Swaddling...arms out or in???

  1. 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...
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    About USA987, BSN

    Joined: Aug '99; Posts: 879; Likes: 76

    23 Comments

  3. by   Mimi2RN
    The only time I would leave the arms up, it would be to facilitate hand to mouth comfort. The baby would still be bundled.

    We also position the arms upward on prone babies, but they aren't usually bundled.
    Last edit by Mimi2RN on Apr 14, '05
  4. by   lady_jezebel
    As a nurse, I work with adults... but as a mom with a 5 month old, I've found that he still likes to be swaddled with his arms in. It makes him feel secure. When his arms are out, they swing around sometimes in a haphazard manner (even though he sucks on his fingers during the day, when not swaddled).

    As for up or down, the book "happiest baby on the block" (not exactly "evidence based research", though he's an MD relying on experience & research) recommends down -- it's harder for the baby to escape the swaddle that way. Eventually they move their arms to the midsection, anyway.
  5. by   suzanne4
    We swaddle with arms in to prevent extubation (if radiant warmer is not needed).............even after extubation, they still get swaddled with arms in............
  6. by   SmilingBluEyes
    I dont know of any "evidence-based" practices regarding swaddling of healthy newborns, but as a rule I swaddle them with their arms in a TIGHT blanket. Most like it this way. Those who wriggle out, will find a way and I don't kill myself to repeatedly swaddle them arms-in after that point.
  7. by   baby&mommynurse
    I usually swaddle with arms in. Not pinned down to the baby's sides (and I've seen some nurses do this), but relaxed to the midsection. I agree with Deb... most seem to like it that way. Just like being back in utero and a nice comfy, tight space. But some will wiggle their way out of the blanket. If they do, I'll from then on just swaddle with their arms out. Swaddling newborns also helps with breastfeeding when they are fussy and their arms get in the way.
  8. by   USA987
    Thanks for the thoughtful input. We have a nursery nurse who insists that the SIDS Foundation states the arms should be up....but I have yet to find any literature to back that up!
  9. by   SmilingBluEyes
    Hmm maybe we should check w/the SIDS foundation then, for that literature. I would be really interested to know if something I have been doing is wrong.

    I always just swaddle them after they get into their "natural position", usually w/arms at sides or curled up by shoulders. I never pull them against their will to swaddle. I have to say, most newborns do not sleep w/arms up by the head and out of blankets. And where I work, we encourage skin-to-skin at breast as much as possible, so swaddling is not a huge issue in that case. If baby is in bed w/mom we just have baby at mom's skin.

    I am curious about that literature though, so I am going to do some research. Thank you for the food for thought. I am always interested in updating to keep up with the latest, best practices!
    Last edit by SmilingBluEyes on Apr 15, '05
  10. by   palesarah
    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.
  11. by   baby&mommynurse
    Quote from SmilingBluEyes
    Hmm maybe we should check w/the SIDS foundation then, for that literature. I would be really interested to know if something I have been doing is wrong.

    I always just swaddle them after they get into their "natural position", usually w/arms at sides or curled up by shoulders. I never pull them against their will to swaddle. I have to say, most newborns do not sleep w/arms up by the head and out of blankets. And where I work, we encourage skin-to-skin at breast as much as possible, so swaddling is not a huge issue in that case. If baby is in bed w/mom we just have baby at mom's skin.

    I am curious about that literature though, so I am going to do some research. Thank you for the food for thought. I am always interested in updating to keep up with the latest, best practices!
    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.
  12. by   palesarah
    Quote from baby&mommynurse
    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.
    sounds like those moms aren't really feeding on demand, does it?
  13. by   baby&mommynurse
    Quote from palesarah
    sounds like those moms aren't really feeding on demand, does it?
    I guess they think demand means whenever the baby wakes up screaming for food!
  14. by   Mimi2RN
    Quote from palesarah
    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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