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
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