Swaddling...arms out or in???

Specialties Ob/Gyn

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Do you swaddle with arms up or down? We have been swaddling with them out. Some are still swaddling with them in.

We are looking for some evidence based research on the subject...

Specializes in NICU.
we mostly swaddle with arms in- there are always some babies who like to have their arms up & out but most seem so much more secure with their arms swaddled in. I don't know what the SIDS foundation says, but last spring my workplace had us all attend a day-long perinatal conference. The NNP who spoke mentioned that the new SIDS guidelines for sleep were "back to sleep, feet to foot": baby on their back (of course) but instead of swaddling, with their feet at the foot of the crib and a single blanket tucked across the chest/arms out and into the sides of the crib mattress to keep the head/face uncovered.

But, we still swaddle.

Babies that would sleep on their backs with their arms over their heads are usually a few months old. I've seen photos of babies tucked in at the foot of a crib, and they are not newborns. Mine slept in a bassinet by my bed for the first four months, anyway. Most newborns sleep better swaddled, and I prefer to have newborns on their sides, especially just after a feeding. They are not capable of turning their heads to the side if they throw up. I don't like to see a baby trying to aspirate!

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We promote "skin-to-skin" at our hospital and putting the baby to breast right after delivery, too... I just find it sometimes when a baby is super fussy to swaddle them in for a little bit to calm them down. As much as we encourage mom's to feed at least 8-12 times a day, there are some mom's that only want to and even insist that they feed only on demand. By the time the baby wakes up, the baby is frantically hungry and sometimes even holding skin-to-skin doesn't always help.

Many babies do not feed 8-12 times at first. Research shows that the average baby only feeds 4.3 times in the first 24 hours. That second day is when they come to the party more.

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Babies that would sleep on their backs with their arms over their heads are usually a few months old. I've seen photos of babies tucked in at the foot of a crib, and they are not newborns. Mine slept in a bassinet by my bed for the first four months, anyway. Most newborns sleep better swaddled, and I prefer to have newborns on their sides, especially just after a feeding. They are not capable of turning their heads to the side if they throw up. I don't like to see a baby trying to aspirate!

"Back to Sleep" is the AAP's recommendation: no longer side sleeping. Putting them on their backs is the recommended way for SIDS prevention.

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"Back to Sleep" is the AAP's recommendation: no longer side sleeping. Putting them on their backs is the recommended way for SIDS prevention.

I know that is the recommendation but I am like Mimi - propping them on their sides seems smarter to me when there is a risk for aspiration.

We did the co-sleeping thing with all our kids - actually our toddler is still co-sleeping. :)

We swaddle with arms in. Seems to comfort them more. Plus their little hands are out of the way for nursing.

steph

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I know that is the recommendation but I am like Mimi - propping them on their sides seems smarter to me when there is a risk for aspiration.

We did the co-sleeping thing with all our kids - actually our toddler is still co-sleeping. :)

We swaddle with arms in. Seems to comfort them more. Plus their little hands are out of the way for nursing.

steph

Actually, babies should be unwrapped and skin to skin for nursing:especially when they are just learning.

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Specializes in OB.
Many babies do not feed 8-12 times at first. Research shows that the average baby only feeds 4.3 times in the first 24 hours. That second day is when they come to the party more.

Yes, I'm aware that babies are sleepy the first 24 hours. I'm not saying that it's always feasible to breastfeed that many times the first day, but we encourage feeding the baby 8-12 times a day to bring that milk in. Our couplets are usually with us for a few days anyway... might as well teach them the right thing off the bat. Skin to skin is always encouraged when breastfeeding and PRN. Now back to the OP about swaddling...

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Specializes in NICU.
I guess they think demand means whenever the baby wakes up screaming for food!

But isn't that exactly what feeding on demand is? If the baby is sleeping, he isn't demanding anything. When we have babies on our unit that are feeding "on demand" we don't wake them up, we let them tell us when it's time to eat. Otherwise they're on scheduled feeds. Is it any different with breastfeeding moms? I just always thought "demand" was demand.

We swaddle babies with their arms inside the blanket, but with the hands up near their faces. The only kids we swaddle with the arms down are vented and trying to extubate themselves. Some nurses swaddle them with their arms out of the blanet - like swaddled from the waist down only, really - but they always seem to be flailing those arms around, so it's like that kind of swaddling is pointless for comfort and security. I do think for SIDS prevention they recommend swaddling like that so the blanket isn't near the baby's face. I tell parents that at home, they really should just dress the baby in a sleeper to stay warm and skip the blanket altogether, just to be safe.

