Does Swaddling Reduce Excessive Crying in Infants?
Does Swaddling Reduce Excessive Crying in Infants?
Van Sleuwen BE, L'Hoir MP, Engelberts AC, et al.
J Pediatr. 2006;149:512-517
This study tackled a long-vexing infant condition -- excessive crying and what to do about it. The authors contend that stimulus reduction and allowing infants to fall asleep in their cribs holds more promise than active interventions to quiet an infant, such as holding or rocking.
This study compared outcomes of 2 modes of an intervention to reduce crying (the baseline intervention with and without swaddling). The authors defined a child with excessive crying as one who cried for more than 3 hours in a 24-hour period on at least 3 days per week. During a run-in period of 1 week, infants and mothers (if breastfeeding) were fed a hypoallergenic diet in an attempt to identify infants with excessive crying due to allergic disorders. Those infants with improvement in crying scores during the run-in were excluded from the study. The randomized infants and mothers reverted to their usual diets after the 1-week run-in.
Subjects were infants under 13 weeks of age, of at least 32 weeks gestational age at delivery, and who met the definition of excessive crying. The intervention consisted of a set pattern of care -- sleep, then feeding, followed by interactive play with the infant, then alone awake time. When the infants demonstrated signs of being tired, parents were to place the infant into bed. In addition to the set pattern, one group added swaddling of the infant when put down to sleep. Parents completed symptom diaries daily for the first 7 days of the intervention, then recorded in the diary 1 day per week for the remaining 11 weeks.
Three hundred ninety-eight (398) infants remained in the randomization after the hypoallergenic run-in period. During the baseline week, infants cried or were fussy on average for 4.37 hours per day. For the entire group, the type of intervention (with or without swaddling) did not influence duration of crying or fussiness. However, infants younger than 8 weeks did benefit from the addition of swaddling, but the older infants did not. The authors conclude that swaddling may offer modest benefit to young infants, but not to infants older than 8 weeks. On average, all infants experienced decreased crying and fussiness over the 12 weeks of the study follow-up period.
Well, telling parents not to swaddle their infants may be as futile as pouring a bucket of water in the ocean, but at least now you know the evidence! However, I'm disappointed in the lack of a true control group. Given the considerable disagreement in this country on whether set schedules are helpful or harmful to infants, the current study is not able to say that the intervention worked at all! The investigators cannot prove, for example, that the improvements noted in the 2 groups were not solely due to aging of the infants. One can conclude that time helps, and this fact alone may offer some comfort to frazzled parents.
Abstract
Van Sleuwen BE, L'Hoir MP, Engelberts AC, et al.
J Pediatr. 2006;149:512-517
This study tackled a long-vexing infant condition -- excessive crying and what to do about it. The authors contend that stimulus reduction and allowing infants to fall asleep in their cribs holds more promise than active interventions to quiet an infant, such as holding or rocking.
This study compared outcomes of 2 modes of an intervention to reduce crying (the baseline intervention with and without swaddling). The authors defined a child with excessive crying as one who cried for more than 3 hours in a 24-hour period on at least 3 days per week. During a run-in period of 1 week, infants and mothers (if breastfeeding) were fed a hypoallergenic diet in an attempt to identify infants with excessive crying due to allergic disorders. Those infants with improvement in crying scores during the run-in were excluded from the study. The randomized infants and mothers reverted to their usual diets after the 1-week run-in.
Subjects were infants under 13 weeks of age, of at least 32 weeks gestational age at delivery, and who met the definition of excessive crying. The intervention consisted of a set pattern of care -- sleep, then feeding, followed by interactive play with the infant, then alone awake time. When the infants demonstrated signs of being tired, parents were to place the infant into bed. In addition to the set pattern, one group added swaddling of the infant when put down to sleep. Parents completed symptom diaries daily for the first 7 days of the intervention, then recorded in the diary 1 day per week for the remaining 11 weeks.
Three hundred ninety-eight (398) infants remained in the randomization after the hypoallergenic run-in period. During the baseline week, infants cried or were fussy on average for 4.37 hours per day. For the entire group, the type of intervention (with or without swaddling) did not influence duration of crying or fussiness. However, infants younger than 8 weeks did benefit from the addition of swaddling, but the older infants did not. The authors conclude that swaddling may offer modest benefit to young infants, but not to infants older than 8 weeks. On average, all infants experienced decreased crying and fussiness over the 12 weeks of the study follow-up period.
Well, telling parents not to swaddle their infants may be as futile as pouring a bucket of water in the ocean, but at least now you know the evidence! However, I'm disappointed in the lack of a true control group. Given the considerable disagreement in this country on whether set schedules are helpful or harmful to infants, the current study is not able to say that the intervention worked at all! The investigators cannot prove, for example, that the improvements noted in the 2 groups were not solely due to aging of the infants. One can conclude that time helps, and this fact alone may offer some comfort to frazzled parents.
Abstract
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