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Swaddling: A Second Look




 


 



 


Harvey Karp’s book The Happiest Baby on the Block has changed the landscape of parenting in the US. As a result of its irresistible title, easy to learn method and national network of 2500 teachers, most new parents in the US today are instructed to swaddle their babies. Despite this popularity, there are growing concerns that swaddling is not the cure-all parents hoped it would be.


Since the publication of the book in 2003, I have increasingly heard reservations from health professionals about its recommendations. A nurse practitioner wonders if the shushing sound recommended in the book can hurt the baby’s ears. A renowned neonatologist worries that preventing a baby from flapping his or her arms to cool down might hurt temperature regulation. And, more recently I began to hear that routine swaddling had adverse effects on breastfeeding.


As a result of these concerns, I commissioned Gussie Fauntleroy to write an article on swaddling, which we’re releasing today. It is accompanied by a piece by renowned lactation consultant, Nancy Mohrbacher. And, our web editor, Melanie Mayo, has put together a special report on swaddling.


For even more coverage of the subject, read Mohrbacher’s exceptional critique of swaddling and debate with Dr Karp on its merits in the International Journal of Childbirth Education. She looks at alarming research: Swaddling newborns delays the first breastfeeding and leads to less effective sucking. Swaddling during the early months puts an infant at risk for respiratory illness, hip dysplasia, overheating and SIDS. And, finally, a small, 2010 study showed The Happiest Baby interventions ineffective in reducing crying.


Take a breath. Many parents have found swaddling helpful and these articles are not meant to discredit their experience. This research comes as shocking news to us all. We do not mean to offend other parents; we all want our babies not to cry. Rather, we hope to shed light on a practice that has benefits, but that has become dogmatic and thus may interfere with parental instinct.


 



The first question one certainly asks is, “If I don’t swaddle, what else will I do.” Here are some things that have been shown to be highly effective:


Hold your baby.


Breastfeed your baby.


Walk around holding your baby.


Rock your baby.


According to neurologist Richard Restak, MD, “Physical holding and carrying of the infant turns out to be the most important factor responsible for the infant’s normal mental and social development.” Neural and neuroendocrine functions underlying emotional behaviors are responsive to early experiences in enduring ways. For example, the anthropologist Margaret Mead found in her research that the most violent tribes were the ones that withheld touch in infancy.


I realize that these swaddling articles are provocative; I hope they will also be helpful. We’ll be talking more about their findings in the community and on Facebook. Please join us to share your comments, concerns and suggestions.


 


 


Peggy O'Mara  (101 Posts)

Peggy O’Mara founded Mothering.com in 1995 and is currently its editor-in chief. She was the editor and publisher of Mothering Magazine from 1980 to 2011. The author of Having a Baby Naturally; Natural Family Living; The Way Back Home; and A Quiet Place, Peggy has lectured and conducted workshops at Omega Institute, Esalen, La Leche League International, and Bioneers. She is the mother of four.

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Tags: Harvey Karp, Holding your Baby, International Journal of Childbirth Education, Margaret Mead, neural functions, neuroendocrine functions, Richard Restak, Rocking your Baby, Swaddling, The Happiest Baby on the Block





Comments (39)

