How Swaddles, SNOOs & Swings Can Sabotage Breastfeeding
Over the past 10 years we’ve seen an incredible rise in the frequency, duration, and intensity of infant swaddling practices. Unfortunately, the amount of time babies are spending constrained in swaddles, swings, and other containers is wreaking havoc on infant feeding and development. It might even be behind the recent dip in breastfeeding rates.
Until recently, it was common to wrap (“swaddle”) a baby in a blanket intermittently during the first week or so as they were adapting to life outside the womb. This practice was usually abandoned fairly quickly as the increasingly strong baby kicked and wiggled their way out of the blanket burrito. With the past 10 year’s rising popularity of books and programs promoting extended swaddling, genius (or opportunistic?) product developers invented tight fitting wearable swaddles that could be zipped, velcroed and secured in place - long past the age of kicking the blanket off. As a result, many babies are now swaddled for months instead of days or weeks. Since infants usually sleep 14-18 hours per day, they are often spending more time in swaddles than out of them.
Add to this, we live in a culture teaming with infant gear. Many babies are placed in containers of some sort such as swings, rock-n-plays, bouncer seats, loungers, and car seats when they aren’t swaddled. They are moved from one movement-constraining container to the next.
We would like to draw attention to a few ways the excessive use of containers is having unintended consequences for infants and specifically infant feeding:
Limiting Baby’s Ability to Communicate - Reducing Feeds
Infants tell caregivers what they need by using “cues,” a form of body language (like sign language) that communicates when they are hungry, tired, or need soothing. This communicate-and-respond interchange is especially crucial for the success of breastfeeding as healthy babies are experts at self regulating their intake. Every major health organization recommends feeding infants in response to their feeding cues which includes putting hands to mouth, turning head side to side, opening and closing mouth, fidgety body movements, clenched fists, and moving their upper body towards the breast/parent. Note that crying is not considered a feeding cue, as it is instead a sign of distress after hunger has built up for a prolonged period. Many babies do not cry until they have been hungry for about an hour, after having tried to communicate their hunger for about an hour or having slept through the early stages of their hunger. Repeatedly delayed feeds often results in slow weight gain and reduced milk supply.
So what does this have to do with swaddling? When an infant is swaddled, they are unable to express their most basic ability to communicate because their hands, arms, and bodies are restrained from using their native language of movement. Parents will not “see” the feeding cues, until the baby has been hungry long enough to start crying.
Additionally, when babies are swaddled during sleep they tend to feel as though they are back in the womb. In the womb, they were continuously cord-fed whether they were awake or asleep. Developmental progression demands that babies be adept at waking up and communicating when they are hungry, unlike during fetal development. However, swaddling often overrides this instinct as it feels like they are back in a womb-like environment that allowed passive feeding while they slept.
Studies demonstrate that swaddling reduces the frequency of feeds and slows infant weight gain. We can confirm in our practice that a surprising number of babies who are swaddled are underfed as a result of insufficient number of feeds (most newborns need 8-12 feeds per 24 hours and most older babies average 7-10 feeds). Although long stretches at night might sound like a new parent's dream, frequent feeding is the number one key to successful breastfeeding because it supports milk supply, infant growth, and responsive parenting. In order to fully implement the recommendation to feed in response to infant cues, infants need to be capable of expressing their cues without masks or restraints. This interaction between parent and infant: baby “talking,” parent responding - forms an absolutely essential foundation of love, trust, and connection.
Limiting Baby’s Range of Movement - Tightness
The second way that swaddling, SNOOs, and container use can effect breastfeeding outcomes is by causing babies to have significant muscle and fascia tightness and limited range of motion. Imagine if your ability to bend, stretch, move your arms, or generally wiggle was limited most hours of the day. Maybe think about the longest flight/car ride you’ve ever been on and how you felt afterwards, or, if you’ve ever had to wear a sling or brace what that was like. Once you were finally out of it, you might have difficulty stretching or moving as well and feel stiff. Compare that to how you feel after finishing a yoga class or a good exercise routine with lots of movement. Infants who spend several hours a day with their movement limited often develop significant muscle and fascia tightness that limits their range of movement. This is in contrast to babies who are held most of the day (holding allows more variety of movement than a swing/bouncer seat/swaddle/car seat) and given lots of opportunities to wiggle on flat surfaces like a mattress, floor, or even next to their parent on the sofa.
