There is a widespread belief that swaddling is an outdated and even dangerous practice for a newborn. We decided to check whether this belief is supported by scientific evidence.

The unsafety, possible or even proven harm of swaddling is described in many articles in Media, blogs, on websites children's clinics and specialized resources for parents. Authors alone publications worries the effect of swaddling on the risk of sudden infant death syndrome (SIDS), others - on the musculoskeletal system. Some perform exclusively against tight swaddling, but do not call for a complete abandonment of this practice (with them jointly, for example, the Ministry of Health of the Krasnoyarsk Territory), other - against swaddling as such, third they insist that swaddling can even be useful.

Swaddling is a very ancient practice. Wrapping a newborn in strips of cloth is likely practiced already in the 4th millennium BC. e. Information about this has survived to this day, for example, in the form of votives - special gifts to deities. Thus, the ancient Romans created votives of swaddled babies and used them to pray for successful pregnancy and childbirth.

Votive of a swaddled baby from the sanctuary of Peciano near Cortona, 3rd–2nd century BC. e. Source: Wikimedia Commons

Ancient doctors explained the benefits of swaddling by the fact that it gives the baby’s body the correct shape. Greek physician Soranus of Ephesus (98 - ca. 138) wrote: “Every part of the body must be bound in accordance with its natural shape, and if anything has been displaced during childbirth, it must be corrected and returned to its natural shape.” He was echoed by Galen (129 - c. 210): “When a baby is born, he necessarily comes into contact with cold and heat and with many bodies that are harder than himself. Therefore, it is appropriate that its natural cover should be best prepared by us for [various] impacts.” Later, in the 15th century, the Italian physician Paolo Bagelardo gave instructions on how to swaddle newborns: “Cover the baby's head with a thin linen cloth in the form of a hood, take another piece of cloth and stretch the baby's arms straight forward to the knees and hips, shaping them evenly so that the baby does not acquire a hunchback... turn the baby on his stomach and, holding his legs, make his soles touch the buttocks all the way to his knees. could have been laid out correctly."

Probably the first against swaddling spoke Swiss physician Felix Wurtz, who lived in the 16th century: “I saw children born straight, but becoming lame and crooked; their mothers or nurses did not leave newborns the way God created them; they wanted to make their children even more beautiful and swaddled them. But when babies are swaddled with tight cloth, they usually grow crooked; and no one will grow more upright in their body than those who are free and whose hands and feet are free.” British physician William Cadogan in the 18th century associated swaddling with the appearance of edema in infants and poor muscle development in adulthood. His compatriot and contemporary William Smellie wrote that swaddling prevents children from breathing and eating normally, and the French philosopher Jean-Jacques Rousseau wrote that it causes psychological harm to newborns: “The child has barely left the womb, he has barely begun to move and stretch his limbs, when he is doomed to new bonds. <…> Where does this unreasonable custom come from? <…> This is one of the vain rationalizations of our false wisdom, which experience has never confirmed.”

The restriction of the freedom of the newborn, in which Rousseau saw the main danger of swaddling, is now, on the contrary, considered the main argument in favor of this practice. Boston Children's Hospital pediatrician Claire McCarthy reports for Harvard Medical School explains: "Swaddling... makes the baby feel as if he is back in the womb or as if he is being held tightly." This calms the newborn and helps him fall asleep. Swaddling works especially well for children who have neurological problems or are experiencing a period of colic, as well as those born to mothers with drug addiction. Similar point of view adheres to and the American Academy of Pediatricians.

However, Australian scientists held an experiment showing that although swaddling promotes sound sleep, it itself carries certain risks. The study involved 27 healthy full-term infants aged three to four weeks. Parents of 15 of them regularly swaddled their children before bed, while 12 others slept without diapers. During the experiment, all children were swaddled and then their sleep was assessed. polysomnography method. The study was repeated when the infants were three months old. It turned out that children who were accustomed to swaddling had arousal thresholds during sleep that corresponded to the population average, but for those who were new to sleeping in swaddles, these thresholds increased significantly. In other words, the former did not wake up from the slightest noise, but their sleep was not particularly sound, but the latter slept almost soundly. The study authors emphasize that an increased arousal threshold increases the risk of SIDS—sudden death from respiratory arrest in a healthy infant. This is the most common cause of death of children aged from one month to one year. Based on the data obtained, scientists concluded that swaddling a child who is not used to it can increase the risk of such a pathology, but there is no harm from it to children who are used to it.

However, not the entire scientific community agreed with this position. Pediatrician Bradley Thuch of the University of Washington noticesthat his Australian colleagues have not experimentally proven the connection between an increased arousal threshold and an increased risk of SIDS. In addition, Thach notes, in their study, the scientists did not divide the children into groups depending on their sleeping position - on their side or on their back. Sleeping on your side, and especially on your stomach, is the main thing. factor risk of SIDS, so swaddling, the pediatrician points out, will help secure the baby in a safe position and thereby reduce the risk of pathology. Based on the sum of the arguments, Tuch draws the opposite conclusion: swaddling during sleep is more useful than dangerous.

