Every new mother would have received advice from elders in the family, “Wrap the child tight, it will sleep well, grow stronger”. A lot has changed since the ancient times where new mothers would be taught how to wrap her child only by her mother! In the modern age, you have prenatal classes, Nurses teaching swaddling to new mothers in hospitals and to add on, lot of information on the internet for new parents which may sometimes be confusing or contradicting. Even so, I have come across numerous babies clothed too tight or in faulty positions which can be unsafe to the new baby. This got me thinking and encouraged me to write about this ancient art of ‘Swaddling’ and how it’s now modified after curious research on it.
Let’s look at the science behind Swaddling. The foetus in mother’s womb is in position of flexion with arms held close and hips curled up into flexion.
A correct Swaddling technique is aimed to recreate this womb space especially in new born infants and neonates up to 2 months of age. Parents would commonly ask me this question, “ How should one swaddle a child?” I would always answer, “Swaddle – firstly, according to child’s comfort and secondly, catering to natural posture of the child”.
To make things simple, let me show you how we can swaddle a child at different months…
Newborn- 2 months
Swaddle a child maintaining Fetal position at this age.
Place blanket on a flat surface in a diamond position in front of you Fold the top corner down about 6 inches, and place baby in the center of the blanket with top fold of blanket placed at angle of neck and shoulder
Starting on your left, bring the 1st corner over and tuck snugly behind baby. Ensure baby’s hips and knees are in a flexed froglike position inside the swaddle.
*Do not straighten or over extend your baby’s arms and legs.
The bottom corner goes up and over baby’s left shoulder and behind baby’s back. The weight of the baby will help to keep the swaddle secure.
Take the 3rd corner across and all the way around behind baby, tucking the tail of the blanket into the fold in the front.
*Avoid having the blanket touch baby’s cheek. This can stimulate baby’s rooting response and wake baby. Ensure face and neck areas are free of swaddle cloth.
Swaddle according to comfort such that there is a 2 finger space between baby’s arms and the swaddle cloth
This allows for tiny arm movements during sleep while still giving a cozy environment to the child. The space also allows the child to breathe well in the swaddle without restriction
Hips start getting more extended from flexed foetal position due to kicking movements and tummy time as baby nears 4months. So swaddle with muslin cloth as shown in previous stage but at this stage allowing hips to stay naturally extended (straightened) without pulling them straight (as seen in above baby)
*Till 6 months of age, hips not completely straightened, so DO NOT pull the legs straight when swaddling
Babies now roll from side to supine and are more active from 4th month of age. It’s best to keep a weighted blanket during sleep hours and wean swaddling from this stage to avoid risk of respiratory distress, which can be precipitated by increasing baby movements causing swaddle cloth to trap around neck or face.
Best cloth material for Swaddle?
I would suggest using a thin muslin cloth for swaddling which gives room for baby`s skin to breathe.
Although there is an ongoing debate whether should Swaddling be done, I would like to say,
‘Swaddling when done correctly has various benefits’
- Infants arouse less and sleep longer
- Comforting flexed posture gained through swaddling helps to manage pain and distress in infants e.g. Colicky pain, GERD, flatulence, constipation
- Provides baby’s growing nervous system with valuable information and feedback about this little body that they are just getting used to. The comforting tightness of swaddle is a type of deep pressure input (called Proprioceptive input or body awareness) to the body and limbs that help the brain learn about this new body of theirs, in a very calming, organizing way.
- Improved Neuromuscular development, less physiologic distress, better motor organization and more self-regulatory ability through facilitation of midline orientation, gentle flexed posture and increased body awareness
- Secondarily may also prevent other serious problems triggered by infant crying and parental exhaustion like postpartum depression, breastfeeding failure and child abuse.
Now that we went through steps to swaddle a baby and its benefits, it’s natural to ask oneself how long should a baby be swaddled? To answer that, I would tell, swaddle when you see the baby starting to get sleepy through the time the baby is asleep. Gently loosen the swaddle and open the baby if the baby has slept too long and it’s time for baby to feed.
* DO NOT swaddle when the baby is awake and active*
Remember, not everything is rosy about swaddling! There are a few precautions new parents have to take when baby is swaddled
Never put child in prone when swaddled
Never pull legs straight
Let the arms be softly in mid-line rather than pulling it straight down or across
Never wrap child too tight
Observe for signs of increased body heat especially if one lives in warmer areas like redness of facial skin, sweating over scalp hair or forehead. Loosen your swaddle cloth or open it
Ola! Take care of them and you will see your cute ‘Baby Burrito’ stay calm, sleep peacefully and with all that, enjoy your time with your bundle of joy!
Written by: Shivangi Trivedi (Registered Physiotherapist, Specialized Pediatric Training)
MATRIX PHYSIOTHERAPY TORONTO