Effect of Swaddling and other Motor Restraint

On

Infants & Children

By

Hajar A. Hajar Albinali (Med. Student)

Univ. Of Colorado, School of Medicine

Psychiatry 501

April 1, 1970

INTRODUCTION:

As civilization of man proceeds, many of the old traditional customs are abandoned by societies or come to extinction. Swaddling practice of infants is facing the same fate of extinction at the present time of man's history.

My interest in swaddling is intensified by watching infants swaddled by some families at home (the Arabian Gulf) and by the fact that I was subjected to such practice when I was an infant.

The method of swaddling in the Arabian Peninsula, as described recently for me by my mother is as follows: The infant is laid down on its back on a piece of soft cloth that extends from its neck to its toes. The cloth is then folded around its body enclosing its stretched hands, lying to its sides. Then a soft string is wrapped not very tightly around the body from the chest to the toes keeping the body stretched and almost immobilizing the extremities. Then the infant is placed in its cradle and rocked till it sleeps.

According to my mother, most ladies of the older generation, at home, believed that swaddling was necessary for an infant to have a good sleep. The infants, she explained will be awakened by the movement of its extremities associated with a

dream. She insisted that the infant when awake got startled and frightened by the unintentional movement of its hands across its visual field.

From what I observed and heard about swaddling, I hypothesized that swaddling is a very frustrating experience for the infant. I assumed that it causes anxiety and produces stress on the body that might cause physiological and psychological disturbances, manifested in diarrhea and skin rash that I noticed on some babies at home.

On reviewing the available literature on the subject up to date (which I am summarizing in the following pages) I concluded that my own hypothesis was false, and swaddling might not be as bad as it seems.

 

Cultural Communications:

Swaddling of Infants has been practiced by many cultures past and present. The controversy over its effect on children is not completely settled yet. The infant apparently learns, by mother's talk, smile or singing during swaddling process, that this method of physical restriction on his movement is not meant as punishment.

The infant is sensitive to mother's tenseness or permissiveness, her pleasure or disgust, whether these are expressed in her elbows, her tone of voice or her facial expressions. Communication of these sorts take place from birth on, and when a particular form of parental handling is standardized as "good" and "necessary" in any community, the infant has a great multiplied opportunity to learn to react to the traditional patterns.(Benedict). Swaddling is a means of communication to the child, no less than mother's tone of voice. (Benedict).

"The common anthropological assumption of psychic unity of mankind is that a child at birth is equally capable of learning any natural language and of coming to embody any human culture." (Margaret). Gorer's hypothesis is that an unusually long swaddling experience is a significant aspect of the educational process by which human infants, born to and reared by Russian parents, become Russians. (Margaret).

Different cultures have different reasons for swaddling practices. Swaddling in Russia was justified as necessary for the safety of infant who is regarded as being in danger of destroying itself. (Benedict). In the words of informants, "It would tear its ear off. It would break its legs". (Benedict).

The baby's one mean of grasping the outside world is through its eyes and it is significant that in all Russian speech and literature the eyes are stressed as the "mirror of the soul". (Benedict).

The Polish version of swaddling was that infants were regarded not as violent but fragile. Swaddling was conceived as the first step in" hardening" a child. Hardening is valued in Poland, and since one is hardened by suffering, suffering is also valued. (Benedict).

In Rumania, swaddling was necessary to prevent masturbation. The infant's hands, when he is too old to be swaddled, are tied to his crib and immobilized by special clothing. (Benedict).

Other cultures have different reasons for swaddling, and as I noted in my introduction that in my own culture, it was considered necessary for the baby to have a good sleep.

INFANT AND CHILD REACTION TO MOTOR RESTRAINT IN GENERAL:

Motility can be considered an urge in the same sense as oral, excretory and genital urge. It is also gratification of other urges such as escape from pain. (Mittelmann).

Watson (1928) stated that" Hampering of movements will bring out a rage response even in the newborn." (Watson, 1928).

Levy (1944) studying hens in cages and in large houses concluded that" There is a close correlation between the number of head-shakes and the limitation of floor space. The smaller the cage, the greater the head-shakes. It would appear that head-shaking is due to a frustration resulted from increasing restraint of movement. (Levy).

"Observation seemed to show that hampering of the infant's movements is the factor which apart from all training brings about the movement characterized as rage. If the face or head is held, crying results quickly followed by screaming. The baby stiffens and fairly well coordinated slashing or striking movements of the hands and arms result, the feet and arms are drown up and down, the breath is held until the child's face is flushed. In older children the slashing movements of the arms and legs are better coordinated and appear as kicking, slapping, pushing, etc. Almost any child from birth can be thrown into rage if its arms are held tightly to its sides, sometimes even if the elbow joint is clasped tightly between the fingers, the response appears.

At times just the placing of the head between cotton pads will produce it. (Watson, J.B. Psychology from Standpoint of a Behaviorist, p.200., quoted by Greenacre).

Movement restraints in children which prevent freedom of locomotion, for example, the playpen, locking children in rooms, prevention of creeping, immobilization in plaster cast result in hyperactivity immediately after the child is freed. (Levy).

During immobilization period most children (suffering from a pathological condition such as dislocation of hips and paralysis) were over-patient with ordinary measures such as injection and broke down only when unusual surplus pain was inflicted such as a bee sting. At the beginning of motility recovery period, their behavior was characterized by impatience and over sensitivity toward further restrictions. (Bergmann).

Restraint of movement would in time result in stereotyped activity, regardless of toys or other objects of interest, since the need for movement would eventually win out over all distraction. Severe motor restrictions produce tics, and movement frustration is possible cause of mental deficiency. (Levy).

