Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1307-1311 (doi:10.1542/peds.2004-1460)
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Influence of Swaddling on Sleep and Arousal Characteristics of Healthy Infants

Patricia Franco, MD, PhD*,{ddagger}, Nicole Seret, MD§, Jean-Noël Van Hees, MD§, Sonia Scaillet, MD*, José Groswasser, MD* and André Kahn, MD, PhD*

* Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium
{ddagger} Institut National de la Santé et de la Recherche Médicale 628, Lyon, France
§ Pediatric Sleep Unit, Centre Hospitalier Chrétien Site de l'Espérance, Liège, Belgium

Objective. Swaddling is an old infant care practice. It was reported to favor sleep and to reduce crying among irritable infants. There are few data on the physiologic effects of swaddling on infants' sleep-wake characteristics. This study was conducted to evaluate whether swaddling influences infants' arousal thresholds for environmental auditory stress.

Design. Sixteen healthy infants, with a median age of 10 weeks (range: 6–16 weeks), underwent polygraphic recording in their usual supine position during one night. The infants were successively recorded swaddled and nonswaddled, or vice versa. In both conditions, the infants were exposed to white noise of increasing intensity, from 50 to 100 dB(A), during rapid eye movement sleep, to determine their arousal thresholds.

Results. Swaddling was associated with increases in the infants' sleep efficiency and in the time spent in non–rapid eye movement sleep. When swaddled, the infants awakened spontaneously less often. However, significantly less-intense auditory stimuli were needed during rapid eye movement sleep to induce cortical arousals when swaddled than when not swaddled.

Conclusions. Swaddling promotes more-sustained sleep and reduces the frequency of spontaneous awakenings, whereas induced cortical arousals are elicited by less-intense stimuli. These findings could indicate that, although swaddling favors sleep continuity, it is associated with increased responsiveness to environmental auditory stress.

Key Words: arousal • infant • sleep • swaddling • sudden infant death syndrome

Abbreviations: HR, heart rate • NREM, non–rapid eye movement • REM, rapid eye movement • SIDS, sudden infant death syndrome • EEG, electroencephalographic

Accepted Sep 24, 2004.


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