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Quote:

Originally Posted by baby&mommynurse

I guess they think demand means whenever the baby wakes up screaming for food!

But isn't that exactly what feeding on demand is? If the baby is sleeping, he isn't demanding anything. When we have babies on our unit that are feeding "on demand" we don't wake them up, we let them tell us when it's time to eat. Otherwise they're on scheduled feeds. Is it any different with breastfeeding moms? I just always thought "demand" was demand.

Crying is a late sign of hunger. We teach our parents to watch for & respond to early signs of hunger such as rooting or when baby is bringing his/her hands to the mouth to try to suck on them. That is what breastfeeding on demand should be. In my experience breastfeeding is much more successful when babies go to breast when they are showing these early signs of readiness; waiting until a baby is screaming and frustrated rarely benefits anybody.

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Specializes in Pediatrics, Nursing Education.
Crying is a late sign of hunger. We teach our parents to watch for & respond to early signs of hunger such as rooting or when baby is bringing his/her hands to the mouth to try to suck on them. That is what breastfeeding on demand should be. In my experience breastfeeding is much more successful when babies go to breast when they are showing these early signs of readiness; waiting until a baby is screaming and frustrated rarely benefits anybody.

From what I have seen, this is true. It is so much harder to get an inexperienced baby to latch on if it is so hungry it has started to cry. We always teach our mom's the signs of hunger right away.

In response to the swaddling issue... I usually always swaddle with arms against the belly in the blanket. I thought that was the whole point of "swaddling"... to wrap the baby up with it's extremities to the body for both warmth and comfort.

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Specializes in OB.
But isn't that exactly what feeding on demand is? If the baby is sleeping, he isn't demanding anything. When we have babies on our unit that are feeding "on demand" we don't wake them up, we let them tell us when it's time to eat. Otherwise they're on scheduled feeds. Is it any different with breastfeeding moms? I just always thought "demand" was demand.

Not trying to turn this post into a breastfeeding issue, but... Crying is a late sign if hunger as palesarah and jeepgirl mentioned. Which is why we teach mom's to recognize the early signs of hunger. We also encourage mom's to breastfeed 8-12 times a day or wake their baby up if the baby has been sleeping more than 4 hours, so that 1) they get the practice 2) the baby isn't super, frantically hungry making it harder for latching on and 3) by putting the baby to breast even if the baby isn't latching on or still sleepy because that's stimulation for the milk to bring the milk in. Maybe it's different in the NICU because the mom isn't there all of the time?

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Specializes in NICU.
In response to the swaddling issue... I usually always swaddle with arms against the belly in the blanket. I thought that was the whole point of "swaddling"... to wrap the baby up with it's extremities to the body for both warmth and comfort.

From a developmental point of view, the purpose of swaddling is to provide boundries to remind the baby of being in utero, and in utero they usually have their hands up near their face. It's very comforting to have their hands midline like that, right near their mouth. I personally hate swaddling with arms down, we call it "mummifying" instead of swaddling in our NICU, and like I said, usually save it only for large, intubated babies.

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Specializes in NICU.
Not trying to turn this post into a breastfeeding issue, but... Crying is a late sign if hunger as palesarah and jeepgirl mentioned. Which is why we teach mom's to recognize the early signs of hunger. We also encourage mom's to breastfeed 8-12 times a day or wake their baby up if the baby has been sleeping more than 4 hours, so that 1) they get the practice 2) the baby isn't super, frantically hungry making it harder for latching on and 3) by putting the baby to breast even if the baby isn't latching on or still sleepy because that's stimulation for the milk to bring the milk in. Maybe it's different in the NICU because the mom isn't there all of the time?

It's a whole lot different in the NICU. We never wake up "on demand" babies to eat, unless they've been losing a lot of weight. Of course if a mom is always with her baby, holding it or next to it, she's going to see the very early signs of hunger. But if they're in a busy nursery, it's quite different. The squeaky wheel gets the oil. But in the NICU, we usually value SLEEP over anything. If the baby is eating well and gaining weight, we would never wake them, especially at night, because sometimes sleep can be hard to come by. Especially with preemies - they seem to grow better if they aren't woken up all the time, as growth hormone is secreted when they sleep. As far as early signs of hunger, we do notice when a baby wakes up, but we usually wait a little bit to see if he's really hungry, because NICU babies tend to fall asleep pretty early in a feeding if they weren't really "up" yet.

It's a whole other world - healthy mom always with her breastfeeding newborn compared to a NICU baby eating on demand. I don't think either way is wrong, just very different.

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