However, one of the risk factors for SIDS is overheat bodies. Both Australian scientists and Touch ignore in their reasoning the fact that a diaper is an additional layer of clothing for a baby. Neonatologist and infant sleep expert Michael Goodstein warnsthat overheating is extremely dangerous, so when swaddling you should check from time to time to see if the baby is getting too hot.

Finally, note specialists, swaddling becomes more and more unsafe as the child learns to roll over from side to side and from back to stomach. If a swaddled baby turns over from a position on his back, without support from his arms it will be difficult for him to turn back over. As mentioned above, when sleeping on the side or stomach, the risk of death of a child under one year is higher.

Regarding fearsrelated to the influence of swaddling on the development of the musculoskeletal system, here the expert recommendations are more clear. Tight swaddling with straight legs and locked hips actually increases the risk of developing dysplasia hip joint - a pathology caused by insufficient development of the upper part of the femur or irregular shape of the acetabulum of the pelvic bone. With this disease, the femoral head does not match the shape and size of the socket, which leads to instability in the joint and in the future is fraught with restrictions in mobility, pain and lameness. Pediatric podiatrist Emily Dodwell offers Consider the hip joint as a ball and socket design - the former must fit perfectly into the latter. However, constant restriction of movement retards the growth of the “ball”, and it runs the risk of starting to fall out of the “nest”. At the same time, the orthopedist explains, swaddling itself does not cause dysplasia, but only increases the risk of its occurrence in those children who are already predisposed to pathology due to other factors (for example, genetics or breech presentation of the fetus in the third trimester, in which the legs are significantly limited in movement). About every hundredth child encounters it - when examining a newborn, the pediatrician should notice the problem and send him for ultrasound diagnostics. International Hip Dysplasia Institute writesthat improper swaddling with legs stretched out can contribute to the development of pathology, but if a swaddled child can bend his legs at the knees and pull them towards his stomach, there is nothing dangerous in such a practice.

In 2007, scientists from the University Medical Center Utrecht in the Netherlands published A meta-analysis examining various aspects of swaddling. They were interested in the impact of this practice on the child’s behavior, his physical condition and development, the risk of SIDS and certain diseases. The scientists found that swaddling had no effect on the two aspects they considered - breastfeeding success and the risk of developing rickets. This practice had a positive effect on the duration and depth of sleep, reduced the level of pain and frequency of crying, improved motor development in premature infants, promoted thermoregulation and reduced the risk of SIDS when sleeping in the supine position. However, experts have raised concerns about overheating due to swaddling, an increased risk of SIDS with prone sleep, an increased risk of hip dysplasia with tight swaddling, and a slightly higher risk of respiratory infections due to restricted air circulation. Apparently, the scientists noted, swaddling somewhat slows down weight gain, but, in their opinion, there is nothing dangerous about it. The authors of the meta-analysis emphasized that in general, swaddling is safe and even beneficial if parents follow four rules: the baby should sleep only on his back, the swaddle should not cover his head, his legs should bend freely, and the baby should not overheat.

Similar work a decade and a half later held scientists from the University of Durham in the UK, who focused on the connection between swaddling and the quality of infant sleep. Their findings were similar: the practice increased the amount of restful sleep in swaddled babies, but babies who weren't swaddled from birth may be at slightly higher risk of SIDS, especially when sleeping on their stomachs. In other words, swaddling is safe from the moment your baby is born, but it can be risky for those who have already learned to sleep freely.

The British non-profit organization National Childbirth Trust, specializing in promoting an evidence-based approach to pregnancy, childbirth and parenthood, gives clearer timing: swaddling is safe if it is practiced from birth until the moment when the baby can roll over (usually this happens between the fourth and seventh month of life). At the same time, experts advise that you should not start swaddling a child who has already reached the age of two or three months. The National Childbirth Trust stresses that in any case, a swaddled baby's legs should move freely and his body should not overheat.

Thus, there is no definite answer whether swaddling is beneficial or harmful. On the one hand, it calms the child and improves his sleep, and also fixes him in a safe position. On the other hand, if the baby already knows how to roll over, then in a diaper he will be able to roll over from his back to his side or even his stomach, but not back, and this is fraught with an increased risk of SIDS. Therefore, once the baby develops this skill, experts advise stopping swaddling and not swaddling children at all who have not been accustomed to it since birth. From the point of view of orthopedics, everything is clearer: swaddling does not harm if the baby can bend his legs at the knees and press them to his stomach. To follow this recommendation, it is enough to swaddle the upper limbs tightly, but loosely the lower ones.

Cover image: Engin Akyurt from Pixabay