Swaddling is an age-old practice of wrapping infants in swaddling cloths, blankets or similar cloth so that movement of the limb

Limb (anatomy)

A limb is a jointed, or prehensile , appendage of the human or other animal body....

s is tightly restricted. Swaddling bands were often used to further restrict the infant. Swaddling fell out of favor in the seventeenth century.

Some authors are of the opinion that swaddling is becoming popular again, although the medical and psychological effects of swaddling are in dispute. Some modern medical studies indicate that swaddling assists babies to sleep, and to remain asleep; and that swaddling lowers the risk of Sudden Infant Death Syndrome

Sudden infant death syndrome

Sudden infant death syndrome is marked by the sudden death of an infant that is unexpected by medical history, and remains unexplained after a thorough forensic autopsy and a detailed death scene investigation. An infant is at the highest risk for SIDS during sleep, which is why it is sometimes...

 (SIDS). However, one recent study indicated that swaddling increased the risk of SIDS. Additionally emerging evidence is showing certain swaddling techniques may increase the risk of Developmental Dysplasia of the Hip.

Origin and history

Mothers have swaddled their babies throughout history. Archaeological records suggest that swaddling first developed around 4000 B.C. in Central Asia

Central Asia

Central Asia is a core region of the Asian continent from the Caspian Sea in the west, China in the east, Afghanistan in the south, and Russia in the north...

 with use of the back-pack cradle board by migrating peoples. As desertification

Desertification

Desertification is the degradation of land in drylands. Caused by a variety of factors, such as climate change and human activities, desertification is one of the most significant global environmental problems.-Definitions:...

 progressed, migration from region to region became a relatively permanent way of life. Swaddling subsequently became an institutionalized part of child-rearing tradition in those same areas.
Votive statuettes

Votive offering

A votive deposit or votive offering is one or more objects displayed or deposited, without the intention of recovery or use, in a sacred place for broadly religious purposes. Such items are a feature of modern and ancient societies and are generally made in order to gain favor with supernatural...

 have been found in the tomb

Tomb

A tomb is a repository for the remains of the dead. It is generally any structurally enclosed interment space or burial chamber, of varying sizes...

s of Ancient Greek

Ancient Greece

Ancient Greece is a civilization belonging to a period of Greek history that lasted from the Archaic period of the 8th to 6th centuries BC to the end of antiquity. Immediately following this period was the beginning of the Early Middle Ages and the Byzantine era. Included in Ancient Greece is the...

 and Roman

Ancient Rome

Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....

 women who died in childbirth, displaying babies in swaddling clothes. In shrines dedicated to Amphiaraus

Amphiaraus

In Greek mythology, Amphiaraus was the son of Oecles and Hypermnestra, and husband of Eriphyle. Amphiaraus was the King of Argos along with Adrastus— the brother of Amphiaraus' wife, Eriphyle— and Iphis. Amphiaraus was a seer, and greatly honored in his time...

, models representing babies wrapped in swaddling clothes have been excavated. Apparently, these were frequently given as thank-offerings by anxious mothers when their infants had recovered from sickness.

Probably the most famous record of swaddling is found in the New Testament

New Testament

The New Testament is the second major division of the Christian biblical canon, the first such division being the much longer Old Testament....

 concerning the birth of Jesus

Jesus

Jesus of Nazareth , commonly referred to as Jesus Christ or simply as Jesus or Christ, is the central figure of Christianity...

 in :
Swaddling clothes described in the Bible consisted of a cloth tied together by bandage-like strips. After an infant was born, the umbilical cord was cut and tied, and then the baby was washed, rubbed with salt and oil, and wrapped with strips of cloth. These strips kept the newborn child warm and also ensured that the child's limbs would grow straight. describes Israel as unswaddled, a metaphor for abandonment.
During Tudor

Tudor period

The Tudor period usually refers to the period between 1485 and 1603, specifically in relation to the history of England. This coincides with the rule of the Tudor dynasty in England whose first monarch was Henry VII...

 times, swaddling involved wrapping the new baby in linen bands from head to foot to ensure the baby would grow up without physical deformity. A stay band would be attached to the forehead and the shoulders to secure the head. Babies would be swaddled like this until about 8 or 9 months.

