Why might modern parents need to swaddle their baby?
Immediately after birth, babies are swaddled in the delivery room and are advised to do the same throughout their stay in the maternity hospital. The baby is swaddled tightly, with the arms located along the body and the legs straightened. This position of a newborn is not physiological. After birth, the baby has severe hypertonicity in his hands and hacksaws. This is manifested by the fact that the child’s legs and arms are bent and brought towards the body. Why then do you need tight swaddling?
The essence and indications for swaddling in general
In the time of our grandparents, it was customary to “dress” a child this way. This was due to the lack of disposable diapers. Therefore, swaddling a child was easier than changing the entire set of clothes several times a day. Tight swaddling of the legs was used to prevent the development of deformities of the legs. But this assumption is absolutely false.
In children, deformation most often occurs as a result of vitamin D deficiency. Some experts say that swaddling reminds the baby of being in the womb. But this assumption remains controversial. The indications for swaddling include the following: if the baby cannot sleep peacefully, disturbing himself with his arms and legs, then this method can be used.
Undoubtedly, in the first months of life a child makes erratic and chaotic movements. To calm your baby, you can try swaddling him, but not tightly. It is important to ensure that the diaper restricts the movements of the limbs, but does not constrain them.
The essence of wide swaddling
This technique consists of fixing the child’s legs, separated at the hip joints and set aside. The head of the femur in this position is in the acetabulum. In this situation, the joint is strengthened by ligaments and muscles (“matures”). And then the risk of developing hip dislocation will decrease.
What is the hip joint?
A baby's hip joint is the largest in his body. It consists of two bone formations (the head of the femur and the acetabulum of the pelvis), an articular capsule, and ligaments. The acetabulum can be depicted figuratively as a cup or hemisphere. The head of the femur is a completely smooth ball. When moving in the joint, the head slides along the inner surface of the cavity thanks to a special lubricant - joint fluid.
All this is covered on top by the articular capsule. It is quite strong, elastic, and quite thick, so the head does not slip out of the socket when moving. In addition, ligaments and muscle tendons help to additionally fix the joint capsule.
Indications for wide swaddling of infants
As mentioned above, wide swaddling is indicated for children with hip dysplasia. This disease involves defective formation of the hip joint, which can lead to dislocation of the joint.
Wide swaddling of a newborn is used as a preventive and therapeutic measure for hip dysplasia.
Wide swaddling can also be used to prevent and treat diaper rash in the skin of the perineum, around the anus and external genitalia.
How does a hip joint with dysplasia differ from a healthy one?
Having imagined the structure of a healthy hip joint, it is easy to understand what it looks like with dysplasia:
- the shape of the acetabulum changes (becomes flatter);
- the process of ossification of the femoral head is slow and delayed over time;
- the joint capsule may lose its elasticity and strength;
- The ligaments of the joint lose their elasticity.
Such changes no longer allow the head of the femur to be supported during movements. During movement, it slides off the flat surface of the socket and rests on the articular capsule. The capsule is not able to withstand such a load.
What products do you need to purchase to perform wide swaddling?
For wide swaddling, diapers or special devices may be needed. For more convenient use of swaddling with diapers, you can purchase a special fastener that will hold the diaper in one position.
If mom has a desire to sew a special cover with her own hands, she may need rivets, ties, and Velcro. The surface on which this procedure will be performed must be hard. Therefore, this should be done on the changing table.
How many and what kind of diapers should I buy?
The composition of diapers for wide swaddling can be anything.
This issue is not relevant for this process. But it will be more convenient for parents to use knitted diapers, which stretch well and are easy to give to the desired shape. There are several swaddling techniques. And only the mother can decide which one is more convenient for her to use, unless of course this contradicts the recommendations of a specialist. There is a method of wide swaddling using three diapers. Therefore, the minimum should be three.
One diaper should have a rectangular shape, size 80*120 cm. The rest should be size 80*90 cm.
Special case
The purpose of the special cover is to ensure maximum separation of the legs at the hip joints. This cover fits over pants, panties, and a diaper. It is a diaper located between the legs, which is fixed at the top and sides.
