Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e1097-e1106 (doi:10.1542/10.1542/peds.2006-2083)
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REVIEW ARTICLE

Swaddling: A Systematic Review

Bregje E. van Sleuwen, MSca, Adèle C. Engelberts, MD, PhDb, Magda M. Boere-Boonekamp, MD, PhDc, Wietse Kuis, MDd, Tom W.J. Schulpen, MDe and Monique P. L'Hoir, MSc, PhDa

a Departments of Medical Psychology
d Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
b Department of Pediatrics, Maaslandziekenhuis, Sittard, Netherlands
c Department of Science, Technology, Health, and Policy Studies (STeHPS), School of Management and Governance, Twente University, Enschede, Netherlands
e Paediatric Association of the Netherlands, Utrecht, Netherlands

Swaddling was an almost universal child-care practice before the 18th century. It is still tradition in certain parts of the Middle East and is gaining popularity in the United Kingdom, the United States, and the Netherlands to curb excessive crying. We have systematically reviewed all articles on swaddling to evaluate its possible benefits and disadvantages. In general, swaddled infants arouse less and sleep longer. Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled. When compared with massage, excessively crying infants cried less when swaddled, and swaddling can soothe pain in infants. It is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions. It can be helpful in regulating temperature but can also cause hyperthermia when misapplied. Another possible adverse effect is an increased risk of the development of hip dysplasia, which is related to swaddling with the legs in extension and adduction. Although swaddling promotes the favorable supine position, the combination of swaddling with prone position increases the risk of sudden infant death syndrome, which makes it necessary to warn parents to stop swaddling if infants attempt to turn. There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling. Furthermore, swaddling does not influence rickets onset or bone properties. Swaddling immediately after birth can cause delayed postnatal weight gain under certain conditions, but does not seem to influence breastfeeding parameters.

Key Words: swaddling • systematic review • traditional care • sudden infant death syndrome • developmental dysplasia of the hip

Abbreviations: SIDS—sudden infant death syndrome • DDH—developmental dysplasia of the hip • RCT—randomized, controlled trial • HR—heart rate • QS—quiet sleep • REM—rapid eye movement • SpO2—pulse oxygen saturation • VLBW—very low birth weight

Accepted Mar 3, 2007.


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M. A. Blom, B. E. van Sleuwen, H. de Vries, A. C. Engelberts, and M. P. l'Hoir
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[Abstract] [PDF]

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Limit swaddling and massage to colicky babes
Edward J. O'Hagan
Pediatrics Online, 31 Oct 2007 [Full text]