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The Great Swaddling Debate

As parents, we can never get enough of sleep solutions for newborns. If you've ever taken a look at the DVD, book, website or YouTube site for Dr. Harvey Karp's The Happiest Baby on the Block, you have learned the value of swaddling a newborn to get that little squirmer down for the night. You've also been schooled in the "arms down to his side" snug wrap method, and may have used it to some success. And that's why I was surprised when both my baby boys were handed to me in the hospital, swaddled with their arms out, free to wave hello.

Once we were home, I scrapped the hospital's method and swaddled my baby arms-in, but I felt anxious and couldn't sleep, myself. I peered over the bassinet, terrified he'd smother. It gnawed at me: Was I endangering my newborn?

To find out what in the heck was going on, I called three experts to get the current scoop in the world of pediatrics on swaddling.

Naturally, my first stop was Dr. Karp, a natural sympathizer, “Parents are understandably confused about how to best protect their babies,” he says. “We want kids to sleep on their back to prevent SIDS, but babies often cry and wake up more unless they are snuggly swaddled. Swaddling arms-out is worse than doing nothing, it actually makes babies cry more!” A recent study in New Zealand showed that swaddled babies had a 30 percent less chance of SIDS, something to consider here in the United States. Since 1992’s “Back is Best” campaign, SIDS has decreased by 50 percent in the United States. Swaddled babies placed on their stomachs are actually at a higher risk of SIDS according to a review last year by the American Academy of Pediatrics, so placing baby on her back is key.

It seems everyone is in agreement that swaddling soothes babies, and that they look really cute wrapped up like caterpillars. So why do some experts caution against it completely, while others suggest swaddling some babies and not others? It seems the very reasons swaddling helps some parents (less crying and more sleep) worries some experts.

Dr. Paul Fleiss, a pediatrician in Los Angeles came out as strongly opposed to routine swaddling recently on Mothering.com: “You can say swaddling works; it stops the baby from crying. But because something works doesn’t mean it’s a good thing to do. I tell parents not to swaddle, ever. When a baby is crying, he’s saying where’s my mommy? He’s not saying, wrap me up real tightly. He should be put to the breast, he should be talked to, sung to, held, loved.”

RELATED: 10 Ways to Calm a Constant Crier

Other concerns include baby overheating, and baby sleeping through the night and missing a night feeding. The solution is simple, Karp explains: “I recommend bulking up feedings during the day, and monitoring your baby’s weight gain with your pediatrician.” Also, wrap your bean with a lightweight cotton blanket, count it as one layer of dress, and keep your eye on that thermostat: The room should be neither too hot, nor too cold."

Some parents and physicians are concerned about hip dysplasia, a mostly hereditary condition which affects two to three in every one thousand babies born worldwide, according to the International Hip Dysplasia Institute. Dysplasia means the bones of the hip joints are not aligned correctly. To prevent hip dysplasia you should swaddle your baby’s legs loosely, so she can bend her knees. Although no reports of hip dysplasia as a result of swaddling have been reported in the U.S.; countries in Asia swaddling a baby’s legs tightly to a board have a much higher rate of this problem. Susan Pappas, spokesperson for the IHDI, says, “Unfortunately, in this country, no one has kept statistics on how many swaddled babies have gotten hip dysplasia. We have been conducting research for the past two years in seven sites in the U.S. on babies with hip dysplasia. Hopefully, in the near future, we will have this kind of information.”

Parents who want to swaddle shouldn’t worry—it’s easy to learn the proper steps. “Hip-safe swaddling is pretty easy, just wrap the arms tight but allow the legs to be loose enough to bend the hips and knees,” Karp says. While Karp believes crying babies wish to be swaddled during nap time as well as through the night, Dr. William Sears, author of The Baby Book, has a slightly varying opinion: “Mothers are extremely adept at reading their babies, and become so almost immediately if they do rooming-in at the hospital and observe their newborns. Some babies might like to be swaddled arms-in every night, others arms-out, and others not at all.”

In the end, my curiosity got the better of me and I called my hospital to find out where they came up with the arms-out idea. I spoke with the head doctor of the nursery at Morristown Medical Center in New Jersey, Dr. Mary Anne LoFrumento, also the author of Simply Parenting: Understanding Your Newborn and Infant. “We don’t have an official policy about swaddling the 4,000 babies that are in our nursery per year,” she said. “The nurses feel that if the baby’s arms are out, they can better tell if it’s spit up, or wants to move around.” She, like Sears, believes it’s up to the baby whether it wants to be swaddled arms-in or arms-out: “If baby was in the womb with her fingers in her mouth all day long, she’s going to want to have the freedom to suck on her fists when she’s born. Breech babies, or babies in utero with arms at their sides will probably love being swaddled that way.” She went on to say whatever way you swaddle your baby, the most important guard against SIDS is to keep excess blankets and stuffed animals out of the crib.

You’ll know pretty quickly whether your baby likes swaddling or not. It helped my two boys sleep longer, which I feel kept me slightly more sane. Like any advice from experts, moms should pick and choose what works best for their family.

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