The Swiss surgeon Felix Würtz

Felix Würtz

- Life :He was born in Zurich. The dates of his birth and death are insecure. The date of his birth was between approx. 1500 until approx. 1510, the date of his death between approx. 1590 and 1596. Würtz lived and practiced in Zurich and Strasbourg....

 (approx. 1500 to approx. 1598) was the first who criticized aspects of swaddling openly.
In the seventeenth century the scientific opinion towards swaddling began to change. There was an association of neglect with swaddling, especially in regard to wetnurses who would leave babies in their care swaddled for long periods without washing or comforting them. More than hundred years after Würtz physicians and philosophers from England began to criticize the swaddling clearly and demanded finally its complete abolishment. The British philosopher John Locke

John Locke

John Locke FRS , widely known as the Father of Liberalism, was an English philosopher and physician regarded as one of the most influential of Enlightenment thinkers. Considered one of the first of the British empiricists, following the tradition of Francis Bacon, he is equally important to social...

 (1632–1704) rejected swaddling in his 1693 publication Some Thoughts Concerning Education

Some Thoughts Concerning Education

Some Thoughts Concerning Education is a 1693 treatise on the education of gentlemen written by the English philosopher John Locke. For over a century, it was the most important philosophical work on education in England...

, became a lobbyist for not binding babies at all. This thought was very controversial during the time, but slowly gained ground, first in England and later elsewhere in Western Europe.

William Cadogan

William Cadogan

William Cadogan may refer to:* William Cadogan * William Cadogan, 1st Earl Cadogan * William Cadogan , British physician and childcare writer* William Cadogan, 7th Earl Cadogan...

 (1711–1797) seems to have been the first physician, who pleaded for complete abolishing of swaddling. In his ”Essay upon Nursing” of 1748 he expressed his view of contemporary child care, swaddling, the topic of too much clothing for infants and over feeding. He wrote:
Philosophers and physicians more and more began to reject swaddling in the 18th century. Jean Jacques Rousseau wrote in his book Emile: Or, On Education

Emile: Or, On Education

Émile, or On Education is a treatise on the nature of education and on the nature of man written by Jean-Jacques Rousseau, who considered it to be the “best and most important of all my writings”. Due to a section of the book entitled “Profession of Faith of the Savoyard Vicar,” Émile was be...

 in 1762:
Although this form of swaddling has fallen out of favour in the Western world

Western world

The Western world, also known as the West and the Occident , is a term referring to the countries of Western Europe , the countries of the Americas, as well all countries of Northern and Central Europe, Australia and New Zealand...

, many Eastern cultures and tribal people

Tribe

A tribe, viewed historically or developmentally, consists of a social group existing before the development of, or outside of, states.Many anthropologists use the term tribal society to refer to societies organized largely on the basis of kinship, especially corporate descent groups .Some theorists...

 still use it.

Modern swaddling

The swaddling cloths of mediaeval Madonna and Child paintings are now replaced with cotton receiving blankets, cotton muslin wraps, or specialised "winged" baby swaddles. Modern swaddling is becoming increasingly popular today as a means of settling and soothing irritable infants and helping babies sleep longer with fewer awakenings. Since the early 1990s the medical community has recommended placing babies on their back to sleep to reduce the risk of SIDS. As studies proved swaddled babies sleep better in the back sleeping position, swaddling has become increasingly popular and recommended so parents avoid the dangerous stomach sleeping position.
Swaddling also prevents newborns waking themselves with their startle reflex

Moro reflex

The Moro reflex, which is distinct from the startle reflex, is one of the infantile reflexes.It may be observed in incomplete form in premature birth after the 28th week of gestation, and is usually present in complete form by week 34...

.

