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Variation in Neonate Swaddling Techniques

Fletcher, Laura, BA; Pham, Tammy, BA; Bar, Sari, DO; Li, Diana, NP; Spinazzola, Regina, MD; Papaioannou, Helen, MD; Milanaik, Ruth, DO

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000506
Original Research

Background: It is common practice for healthcare practitioners to swaddle infants in newborn nursery and neonatal intensive care unit settings. Despite the widespread use of this practice, the American Academy of Pediatrics neither bans nor recommends swaddling. To date, there has been no standard protocol developed for either healthcare professionals or parents to establish optimal swaddling techniques in terms of infant arm positioning, infant leg positioning, and tightness of wrap.

Purpose: To evaluate the variability in swaddling techniques used for infants in the newborn nursery and neonatal intensive care unit.

Methods: Across 2 pediatric hospitals, the swaddling positioning of each open-crib infant in the newborn nursery and neonatal intensive care unit was examined. For each infant, the following data were collected: gender, left and right arm position, left and right leg position, and tightness of wrap.

Results: In total, 132 swaddle observations were recorded. There was significant variability in swaddling positioning of arms and legs. The most common combination of arm/leg positioning was “mixed arm positioning” and “both legs flexed” (25.0% of all observations). In 9.1% of cases, tightness of wrap around chest was “tight,” and in 30.3% of cases, tightness of wrap around legs was “tight.”

Implications for Practice: There was a large variability in swaddling positioning of both arms and legs. For such a widespread practice, the lack of medical guidelines results in inconsistent, and potentially harmful, positioning. Parents and healthcare professionals would benefit from specific, research-driven guidelines regarding proper swaddling techniques.

Implications for Research: Different variations on swaddling should be evaluated for consideration of best practice swaddling.

Division of Developmental and Behavioral Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park (Mss Fletcher, Pham, and Li and Drs Papaioannou, Milanaik); Neonatal-Perinatal Medicine, North Shore University Hospital, Manhasset, New York (Dr Spinazzola); and University of Texas Southwestern Medical Center, Dallas (Dr Bar).

Correspondence: Ruth Milanaik, DO, Division of Developmental and Behavioral Pediatrics, Northwell Health Cohen Children's Medical Center of New York, 1983 Marcus Ave Ste 130, Lake Success, NY 11042 (RMilanai@northwell.edu).

The authors have declared no conflicts of interest.

© 2018 by The National Association of Neonatal Nurses