism From: Nikki Lee Date:Mon, 12 Feb 2007 07:47:22 EST
Dear Friends:
A local doula sent me the book and I've been perusing it. Thank you
Karen. Interesting.
Has any one noticed that in the index there is no mention of
"carrying" or "baby-wearing"? Wouldn't you think that carrying would
be part
of the method as the author boasts about observing the contented
babies in other cultures?
He seems to have either not noticed or forgotten that babies cry just
as much in other cultures as they do in the US; the difference is
that the
caregiver responds to a cry in seconds in other countries (according
to the chapter in Breastfeeding: A Biocultural Perspective.) Plus
babies in other
cultures are carried and worn much more than in the US.
In the US, hospital staff ignore crying babies. As a hospital nurse
and LC, I have seen and still see this every day. Mothers see this and
learn to keep the baby in the fishtank, put a plug in its mouth, and
hold off feeding.
Maybe 'carrying' is in the text somewhere. Can you imagine not
carrying a baby?Grandmothers carried us.
And what about his editor? How could his editor have let Dr. Karp
make statements about external gestation without referencing Ashley
Montague PhD and his classic "Touching" with its 3rd edition in the
1990s? Dr. Montague said that humans needed another 9 months of
gestation after birth.
"Men put the 'us' in uterus"? Give me a break. This man's attitude of
disingenous delight and discovery makes me want to smack him.
He references grandmothers. Fine. Let's remember our our
grandmothers, that held us and rocked us and sang or read to us when
we were
babies. They embraced us with warmth. Warmth is left out of the
"method".
Dr. Karp offers technique. There is no evidence upon which to
recommend this method, this collection of techniques, to the world at
large,
yet the method has been embraced by organizations. Often the same
organizations that promote the 'method' are completely opposed to
safe bed-sharing,
which is entirely evidence-based and supported.
I have received a collection of articles from the National Medical
Library (from a crib death organization) that describe risks of
swaddling. I will
post them on this list if you all want.
On one hand a method that is not evidence-based is endorsed, and a
style of parenting that IS evidence-based is condemned. I am confused.
In my opinion, the 'method' seems like a man's eye view of our
nurturing. Just as labor driven by induction, intravenous
medications, and
machines is a man's eye of of labor.
Technology versus heart, method versus feelings and discovery......I
know which style I like. I also accept that there are other people
that prefer the other.
If the 'method' keeps one baby or child from being beat up, then
let's add it to our toolbox, along with skin-to-skin, spontaneous
undisturbed labor,
unrestricted breastfeeding, and long, paid maternity leave!
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE Lactation Consultant,
Philadephia Department of Public Health
Maternal-Child Adjunct Faculty, Union Institute and University Film
Reviews Editor, Journal of Human Lactation
www.breastfeedingalwaysbest.com
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
www.breastfeedingalwaysbest.com
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