Swaddling from the Nativity to Today
“And she brought forth her firstborn son, and wrapped him in swaddling clothes, and laid him in a manger; because there was no room for them in the inn.”
During the 1960s in Syracuse, upstate New York, a group of Paediatricians were studying baby’s autonomic nervous systems, the part of the nervous system beyond our conscious control. They noticed that swaddling resulted in a more tranquil and co-operative baby. This observation led the group to consider how swaddling fell precipitously out of favour from being, almost ubiquitous, traditional practice. Today, swaddling has enjoyed somewhat of a renaissance. However, some Paediatricians still maintain concerns about the safety of swaddling practices. In particular, the relationship between swaddling and Developmental Dysplasia of the Hip and even more concerning, Sudden Infant Death Syndrome (SIDS).
Swaddling most usually takes the form of some type of restraint of the movement of the baby’s arms and, or legs, with bands of material which, historically, tended to be linen. It has been utilised since the times of Antiquity. Of course, it was also the preferred method to keep the baby Jesus snug. Two main factors helped maintain the popularity of swaddling. Firstly, it was thought that it would protect the newborn from the harsh external environment. Secondly, swaddling, it was assumed, would maintain alignment of the developing skeleton.
Not far from our new doctors surgery on New Kings Road is Hurlingham House, now at the core of the impressive Neo-Classical facade of the Hurlingham Club. It was here in 1760 that Dr William Cadogen chose to build his summer residence after being granted 9 acres of land by the Bishop of London. After the birth of his first child, Cadogen, like myself and many medical fathers since became impassioned about the medical care of children. Cadogen was one of the earliest opponents of swaddling, and greatly influenced it’s demise. In his popular book on childcare Cadogen put forward the view that swaddling was an overindulgence that led to illness and deformity.
Despite declining popularity in Western Europe and North America, swaddling remained commonplace in many other cultures. Russian and Polish parents swaddled their infants in the belief it would mitigate for their weak limbs. In Romania it was used to prevent infant masturbation! The Navajo Indians of North America would strap infants to a cradleboard. Laplanders facilitated easy transportation by strapping the baby in a bark container, which was carried on the parent’s back. These more antiquated practices have now been shown to increase the risk of developmental dysplasia of the hip.
Contemporary parents use a ‘safe swaddle’; this allows baby’s hips to move up and out. Another physician passionate about childcare, Dr Harvey Karp, has contributed to its’ recent resurgence by recommending it his bestselling books. In addition, a 2007 article in the journal Pediatrics that concluded swaddling helped infants sleep longer and wake less also caught the eye of many sleep deprived medical parents.
Last year a study published in the Journal of Paediatrics highlighted the potential dangers of swaddling in relation to SIDS. It is important to learn the lessons from the review, SIDS is thankfully very rare but there are few occurrences in medicine or in life more tragic or heart wrenching. Most of these tragic occurrences resulted from the infant rolling to the prone (face down) position or having being placed that way. This highlights the importance of not placing babies in the prone position to sleep and also not swaddling baby’s arms once they show signs of being able to roll (usually around 4 months). Soft bedding such as bumper pads, blankets and pillows was also strongly implicated so they are best avoided.
Safely swaddled babies lying on their backs are at lower risk of SIDS compared to un-swaddled babies lying on their backs. The reason for this is likely five-fold. Firstly, swaddling likely prevents infants inadvertently rolling face down before they have learnt to roll back again. Secondly, neatly tucked in arms prevent them pulling bedding over their face. Thirdly, although swaddling promotes sleep the baby remains responsive to stimulation. Indeed low-level noise is more likely to arouse a swaddled baby than a non-swaddled baby. Fourthly, the study into SIDS in swaddled babies did revealed one case of overheating when the ambient temperature was very high. However, SIDS is more commonly related to excessive cooling which swaddling prevents. Finally, swaddling likely improves sleep by reducing normal startle responses; these sudden jerks often wake babies. Babies lying prone have less of these jerks, so many parents lie babies prone to promote better sleep, but this is not advisable due to the increased SIDS risk.
The Syracuse researchers concluded their observations by highlighting that childcare practices fall in and out of favour over time, often due to dogma rather than hard evidence. They shared the hope that in the future the care of babies would be based more on scientific studies. In the intervening years since then several systematic studies have been undertaken in childcare practices. They have given us strong scientific evidence that swaddled babies, lying on their backs with room to move their legs, will most likely sleep safe and sound.
Dr Hugh Coyne