Catherine,
You have explained very well what I think Pam's views were and I share these views as well. After 10+ years in infant development, I would never swaddle arms down. Babies are oral creatures and need their hands accessible. They can then learn to self-calm by sucking on their hands or just placing their hands up by their face. This is how they were in the womb and how they should be outside the womb as well.
Having their hands up by their face provides them with security, much like containment. In the NICU, I train parents to contain their infants in a flexed, fetal position...scooping up their legs and arms. Babies almost always instantly respond and are able to reorganize with this approach. Swaddling arms down can lead to further disorganization in a child who already cannot come back to center on their own and will lead to shut down. Shut down is not a healthy response for a child's neurological system and should not be encouraged.
Thank you for sharing so eloquently your opinions!
Holly Bernal, RN, MSN, NNP
"Catherine Watson Genna, IBCLC" <[log in to unmask]> wrote:
I share Pam's concerns about methodizing anything in baby care, and on
her particular critiques of swaddling with arms down, and the words
"calming reflex".
Babies cry because they need something, or because their nervous systems
have become disorganized due to hyperstimulation. Some parents don't
understand subtle cues that the baby needs a break, and keep on
interacting, until their baby cries and becomes overwrought. I suspect
some of this is an inborn problem in sensory processing, and some is due
to lack of having this kind of communication respected when they were
babies and infants. (Remember that as little as 35 years ago, mothers
were taught that their newborns were blind, deaf, and insensate (could
not feel pain). One treats a senseless "blob" much differently than one
treats a human being.
The more we study babies, the more we see that they are competent and
communicate their needs. If this communication is ignored, or the baby's
discomfort/hunger/loneliness get to a certain level, or if there is too
much environmental and internal sensation to process, the baby
disorganizes. Occupational therapists who deal with sensory processing
say to stop all stimulation, then provide organizing stimulation, and
then increase the original necessary stimulus slowly and gently,
watching the child's reaction. What Dr. Karp has done is taken some
organizing stimuli and packaged them.
Swaddling - containment - strong support for the baby's joints brought
in toward the body's center, with firm pressure on the skin. Parents
have done the same thing from time immemorial by snuggling their baby
close.
Again, the arms straight down thing is actually disorganizing, because
it does not bring the joints toward the body's center. It pulls the
shoulder blades apart, which is less stable, which makes the neck,
shoulders and back muscles all work harder, and is less comfortable for
the elbows as well.
Sucking - is a strongly organizing stimulus. Why not just offer the
breast first? Breastfeeding combines containment and sucking.
Rhythmic vestibular stimulation - the jiggling. Parents hold their baby
and walk or sway or bounce in a gentle, steady rhythm to calm them.
White noise - the shh is another thing parents do in almost every
culture. It sounds like the blood flow in the placenta, and is again,
rhythmic.
I don't think there is anything magical about sidelying, and he's left
out darkness and skin to skin contact. When I soothed my own kids, I
breastfed them, and did the rest of these if bf was not possible or they
declined to feed. When I soothe someone else's baby, I snuggle them
against my upper chest, so their face is at my neck, I touch my cheek to
their cheek, providing skin contact and darkness (removing visual
stimuli), cuddle them close in a nice flexed position (stability and
containment), rock or jiggle gently, and talk to them in a quiet,
soothing, repetitive voice right in their little ear. Works very
frequently to help the baby organize enough that they are able to take
their mom's breast.
I think any of us that work with a lot of babies have our own little
combo of variations on these themes that we've packaged for ourselves.
How shrewd of Dr. Karp to have turned his package into an empire! My
concern is that in over-promoting this one package, we are losing the
personhood of the baby, and the sensitive communication we want to
establish between parents and baby that will help the parents scaffold
their baby's developing nervous system better so the baby learns to
modulate incoming stimuli, rather than just constantly treating a
hyperstimulated infant. Part of this is the either culturally or
biologically determined differences in male vs female thought - notice
most of the people promoting specific, rigid, all-inclusive systems are
male, and females are more likely to provide toolboxes and guidelines
for tool choice.
I have shared most of these concerns with Harvey in person and in email,
so I'm not talking behind his back. No one made me the expert on
everything either, so he doesn't have to agree with me. Nor do any of
you. I'm sharing what I've learned in my work, so you can perhaps add
something to your toolkit!
Catherine Watson Genna, IBCLC NYC
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