> 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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