Swaddling...arms out or in???

Mimi2RN, ASN, RN · Apr 15, 2005

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.

lady_jezebel · Apr 15, 2005

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.

suzanne4, RN · Apr 15, 2005

We swaddle with arms in to prevent extubation (if radiant warmer is not needed).............even after extubation, they still get swaddled with arms in............

SmilingBluEyes · Apr 15, 2005

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.

baby&mommynurse · Apr 15, 2005

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.

USA987, MSN, RN, NP · Apr 15, 2005

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!

SmilingBluEyes · Apr 15, 2005

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!

palesarah · Apr 15, 2005

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.

baby&mommynurse · Apr 15, 2005

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.

palesarah · Apr 16, 2005

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?

baby&mommynurse · Apr 16, 2005

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!