Because muscles and fascia interconnect throughout the body, tightness anywhere in the body can often result in a dramatically different suck pattern and ability to latch well or position comfortably at the breast. The baby might look rigid and uncomfortable held in cradled/breastfeeding positions, or tuck their chin down to their chest (a typical position for a baby in swing or bouncer seat) when trying to nurse, block the breast with their tight t-rex arms, or be unable to move their tongue and jaw well due to neck tightness. Additionally, we have noted babies who have had tongue-ties released are much more likely to experience reattachment if they have generalized tightness. Babies are supposed to be able to use their bodies to latch well - incorporating both reflexive and intentional movements to wrap their bodies around their mother’s body, gently hold the breast between their hands, move their upper bodies towards the breast when they are ready to latch, and tip their head back to make space for a wide open mouth and deep swallows. All of this (and more) is very difficult for baby struggling with stiffness. It comes much more easily to a baby who is loose, limber and practiced at freely moving their bodies on a blanket, mattress or parent’s arms.
Limiting Baby’s Opportunities to Play - Developmental Delays
Over time, the lack of opportunities for baby to move, play and explore their bodies (day or night) combined with the discomfort of tight muscles and fascia is causing more and more babies to experience developmental delays and head shape issues. Did you know that each time an infant startles and throws their arms up and legs out it maps their body parts and their movement in their brain, creating the well worn paths needed for this movement to become intentional instead of reflexive? If a baby is prevented from expressing this reflex, it will last many months longer compared to a baby who has been naturally and frequently “starting themselves.” Don’t let an infant’s natural reflexes stop you from placing them on their backs unswaddled or playfully moving them around. Infant reflexes such as the startle reflex only go away (“integrate”) when they have been activated a certain number of times.
Infants who get lots of movement and play time on flat surfaces are less tight, integrate their reflexes sooner, and are more comfortable during tummy time. We have noted that babies who are not swaddled and rarely placed in containers often start to self-latch to the breast by 2 months and roll by 3 months. Mothers really appreciate when infants master the ability to independently latch to the breast without needing a lot of extra guidance and support. The more infants master physical development the better they get at breastfeeding. Gross and fine motor development also impacts when infants are ready to start solid foods, crawl, walk and many more important milestones down the road.
Alternatives that Support Happy Babies & Happy Parents
We understand the idea of not swaddling or packing up your infant gear might sound scary or foreign. However, we have worked with hundreds of families who have found alternatives that are actually easier for everyone and promote happy, healthy infant development.
Our first suggestion, is to swaddle as little as possible (or not at all) in the beginning. If you do decide to swaddle, use a linen blanket or a swaddle that allows room for movement (or arms out). Use it only at night and only until your baby is sleeping 3+ hour stretches. As soon as your baby starts sleeping longer stretches at night (3+ hours), discontinue use. If you need sleep support, take a look at the Isla Grace sleep information, our articles on the topic, and schedule a consult with us. There is so much wonderful, supportive sleep information available we couldn't possibly cover it all in this article.
Second, use a stroller that has a flat bassinet bottom instead of car seat attachment so your baby isn’t spending more time than necessary constrained the car seat. Although car seats are the safest option in vehicles, they put babies into a very non-ideal C shape that limits range of motion in almost every direction. Once you get to your destination, let baby move and stretch!
Finally, return or give away your infant swings, bouncer seats, and nest shaped lounge pillows. We promise, you really don’t need them at all. Instead, when you need to put your baby down during the day use a flat bottomed lounger like a Doc-A-Tot, pack-n-play, or a simple blanket on the floor. Most babies love to play on their backs when they are well rested and well fed, and enjoy the opportunity to wiggle, stretch, and activate their reflexes. The younger you start the better. Although it might seem countercultural, putting your baby down on the floor can become a really comfortable habit once you see how much your baby enjoys and benefits from it. A cushioned mat may help, and if you have a lot of pets or other children you are concerned about, consider getting a playpen to provide a nice boundary. Incorporate high contrast toys, cardboard books, or visual cards. Both tummy and back play is helpful, so when your baby gets tired of one position assist them rolling to the other by rotating them at the hips to flip back and forth. Alternating between tummy, side, and back play helps them build stamina and utilizes different reflexes and muscles groups. Think of it like doing reps at the gym! For newborns, tummy time on parent’s chest is ideal while they are tiny, but don’t wait more than a few weeks to start trying tummy time out on the floor, too. We love it when families build floor play into the daily routine after every nap. You’ll discover so many benefits - a happy baby who enjoys being put down on the floor, better milestone achievement, less head shape issues, improved breastfeeding ability, and less awkward baby gear taking over your house!