> Dear Lacnetters,

> Laura raised a good question about arm position and swaddling.  As  
> she mentions, numerous experts recommend swaddling preemies with  
> arms flexed to help them be "organized" neurologically.  At 28  
> weeks gestation, fetuses keep their arms extended almost all the  
> time.  Then gradually, over the next 2 months, they spend more and  
> more time with arms flexed...and during the last month they are so  
> confined that the arms are flexed most of the time.  In fact, their  
> biceps become hypertonic and when you strengthen the arms they  
> resist and then boing them right back to flexion.								

> So why do I strongly recommend swaddling term babies with extended  
> arms to help calm their crying (and improve their sleep)?

> Simple...it works better!  If you want to calm a fussy term baby or  
> help them sleep a little longer (ie go from waking every 2-3 hours  
> to sleeping 3-4 hours) you will be much more successful if the baby  
> is wrapped with arms flexed.

> Persistent crying is a problem of term babies (and preemies who  
> have reached term)...preterm babies never have persistent crying.  
> Once a baby begins having crying episodes that don't simply resolve  
> with feeding and holding the swaddling becomes a great  
> tool...however, term babies who are wrapped with their arms in  
> flexion often wriggle out of the swaddling and then flail and  
> become even more agitated.  Some worry that this will keep a baby  
> from self soothing on the thumb...but most babies cannot self  
> soothe from a crying episode by thumb sucking until 3-4 months of  
> age...after the colicky period.  Other's worry that the swaddling  
> in this way will prevent hand-mouth early hunger...but the baby  
> still has several other ways to cue us in to early hunger (rooting  
> mouth and head moves, increasing alertness and vocalization, etc).  
> 											

> One last note that often confuses parents, babies often seem to  
> resist the swaddling...especially with arms flexed.  THis is  
> because their biceps are hypertonic...so they naturally want to  
> recoil back to flexion.  Think of it like pulling curly hair  
> straight...it automatically "boings" back!  It's not that the hair  
> "wants" to be curly...it is just built that way.  Similarly, it's  
> not that babies' arms automatically tend to go back into  
> flexion...but inside the uterus the walls of the womb kept the baby  
> from flailing the arms around...once they are born there is too  
> much freedom for a baby's arms and the freedom only makes them feel  
> insecure...this is the reason for the success of all enveloping  
> techniques (swaddling, kangaroo care...in fact parents who don't  
> swaddlie with a blanket always swaddle....with their arms...it's  
> just that when they then go to put the baby down the  arms often  
> flail out and the crying starts all over again).		

> Also, we always teach new parents to make sure to they wake their  
> babies up and feed them 8-12 times a day for the first couple of  
> weeks to help establish the nursing...this is especially important  
> to do with parents who swaddle their babies because a few babies  
> are so comforted by the swaddling they might sleep past their early  
> hunger if you let them.			

> Another way to think of the swaddling is that it provides a  
> calming, continuous "white noise" of tactile stimulation.  Many  
> books mistakenly state that crying infants are "overstimulated."   
> While all the senastions ot the world outside the uterus are quite  
> stimulating...most babies fall asleep in crowded parties and at  
> basketball games.  A much larger problem...especially for preemies  
> and "disorganized" babies is...understimulation.  Being born then  
> put in a quite dark room, by yourself, on a flat mattress...is  
> sensory deprivation!  It is like locking an adult in a dark,  
> silent, closet!  They are missing the continual touch, holding,  
> rocking, and strong shush they experience 24/7 inside the womb.   
> The great benefit of swaddling was highlighted by Patricia Franco's  
> article in Pediatrics (5/05) where she demonstrated that swaddled  
> babies have slightly longer periods of uninterrupted sleep...but  
> are MORE arouseable.  This means that swaddled babies are sleeping  
> a little bit longer...and their arouseability means they are  
> probably more protected against SIDS. However, babies who are  
> swaddled with their hands up often get their arms out and unravel  
> the blankets...these loose wraps can get around a baby's face and  
> increase the risk of SIDS.

> One extra note to my Lacnet friends who are interested in learning  
> more about the 5 S's, one year ago I began a certification program  
> for training educators in the Happiest Baby methods.  To date over  
> 800 educators (many of them LC's) have enrolled.  Most recently,  
> the University of Michigan is training 30 nurses and LC's to hold  
> baby calming classes for all moms delivering at their Ann Arbor  
> hospital.   Also, hospitals around the country are beginning to use  
> these classes specifically for helping women be more successful  
> breastfeeding AND to treat postpartum depression.  If you are  
> interested in more information please can come to my presentation  
> at the ILCA meeting in Philadelphia in July or contact  
> www.thehappiestbaby.org.


> I send you all my warmest wishes,  																																	

> Harvey



>
> ----------------------------------------------------------------------
>
> Date:    Wed, 22 Mar 2006 08:10:13 -0800
> From:    "Laura A. Mundt" <[log in to unmask]>
> Subject: OT--swaddling position
>
> I have permission from the Listmothers to ask this question about
> which swaddling positions might be physiologically better for full
> term newborns.
>
> We are having a good dialogue in our hospital system about baby
> positioning for swaddling. In our newborn care classes, we show The
> Happiest Baby on the Block video and the parents love the techniques.
> We had a family who delivered prematurely and the PT working with
> their baby had a hard time convincing the parents that the baby
> needed to be swaddled with the arms flexed.  The Happiest Baby book
> mentions the importance of this position for preemies, but the video
> stresses swaddling with the arms down so the blanket stays tight.
>
> This PT has looked at the research to see if there is anything about
> the benefits of swaddling full term babies in flexion or the risks of
> swaddling them in extension.  Most of the research she has found only
> talks about positioning for preemies, if it addresses position at
> all, but it seems like the flexion position could also be beneficial
> for term babies, for the same reasons (i.e. to facilitate
> neuromuscular development and organization, aid in self-calming).
>
> So is anyone aware of any resources that might be helpful for us to
> continue this discussion?
>
> Thank you
>
> Laura Mundt, MA, ICCE
> Portland, OR

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