Wow, I'm surprised by this article as it appears they are not familiar with Dr. Karp's methods. I am a doula and was a nanny for twins from birth to age 2 and was fortunate to hear Dr. Karp's lecture in person and used and taught his techniques to many parents. They work. However, I'd like to clarify a few points: -Dr. Karp does not encourage babies to be swaddled immediately after birth...there are far too many studies showing that babies should be held skin to skin by their mothers immediately following birth. -His techniques are meant to be used when babies have colic or are crying inconsolably...sometimes just holding and bouncing doesn't work. -He talks about swaddling very specifically and suggests leaving the blanket loose around the hips to prevent hip dysplasia. -If a baby is being breastfed, there is no reason for her to be swaddled (skin to skin is great), though in the case of colic it proves to be helpful in calming the baby down in order for her to latch. - There is no reason to leave a baby swaddled once he has calmed down, meaning the baby is always held while swaddled, which leaves no room for one to overheat or have respiratory issues because mama (or whomever) is right there. I don't know what I would have done with the twins I was responsible for had it not been for Happiest Baby On the Block. His techniques work WELL and I don't understand why he is coming under fire. It is good to reiterate the safety measures when using these techniques, but to say that just holding and bouncing works, well, that just doesn't sound like a mother talking.
Here is a link from the International Hip Dysplasia Institute: http://www.hipdysplasia.org/Developmental-Dysplasia-Of-The-Hip/Hip-Healthy-Swaddling/Default.aspx An issue close to my heart since my daughter was born with it... At almost two we are still dealing with the effects, two different bracing systems, an operation and a full body cast for 17 weeks. Please look at it if you wish to swaddle your infant.
I have to concur with Melissa's understanding of Dr. Karp's recommendations. I never read any suggestion that a baby should be swaddled all the time, and there was nothing at all about newborns.
We literally would have gone bonkers without Karp's techniques. When baby wearing and all day nurse-ins failed to quiet our fussy babe, swaddling, shooshing, and bouncing succeeded. Sometimes it just seems like mothering.com has to work against whatever is popular and common place...
Well put Sara. I was thinking the same thing.
I did not read The Happiest Baby book until after my first daughter was past her colic, and I always wonder how much it might have helped her. We did all the breastfeeding, holding and carrying, and she still screamed and screamed, for hours. I missed out on her babyhood because it was so stressful to have such an unhappy baby. Personally, I think swaddling is an essential tool for parents to have in their bag of tricks, particularly in the era of "back to sleep". Some babies seem to have a stronger startle reflex which, in my experience, led to very poor sleep unless baby's arms were swaddled. We are careful to leave our babies legs loose so that they are able to rest in a flexed position, eliminating concerns about hip dysplasia. I was thankful to have Dr. Karp's suggestions to add to my parenting repertoire for babies 2,3 and 4. No, they weren't magic cure-alls, but had their time and place.
I never swaddled, there was some innate feeling not too. I cant explain it. The alternatives given in the article made me smile. I wish they could go without saying!!
I agree with many of the comments above - most of which are it was a good TOOL to have in addition to all the other healthy parenting things we were doing. I've read his book and chose to use some of his ideas, to a degree, but skipped the swaddle and used the ring sling instead; which luckily was enough for my little one! I think Mothering and parenting experts in general need to remind people 2 key things: "everything in moderation" and "a time and place for everything". Unfortunately I do think there are parents out there who just swaddle their babies the majority of the time, including when feeding; and that's not good. And I live in a town where they swaddle fresh newborns THEN hand them to the mothers, after being weighed, poked, eyes gooped and assessed (unless you come in with a birth plan specifically stating otherwise and are a nurse like me so it is respected to a T...shameful). So no, don't mis-critique Dr. Karp BUT recognize that their are people out there who think they are following his program by swaddling all the time!
I am glad this type of awareness is finally coming forth. It seems so clear to me that infant swaddling goes against all primal instincts. There is no other species that would restrict the movement of its young - probably because no other species has ventured as far from primal birth and parenting as humans have. As someone who has been studying pre- and perinatal psychology for almost a decade, my intuitive thought about swaddling is that it will leave the child with a long-standing imprint of powerlessness -- since he or she does not even have dominion over moving his/her own body at will. My sense is that swaddled babies may be going into a mild form of parasympathetic shock when swaddled. Their system is shutting down to deal with the insult and this is why they "fall asleep" - or disassociate, depending on how you look at it.
