I've noticed a huge increase in swaddling all infants all the time in our
hospital. I think it may be due to the HBOTB, and our more-is-better
culture.
I think that soothing techniques are crucial for breastfeeding mothers to
learn--otherwise they assume the baby is not getting enough milk. However,
soothing techniques are needed only when a baby is upset and the basics of
feeding and diapers have been taken care of. What I see is that parents now
feel that swaddling non-stop is essential--and it does make it harder to
perceive feeding cues--which then makes babies "fussier" and more difficult
to both latch and to soothe.So I think it's essential that in addition to
learning these techniques, parents need to be taught when they are
appropriate.
Interesting to see this study:
Comparison of Behavior Modification With and Without Swaddling as
Interventions for Excessive CryingVan Sleuwen BE, L'Hoir MP, Engelberts AC,
et al. *J Pediatr*. 2006;149:512-517Summary: This study tackled a
long-vexing infant condition -- excessive crying and what to do about it.
The authors contend that stimulus reduction and allowing infants to fall
asleep in their cribs holds more promise than active interventions to quiet
an infant, such as holding or rocking.
This study compared outcomes of 2 modes of an intervention to reduce crying
(the baseline intervention with and without swaddling). The authors defined
a child with excessive crying as one who cried for more than 3 hours in a
24-hour period on at least 3 days per week. During a run-in period of 1
week, infants and mothers (if breastfeeding) were fed a hypoallergenic diet
in an attempt to identify infants with excessive crying due to allergic
disorders. Those infants with improvement in crying scores during the run-in
were excluded from the study. The randomized infants and mothers reverted to
their usual diets after the 1-week run-in.
Subjects were infants under 13 weeks of age, of at least 32 weeks
gestational age at delivery, and who met the definition of excessive crying.
The intervention consisted of a set pattern of care -- sleep, then feeding,
followed by interactive play with the infant, then alone awake time. When
the infants demonstrated signs of being tired, parents were to place the
infant into bed. In addition to the set pattern, one group added swaddling
of the infant when put down to sleep.
Three hundred ninety-eight (398) infants remained in the randomization after
the hypoallergenic run-in period. During the baseline week, infants cried or
were fussy on average for 4.37 hours per day. For the entire group, the type
of intervention (with or without swaddling) did not influence duration of
crying or fussiness. However, infants younger than 8 weeks did benefit from
the addition of swaddling, but the older infants did not. The authors
conclude that swaddling may offer modest benefit to young infants, but not
to infants older than 8 weeks. On average, all infants experienced decreased
crying and fussiness over the 12 weeks of the study follow-up period.
(That last line reminded me of a pediatrician's wry comment about parents
who want to use formulas advertised to reduce colic. He said, "Their baby's
colic will get better when they use that stuff. Just takes 2-3 months...)
Susan Lawrence, RN, IBCLC
Berkeley, CA
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