At least in the first few weeks of life crying is accompanied by alternate windmill movement of upper extremities and alternate flexion and extension of lower extremities. (Mittelmann)

At a relatively early age, transient restriction of motility may, though it does not invariably, lead to a mixture of rage and anxiety. Sustained and recurrent restriction of movement after the child has moved freely for some months leads to a severe state of anxiety and hostility and serious damage to the self, which always has a strong motor component. This can be seen in eczema when child's hands are tied to the sides of the crib for protracted periods. In such situation in addition to fear of not being able to move, there is a fear of complete abandonment, of death by starvation and total helplessness in the face of potential attack, including genital injury. Thus sustained restriction is a total threat to self-preservation (Mittelman).

Motility, while an urge in its own right is also significantly connected with nearly every other motivational or emotional nature, (love, dependency, etc.) and particularly self preservation (Mittelmann).

INFANT REACTION TO SWADDLING:

In most instances the swaddling is not extremely tight, painful, or continuous. The infant is released for periods of time during the day for cleaning and feeding. Stimulation is then given to the arms and legs activity.

Swaddling does not produce the rage reaction described above by Watson, on the contrary, I admit that I have seen crying infants to calm down when swaddled. It is also pointed out by Lipton (1960) that "swaddling is observed to have a quieting effect on infants". Furthermore, the new born's need for movement is very limited by his incomplete neurological development. Reaction to restrain is in proportion to the need for movement, and the need of movement varies according to a number of factors including innate differences, maturation, health, type of restraint and emotional factors. Restraint of any special type of movement before it has been experienced, must be felt different after it has been in practice, (levy).

Swaddling does not result in hyperactivity, restless or emotional out-burst among infants, because swaddling presents modification of activity before it had been exercised sufficiently to represent a real need. (Levy).

Swaddling offers a comfortable support and protection to the newborn which, far from irritating, serves as a happy bridge across the abrupt birth passage and vaguely approximate the inrra-uterine condition until the baby is little more prepared for the world. (Greenacre).

The head-molding carried on by the Columbia River Indians, especially the Chinooks, is also a restraint process starting at birth. Here the restraint is applied with such a force as actually to deform the shape of the head. The baby at birth is placed in a cradle made of a piece of cedar log, hollowed out and lined with softest cedar, a piece of soft skin and cloth. A pad is put at the baby's neck and a soft little pillow of wool and feathers on the forehead enclosing a flat stone. The body is laced into the soft wooden cradle with protective thongs, but the pad is laced on very tightly and with increasing pressure, so that the head is unbelievably flattened by the end of the first year. (Swan, J.G. 1857. Quoted by Greenacre)

Greenacre also quoted both Cox, a trader with the Indians, and Paul Kane, an artist. Kane described the infant's appearance during the course of this flattening process: "The eyes seen to start out of their sockets with the pressure", and Cox: "The appearance of the infant while in this state of compression is frightful, and its little black eyes, forced out by the tightness of the bandages, resemble those of a mouse in a trap."

Kane remarks that the infants seem quiet and placid when the head pressure is on, but if for any reason it is removed, they cry loudly until the wrappings are replaced. Kane offered the explanation that the pressure deadened the sensitivity of the child and only when it was removed did the child become aware of the pain. It may also be true that since the pressure is gradually applied, the child gradually becomes accustomed to the discomfort, and in a sense misses it when the pressure is suddenly released. (Greenacre).

Swaddling produces physiological effects; motor activity, heart rate and respiratory activity are decreased. Swaddling also tends to increase the stability of heart rate. (Lipton). It is suggested that imposing motor restraint reduce the number of different impulses reaching the posterior hypothalamus, the thalamus, and the cerebral cortex, thereby lowering the pre-stimulus heart and respiratory rate and promoting sleep. (Lipton).

Elimination of general proprioceptive impulses as in swaddling condition, would not only decrease cortical awareness of the stimulus, but also lower hypothalmic and sympathetic responsiveness. (Lipton).

SUMMARY AND CONCLUSIONS:

Motility is an urge itself and also gratification of other urges.

Swaddling, even though it is a type of motor restraint, does not have the same effect like other motor restraints. The neurological immaturity of the newborn is one of the major factors that the newborn does not feel a stress caused by swaddling.

Swaddling is a means of cultural communication to the child.

Infants are quieter, sleep more and have lower heart rates when swaddled.

The quieting effect of swaddling cannot be explained by adaptation of the child to restraint, because usually the child resents and struggles against swaddling after six months of age. (Personal observation)

The warmth and the slight tightness of swaddling and the rocking of the cradle might give the newborn a sense of security and might also remind it of its old home (i.e. the uterus of the mother).

Image

Arab Gulf Swaddling

BIBLIOGRAPHY:

· Benedict, R. 1949: Child Rearing in Certain European Countries

Amer.J. Orthopsychiatry. 19=342-356

· Bergmann, Thesi. 1945 : Observation of Children's Reactions to Motor Restraint

Nervous Child. 4=318

· Greenacre, P. 1944: Infant Reaction to Restraint

Amer. J. Orthopsychiatry. 14= 204-218

· Mead, Margaret: The Swaddling Hypothesis : It's Reception.

Amer. Anthrop. 1954-56 395-409

· Mittelmann, B. 1954: Motilitv In Infants, Children and Adults.

The Psychoanalytic Study of Child. 9= 142-177

· Levy, David M. 1944: On the problem of Movement Restraint.

Amer. J. Orthopsychiatry 14=644-671

· Lipton, E. L., et.al. 1960: Automatic Function in Neonate II. Physiologic effect of Motor Restraint. Psychosmatic Medicine. 22=57067

· Waston, J.B. 1928: Psychological care of Infant and Child.

Allen and Unwin 1928

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