I agree with others that have said this is a misreading of Happiest Baby on the Block. He offers the five S's - five different techniques only one of which is swaddling. They can be used all at once or you can use what works for you. My baby was colicky and without these tips I don't know how we would have made it through those first few months. We didn't swaddle much, but I wore her in the Baby K'Tan all day and we bounced and shhhhh'd all the time and it was the only thing that worked. I nursed as much as she wanted, but sometimes she simply didn't want it. All she wanted was to be bounced and shhh'd. You do what you have to. Also, I believe that Dr. Karp addresses the concern that the shhhing might be harmful to baby's ears and concludes that it is not.
Gussie delineated my own concerns about swaddling. I wish the old information about relux hadn't been included. Excellent research shows that reflux is another good reason for putting babies of their backs, so the trachea is on top instead of below the gush. Both SIDS and asphyxiation are less in babies with reflux who sleep on their backs. AAP concurs.
Parents need tools. Babies sometimes need help and swaddling is a lifesaver for some. To the poster who suggests that what looks like calming could really be a form of parasympathetic shock, do you ever think about how babies' movement is restricted in utero, very similar to being swaddled? Are they in shock in utero too? And the sounds of shhhushing are certainly no louder than the sounds baby hears in the womb. I get the feeling that many of the anti-Karp people have not read his book or watched his video. Sometimes I think we resent him for being popular but he is the first to say he did not invent any of these methods of baby soothing- he is helping us to get back in touch with what our grandmothers knew, the wisdom we'd forgot in the age of gadgets. Of course skin to skin is best. of course babies should not be swaddled at birth, all the time or when nursing and of course we should not swaddle hips- Dr.Karp does not advocate any of these scenarios. Babies also should not be swaddled after they are trying to roll. I think these are really important cautions but let's not throw the baby out with the bathwater, eh?
I wish I had not swaddled my little girl as an infant. I believed it was the thing to do, but that belief interfered with my parental instinct. Now, looking back, I realize it did not bring my baby any calm but the contrary; she protested and hated being swaddled. I believe it could also have interfered with breastfeeding and I am remorseful for having subjected my little baby to this practice. I regret not having trusted my own intuition and do feel quite stupid.
I think all mothers should also trust their parental instinct. ALL babies are different. And, all babies respond different. There are helpful suggestions all over the place if you study, including in this book. There are also a lot of pockets of bad information. People should study all they want, and LOOK not listen, at the results. Use judgement, not all information is correct, a lot of it is not correct. A lot of it is, you have to look for yourself and decide for yourself what is right for your baby. But, the more knowledge and experience the more you can decide for yourself.
This article is absolutely ridiculous. It's shameful. I clung to Dr. Karp because it was the ONLY parenting book available that went with my attachment parenting beliefs. Instead of leaving my baby in the crib to cry out of desperation, or putting him in the bouncy seat all day, I was able to swaddle him up, shush him, and rock him in my rocking chair. So many parents have found the wisdom Dr. Karp brings forward as a way to CONNECT with their children. I am horrified that the author would choose to include the "dangers of swaddling" being SIDS, various other health problems, and breastfeeding difficulties. This is fear mongering and praying on mothers' natural desires to keep their babies safe. I agree with the above poster that said that sometimes it feels like mothering.com just wants to be contrary to popular thought. Attachment parents should be thanking Dr. Karp every day for helping parents understand that babies need breastfeeding for food AND comfort, and that babies enjoy being rocked to sleep as opposed to simply laying them in their crib and wondering why they keep crying. Why do I always feel like attachment parenting advocates WANT parents to suffer? It's not enough that women provide the sole nourishment for their children, carry them all day, and attend to their every need day and night until they learn to sleep for themselves... now we must take away a tool that can potentially give them sanity. Quoting a small study that swaddling doesn't reduce crying is simply poor journalism. I could probably find a small study that would prove anything, but it wouldn't be valid because it doesn't have a large enough subject base. This just makes me SO angry. There are mothers who are struggling through the newborn phase who are currently finding some peace with swaddling but are now unwrapping their infants out of FEAR because of this article, even if their babies were soothed by swaddling. That's just not fair.