Loose and ineffective swaddling techniques made using an undersized blanket can generally be kicked off by a wakeful baby. It is important for caregivers to accomplish a secure swaddle to ensure the blanket does not become loose and the newborn stays warm. It is important for caregivers to learn how to swaddle properly to accomplish a secure swaddle and ensure the baby remains wrapped during the sleep period. A loose blanket increases the risk of Sudden Infant Death Syndrome [SIDS], because the blanket may cover the baby's face. The act of swaddling does carry a risk of the baby overheating if the caregiver uses multiple blankets that are too thick or uses thick fluffy fabric that creates excessive thermal insultation.

Modern specialized baby swaddles are designed to make it easier to swaddle a baby than with traditional square blanket. They are typically fabric blankets in a triangle, 'T' or 'Y' shape, with 'wings' that fold around the baby's torso or down over the baby's shoulders and around underneath the infant. Some of these products employ Velcro patches or other fasteners. Some parents prefer a specialized device because of the relative ease of use, and many parents prefer a large square receiving blanket or wrap because they can get a tighter and custom fit and the baby will not outgrow the blanket.

By the time the baby is learning to roll over, often around 4–5 months, parents and caregivers should transition baby from swaddling to a less restrictive covering for sleep. If baby is able to roll over, then it is important for baby to have use of its hands and arms to adjust his or her head position after rolling over.
The traditional swaddling uses flat strings for babies to be tied, care is needed not to tie them too hard or bloodflow would be restricted.

Psychological and physiological effects of swaddling

Modern medical studies of swaddling use a form that is considerably shorter and less severe than the historical forms. The results of such studies are therefore to be understood only as assessments of historical practices. The classical study by Lipton et al. of 1965 dealt with a modern swaddling form. The researchers described the two main effects of tightly wrapping babies: they are motorically calm and sleep much. These effects are detected by means of various psycho-physiological parameters, such as heart rate, sleep duration and duration of crying. The research group around the Dutch biologist van Sleuwen in 2007 confirms this picture in their latest meta-analysis of medical studies on swaddling and its effects. However, severe restrictions on the scope of these studies should be kept in mind, because most of the positive effects mentioned by van Sleuwen et al. are not related to normally developed newborns, but to impaired babies, namely premature babies and cry babies with detectable organic brain damage.
Swaddling enhances the REM sleep (quiet sleep) and also the whole sleep duration.
The effect of swaddling on the regulatory disturbance excessive crying is not very convincing: By adding the swaddling there is an immediate "calming" effect on children, but after a few days the effect of the introduction of regularity with swaddling is exactly the same as the regularity on its own. In other words: after a few days swaddling is completely unnecessary. It is therefore contraindicated to address the potential risk of swaddling, because the effect is only for a short term available, but after a little while is negligible.

Swaddling and motor development

Two studies based on American indigenic cultures did not show a delay in the onset of walking caused by the restraint of the use of the cradleboard. In other areas of the motor development clear delays of the development show up even when mild restrictions take place. Skepticism concerning the allegedly missing effect of swaddling on the onset of walking delivers a Japanese study: the application of the basket cradle (ejiko) leads to a retarded onset of walking. An older Austrian study showed that swaddled Albanian babies were retarded concerning crawling and their ability to reach things with their hands. This shows the need for further substantial scientific clarifying regarding the impairment of motor skills by swaddling.

Swaddling and Sudden Infant Death Syndrome

The effects of swaddling on the Sudden Infant Death Syndrome (SIDS) are discussed controversially. SIDS is the most common cause of death in babies after the newborn period. It is a disorder with unknown causes. As it turned out statistically, that prone sleeping of babies is one risk factor for SIDS, it seemed appropriate to pediatricians to start campaigns for supine sleeping. Subsequently the number of SIDS declined. Swaddling was supposed to keep the babies on their back, in order to prevent SIDS. Swaddling itself is not seen as a protective factor for SIDS. Swaddling even increases the risk when babies sleep in the prone position, it reduces the risk if they sleep in the supine position. A recent study demonstrated now, that swaddling is apparently a risk factor for SIDS, although the opposite was often previously assumed: Of the babies who died of SIDS 24% were swaddled, in the control-groups only 6% were swaddled. Other studies showed that ”heavy wrapping” – a form of swaddling – in connection with infectious diseases also enhances the risk of SIDS. Overall, therefore, several new studies show a significant risk potential of swaddling associated with SIDS.

