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REVIEW ARTICLES:
Bregje E. van Sleuwen, Adèle C. Engelberts, Magda M. Boere-Boonekamp, Wietse Kuis, Tom W.J. Schulpen, and Monique P. L'Hoir
Swaddling: A Systematic Review
Pediatrics 2007; 120: e1097-e1106 [Abstract] [Full text] [PDF]
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[Read P3R] Limit swaddling and massage to colicky babes
Edward J. O'Hagan   (31 October 2007)

Limit swaddling and massage to colicky babes 31 October 2007
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Edward J. O'Hagan,
Retired
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Re: Limit swaddling and massage to colicky babes

eohagan{at}cogeco.ca Edward J. O'Hagan

Dr. Patricia Franco (1) and her co-authors reported in Pediatrics in May of 2005 that their study on swaddling of infants revealed that it was associated with increases in the infants' sleep efficiency and in the time spent in non–rapid eye-movement(NREM) sleep . When swaddled, the infants awakened spontaneously less often.

Both swaddling and prone placement have traditionally been employed in countering the effects of infant colic. Additionally, childcare advocates are currently being quoted widely in the various news media and on Internet websites in regard to the many benefits of employing infant massage techniques ... and not alone in regard to bringing relief to colicky infants, but also as being beneficial to all infants in general. The claimed benefits are widespread and comprised in a lengthy list of well researched and worthwhile outcomes; included are claims of massaged infants experiencing improved sleep efficiency and sleeping more 'soundly'. In short, there is no reason to suspect that the claims being made concerning the benefits of infant massage are other than being entirely valid.

Nevertheless , while all three approaches, namely prone placement, swaddling, and massage, may be employed beneficially in treating infant colic, it should be understood that the infants are to be fully awake and crying, and when sleep eventually initiates they should be placed in the supine position.

Prone sleeping is recognized as being contributory to the overall incidence of SIDS fatalities, and since we do not know which infants may be individually vulnerable, it becomes necessary to recommend that all infants be placed to sleep in the supine position.That being the case ( vis-ŕ-vis prone placement during sleep increasing the possibilities of SIDS outcomes) and since both infant massage and swaddling have been recognized as 'improving' the duration and depth of sleep, the following observations may merit consideration:

There appears to be the assumption that if massage brings relief to victims of infant colic, and has all kinds of benefits for infants generally, not least of which is that sleep becomes longer and deeper, then it should be employed 'holus bolously' with all infants without exception. Therein, may rest a danger paralleling that of prone placement during sleep, inasmuch as increasing the duration and depth of sleep may likewise possibly result in the elevation of the overall incidence of SIDS.

Possible vulnerability to SIDS once again has to be considered, and unless infants have been diagnosed professionaly as experiencing colic, or until such time as research data and/or study outcomes tell us otherwise, namely that infant massage is not contributory to increasing hazard of SIDS, it might be useful to weigh claimed benefits against the possibilty of tipping the scales in the directly opposite direction. Similarly the above considerations can be also applicable to swaddling, and, therefore, consideration once again might be given to restricting its use solely to professionally diagnosed cases of colic.

A search of the Internet will reveal that there are numerous unsupported claims being published concerning the effectiveness of swaddling in reducing the incidence of SIDS. It did not take too long before Franco's and her colleagues' study was being cited on the websites as being supportive of these purely speculative claims, despite the fact that the authors were careful to avoid making any such conclusions.

Dr. G. Manci (2) in an editorial in the New England Journal of Medicine back in February,1993 wrote : "....assuming that the adverse consequences of sleep are limited to the REM phase and considering slow- wave sleep to be invariably beneficial may be unwise. ..."

The bottom line? Swaddling and massage should not be employed with infants under the age of 6 months,unless in cases of professionally diagnosed colic.

(1) Pediatrics. 2005 May;115(5):1307-11. Influence of swaddling on sleep and arousal characteristics of healthy infants. Franco P, Seret N, Van Hees JN, Scaillet S, Groswasser J, Kahn A. Pediatric Sleep Unit, University Children's Hospital, Free University of Brussels, Brussels, Belgium.

(2) Autonomic Modulation of the Cardiovascular System during Sleep; NEJM, Volume 328: 347- 349,February 4,1993; Number 5

Conflict of Interest:

None declared