I totally agree, Melissa! I'm a mama to a beautiful, attached 2 year old and the nanny to an almost 2 year old and a 4 month old who are also well-attached, loving, and engaged with the people around them. All three were swaddled---and all three were also held and cuddled so much that people comment now on how muscular my arms are. Swaddling is what made naps possible in the early months for the older two, and what makes naps possible now for the youngest. My daughter's favorite thing in the world is still "ninny" (nursing), so I don't think swaddling her during colicky periods when she WOULDN'T nurse to help her calm down had an adverse effect on our breastfeeding at all. That said, I do think it's good to bring scrutiny to any "easy fix"----although you and I obviously "swaddled responsibly" and didn't neglect other parenting techniques, many, many people probably do. I think that's what the article is trying to say, although it does seem like the community at Mothering might not be the recipients who need this info the most---aren't we all proponents of holding our kids and loving them as much as we can?
Actually, there are countless other cultures AND species that restrict movement in infants to some extent: what do you think baby wearing does? A baby can't wave his arms about while being worn in a sleeping position in a wrap or a sling--and that is why we swaddle. 0-3 month olds (the age Karp recommends swaddling for) are still in the very early stages of learning control over movement; they can't just think "Oh I'd like to not whack myself right now", especially when they're upset or tired---their movements become spastic and a little restriction of the arms is helpful for calming down and getting to sleep. Karp does NOT recommend swaddling as a general rule---obviously babies need time to explore their bodies and learn how to move them. But saying that it makes a newborn feel helpless to not have control over his movement because he's swaddled when in reality he hasn't learned to control his movement yet period just doesn't make sense.
GREAT REVIEW! I agree with all your thoughts you said in your article, especially at the beggining of your article. Thank you, your post is very useful as always. Keep up the good work! You've got +1 more reader of your super blog:) Isabella S.
Dear Peggy, Thank you for providing a forum for this important discussion about swaddling. Of course, we all want babies to be content, have colic resolved and to nurture them with close contact, skin-to-skin (by ALL caregivers) and breastmilk. In fact, the basis of my approach - the 4th trimester - is all about reducing separation. I believer that is why my work has received broad support from attachment advocates and is taught in hundreds of WIC clinics across the US. "Bursting with wisdom! Some of the best ideas about babies I’ve ever seen.” James McKenna, PhD, Chairman, Dept of Anthropology, University of Notre Dame “The 5 S’s promote attachment and bonding!” Attachment Parenting International (API) "Dr. Karp’s love and respect for infants and new parents permeates his message." Penny Simkin, PT, childbirth educator, doula, author, co-founder of DONA However, we cannot close our eyes to the fact that many parents today are struggling. They often have little experience caring for babies....and little support. Nursing and holding are key calming techniques, but if they were all that parents needed to do, no baby would cry over 2 minutes. Yet, up to 15% infants cry/fuss for more than 3 h/day. In 2 recent studies, 3000 babies averaged 2.5 hours of fussing/day! (BTW, colic babies are just as commonly nursed as bottle fed.) Infant irritability is no benign nuisance or trivial issue...it is very serious business. Crying - and the exhaustion it often provokes – are key triggers for untold suffering and over $1 billion dollars of health care costs, including marital conflict, SIDS/suffocation, BF failure, depression (of both parents), suicide, child abuse and neglect, disturbed bonding, cigarette smoking, extra MD/ER visits, medication for acid reflux, parental overeating, car accidents, etc. These problems particularly befall parents struggling with other stresses. Swaddling is just one of many tools. And, of course it needs to be properly taught so that parents use it correctly (similar to the education we give to all parents about car seat installation). But, for babies who fuss despite nursing and holding...swaddling is a godsend and a cornerstone of successful calming and improved sleep. To give parents and care givers the best advice, ICEA allowed me to respond to the many concerns I had with the Wendy Mohrbacher article. You were very kind to include those comments along with her response in your communication to parents. I hope you will also allow me to respond to the numerous concerns I have with Ms Fauntleroy's article in Mothering as well. Kind regards, Harvey Karp, MD FAAP Assistant Professor of Pediatrics USC School of Medicine Author of the DVDs/books, THe Happiest Baby on the Block and The Happiest Toddler on the Block
Does that long-standing imprint of powerlessness start in the womb? Not actually a lot of free movement going on in there during the last few weeks. What changes at birth that makes it suddenly oppressive?
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