The impact of swaddling upon breastfeeding: A critical review

New study published 14th February found infants swaddled immediately after birth show a delay in initial breastfeeding, less successful suckling at the breast, reduced intake of breastmilk and greater weight loss compared to un-swaddled babies. 

Swaddling visually obscures feeding cues and reduces crying, thereby eliminating two key feeding prompts typically used by parents/carers.

As swaddled babies cry less, and are fed less frequently than un-swaddled babies some clinical trials position swaddling as a ‘novel weight regulation tool’ to combat obesity. However, in the case of breastfed babies, by reducing feed frequency swaddling may impede maternal milk production and thereby infant growth.

Whether swaddling is beneficial for some babies, for instance those that are premature and tube-fed, remains unknown. However, for healthy full-term infants, the potential for swaddling to undermine breastfeeding is a cause for concern. Few studies have examined the direct relationship between swaddling and breastfeeding; those that have overlook important contextual variables necessary to draw firm conclusions. There is insufficient evidence from randomized trials or observational studies to inform robust recommendations. However, any recommendations about swaddling should take into account its potential to undermine breastfeeding given its role in impeding skin-to-skin contact, separating mother and infant bodies, supressing and obscuring early infant feeding cues, preventing optimal feeding positioning and active infant engagement in feeding, interfering with responsive feeding and shared feeding responsibility, reducing feed frequency and thereby under-stimulating milk production.

 This review highlights the urgent need for studies directly examining the impact of swaddling on the above components of breastfeeding behavior and lactation. It also highlights that there is potential cause for concern in promoting swaddling as an obesity prevention mechanism for both breastfed and formula-fed infants and that the role of infant body movements in signaling satiety should be more carefully examined.

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