Empirically proven negative effects of swaddling

There are several empirical studies that clearly demonstrate the negative effects of swaddling.

• Traditional forms of swaddling increase the risk for hip dysplasia.

• Tight swaddling can lead to life-threatening hyperthermia. In the literature, a tragic case is described in which a heavily wrapped child died of hyperthermia.

• In one study, the risk of developing respiratory infections increased fourfold by swaddling.

• A pediatrician found in his sample the flattening of the occipital aspect of the head of babies, who were wrapped tightly and lay in their traditional cradles.

• In the most important contemporary study on swaddling by Bystrova et al., it is shown that this practice is linked with a prolonged recovery from weight loss after birth. A positive effect on the recovery is given by the direct skin-to-skin contact between mother and baby. This result shows the fact that swaddling does not lead to real tactile contact, but only restricts the movements of the baby. The skin-to-skin contact obviously reduces the stress of being born, helps maintaining the body temperature, the mechanical swaddling does not.

• The recent results of an investigation of Bystrova et al. demonstrates that maternal behavior develops weaker under swaddling conditions, reciprocity within the mother-child dyad is reduced.

Tight swaddling today

Swaddling still is distributed worldwide. In some countries swaddling is the standard treatment of babies. In Turkey for instance 93.1% of all babies become swaddled in the traditional way. According to the Human Relations Area Files (HRAF) 39% of all documented contemporary non-industrialized cultures show swaddling practices; further 19% use other methods of movement restriction for infants. Some authors assume that the popularity of swaddling is growing in the U. S., Great Britain and the Netherlands. A British sample showed up 19.4% of the babies are swaddled at night. In Germany swaddling is not used as routine care measure and experiences relatively little acceptance, as the missing mentioning of this practice in the standard work on regulatory disturbances of Papusek shows. Swaddling as a medical intervention with a clearly limited indication range is used in the care practices of premature babies or cry babies with brain-organically provable damage. Also for reducing pain in such care actions as for instance the blood collecting at the heel, swaddling is used. The swaddling of these premature babies (very low birth weight infants, VLBW infants) takes place only very loosely. It is meant to hold the weak arms at the body and make certain movements possible. This "swaddling" is something completely different from traditional swaddling in stretched position.

See also

• Babywearing
  Babywearing
  Babywearing is the practice of wearing or carrying a baby or child in a sling or other form of carrier. Babywearing is far from new and has been practised for centuries around the world...
  
  
• Infant massage
  Infant massage
  Infant massage is a type of complementary and alternative treatment that uses massage therapy for human infants. This therapy has been practiced globally, and has been increasingly used in Western countries as a treatment for infants, though the scientific evidence supporting its use is limited...
  
  
• Infant's binder
  Infant's binder
  An infant's binder is a form of corset for infants. Infant's binders were introduced in the nineteenth century, after swaddling had become unpopular, and were in several forms, shapes and materials in use till well into the twentieth century...
  
  
• Kangaroo care
  Kangaroo care
  Kangaroo care is a technique practiced on newborn, usually preterm, infants wherein the infant is held, skin-to-skin, with an adult. Kangaroo care for pre-term infants may be restricted to a few hours per day, but if they are medically stable that time may be extended. Some parents may keep their...
  
  
• Psychohistory
• Sleeping bag (infant)

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External links

• Swaddling Your Baby, University of Florida/IFAS Department of Family, Youth and Community Sciences
• Swaddling band in The V&A Museum of Childhood
• Terracotta of swaddled infant in Royal Museum of Art and History, Brussels
• 18th Century Baby Swaddling Photo Series, Sharon Ann Burnston