evaluating the effects of swaddling...
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Evaluating the Effects of Swaddling Infants Angeliki Bardis, Lacey Boldt, Julie Davis, Haley Hudson, Courtney Kyzar
Auburn University School Of Nursing
PICOT Question Is it beneficial and appropriate for infants to be swaddled in the
first months of life? This study is significant to nursing practice because it suggests
the need to educate parents on the benefits and risks of swaddling. It is also significant for nursing practice because it
supports the continuation of swaddling.
Review of Literature • Swaddling: A Systematic Review
• (Van Sleuwen, Engelberts, Boere-Booneknp, Kuis, Schulpen & L'Hoir, 2007)
• Level I Evidence • Spontaneous Arousals in Supine Infants While Swaddled and
Unswaddled During Rapid Eye Movement and Quiet Sleep • (Gerard, Harris, Thach, 2002) • Level 3 Evidence
• The Effects of Swaddling on Oxygen Saturation and Respiratory Rate of Healthy Infants in Mongolia
• (Narangerel, Pollock, Manaseki-Holland, & Henderson, 2006)
• Level 2 Evidence • Minimizing the Risks of Sudden Infant Death Syndrome: To
Swaddle or Not to Swaddle? • (Richardson, Walker, & Horne, 2009) • Level 2 Evidence
• Comparison of Pain Responses of Premature Infants to the Heel Stick Between Containment and Swaddling
• (Huang, Tung, Kuo, & Chang, 2004) • Level 3 Evidence
• Swaddling: A Traditional Care Method Rediscovered • (Meyer & Erler, 2011) • Level 2 Evidence
• Does Swaddling Influence Developmental Dysplasia of the Hip?: An Experimental Study of the Traditional Straight-Leg Swaddling Model in Neonatal Rats
• (Wang, Liu, Li, Edmonds, Zhao, Zhang, Zhao, & Wang, 2012)
• Level 2 Evidence
Synthesis The use of swaddling promotes a more quiet sleep, higher sleep efficiency, fewer
sleep stage changes, decreased rate of spontaneous waking, reduced total waking time, lower rates of parental stress and parental abuse, decreased risk of shaken baby syndrome, and reduced risk of SIDS. It's also found that swaddled, supine sleeping infants experience a decrease in arousal during quiet sleep, as well as increased rapid eye movement sleep. Swaddling promotes a comforting environment and leads to lower pain levels. Swaddling does not effect an infant's oxygen saturation. Contrary to the benefits of swaddling, some studies show that swaddling could lead to an increased risk of developmental hip dysplasia.
Recommendations • Due to the various benefits that swaddling offers to newborn infants, including
self-‐soothing, and be9er sleeping pa9erns, infants should be swaddled during the first period of life. Therefore, these provide evidence for this Grade A recommenda@on.
• There is a poten@al risk for developmental dysplasia of the hip in swaddled infants, however there are many benefits to outweigh this risk. Also, other factors, such as breech posi@oning, congenital muscular tor@collis, or posi@ve family history of hip dysplasia are greater risk factors for hip dysplasia than swaddling. Therefore, the sugges@on to avoid the tradi@onal use of swaddling receives a Grade D.
Method When looking for literature related to the effects of swaddling, mul@ple sources provided by the Auburn University Library were used. Most of the informa@on found came from CINAHL, Medline, and Health Source: Nursing/Academic Edi@on. Ar@cles from the past ten years were searched by limi@ng results to publica@on dates between the years of 2003-‐2013, as well as solely scholarly ar@cles. The search began with a broad explora@on of all clinical trials and eventually led to a search for more specific evidence from randomized control trials and evidence based prac@ce ar@cles. Some of the phrases used in the search included basic phrases like “swaddling,” “the effects of swaddling,” “swaddling and premature infants,” and “to swaddle or not to swaddle.” Another source used was Cochrane for informa@on regarding swaddling in rela@on to sudden infant death syndrome. Other sources were not used because the informa@on found was either irrelevant or repe@@ve of the sources already obtained.
Discussion To improve the evidence based
research on the topic of swaddling, more research would help solidify one's decision on the promotion of safe swaddling. More research is needed concerning developmental hip dysplasia and also sudden infant death syndrome due to contradictory studies. Research confirms that babies need to be placed supine when being put to sleep. It is evident that education to a parent is necessary for swaddling to be effective and safe.
APA Reference List: • Gerard, C. M., Harris, K. A., & Thach, B. T. (2002). Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics, 110(6), e70 • Huang, C., Tung, W., Kuo, L., & Chang, Y. (2004). Comparison of pain responses of premature infants to the heel s@ck between containment and swaddling. Journal Of Nursing Research (Taiwan Nurses Associa<on), 12(1), 31-‐40. • Meyer, L. E., & Erler, T. (2011). Swaddling: A tradi@onal care method rediscovered. World Journal of Pediatrics, 7(2), 155-‐160. doi: 10.1007/s12519-‐011-‐0268-‐6. • Narangerel, G., Pollock, J., Manaseki-‐Holland, S., & Henderson, J. (2007). The effects of swaddling on oxygen satura@on and respiratory rate of healthy infants in Mongolia. Acta Paediatrica, 96(2), 261-‐265. doi:10.1111/j.1651-‐2227.2007.00123.x. • Richardson, H., Walker, A., & Horne, R. (2009). Minimizing the risks of sudden infant death syndrome: to swaddle or not to swaddle?. Journal Of Pediatrics, 155(4), 475-‐481. doi:10.1016/j.jpeds.2009. • Van Sleuwen, B., Engelberts, A., Boere-‐Boonekamp, M., Kuis, W., Schulpen, T., & L'Hoir, M. (2007). Swaddling: A systema@c review. American Academy of Pediatrics, 120, e1097-‐e1106. Retrieved from h9p://[email protected]/content/120/4/e1097.full.pdf html • Wang, E., Liu, T., Li, J., Edmonds, E., Zhao, Q., Zhang, L., & Zhao, X., Wang, K. (2012). Does swaddling influence developmental dysplasia of the hip?: An experimental study of the tradi@onal straight-‐leg swaddling model in neonatal rats. Journal Of Bone & Joint Surgery, American Volume, 94(12), 1071-‐1077.