You can sew a wide changing cover yourself. First you need to draw a pattern, it is needed so that the baby does not rub the fabric between the legs. Having measured the child (tummy circumference and body length from the groin to the shoulder girdle), you need to transfer the data to the pattern. After drawing it, attach it to cotton fabric and cut it out.
To make the cover dense, several layers are needed (3 - 4). The layers of fabric are sewn together and the edges are finished. The ends at the top and sides need to be secured. But how, only the mother can decide. These can be ties, Velcro, snaps or buttons.
A wide changing cover cannot be universal! It is created taking into account the proportions and build of the child.
Step-by-step instruction
There are different methods of wide swaddling. They are classified depending on the equipment used. It is recommended to know the instructions for wrapping using different methods. For visual reference, you should watch a video about how to carry out the procedure of wide swaddling a newborn.
Algorithm for wide wrapping using diapers:
- take one or more diapers. The width of the material should be such that its sides rest against the knees. For infants this is approximately 20 cm;
- place the child on his back. The baby will reflexively bend his knees and pull them towards his stomach. In this position you need to swaddle;
- Place three diapers on the table, one on top of the other. The first material should be spread wide, the second should be folded into a triangle, the third should be collected in several layers;
- put the baby on the diaper so that the edge of the fabric structure is located under the arms, and the wide material folded several times is between the legs;
- place the lower edge of the diaper between the legs and bring it to the level of the navel;
- Secure the resulting wide gasket with a triangular diaper. To do this, turn the corner of the triangle, which is located between the legs, onto the stomach. Grasp the right thigh with the right end of the diaper, and the left thigh with the left;
- Wrap the baby on top with a rectangular wide diaper. This is done to securely fix all elements.
Instructions for wide swaddling using a special cover:
- the diaper is folded in several layers and placed between the legs, as in the method described above;
- a cover is placed on top;
- As the child grows, the Velcro or buttons are altered.
Algorithm for wide swaddling using a Freika pillow:
- the pillow is located between the legs;
- fixed with tapes.
Freyka's pillow and special cover need to be worn about 12 hours a day. The exact time should be determined by the doctor. Much depends on the degree of dysplasia. The advantages of the Freyka pillow and cover are convenience and ease of use.
Wide wrapping with diapers is considered more difficult to perform. But such methods are financially profitable. The price of special panties, pillows and covers is high. Diapers are much cheaper.
Wide swaddling of a newborn in pictures step by step
All of these wide swaddling methods are equally effective. Their main function is considered to be fixation of the baby’s hips with knees bent and legs apart.
All four options help the hip bone form correctly. Many parents make the choice of swaddling method based on their own preferences and available equipment. An orthopedic surgeon can choose the best option.
Main technical points of wide swaddling
The main points to remember when swaddling a baby are, first of all, the position. The baby should lie on his back. The surface on which the child is located is hard, without unnecessary objects. Diapers used for changing, as well as other means, must be clean and ironed on both sides.
Wrapping with diapers
As mentioned earlier, there are a large number of swaddling techniques. Each mother must decide for herself which method is convenient for her and suits her best. Of course, first you need to discuss this point with a specialist, in this case with an orthopedic doctor. The methods of wide swaddling are as follows.
With one diaper
The wide swaddling technique using one diaper is suitable for calmer children or can be used before bedtime. To do this, you need to take a diaper that roughly resembles a square. Fold into a triangle. Place the diaper with its most obtuse angle down.
Place the baby on a diaper. Pull the lower part between the legs, and fasten the sharp ends of the diaper to the side. It is important to remember that the legs must be spread apart and fixed in this position. A child can easily get out of these panties. Therefore, you should wear panties or rompers on top. You can also secure the diaper using special fasteners.
With two
This method is used using 2 diapers of different sizes. One should be 80*120, the other smaller. A large diaper should be laid out in the shape of a rectangle on the changing table. Fold the small diaper several times.
We place the baby on the table, placing a folded diaper between the legs so that it completely covers the intergluteal fold, perineum and external genitalia. We fix it with a large diaper, wrapping the legs and fixing the ends on the baby’s stomach. This method can be used for the prevention and treatment of diaper rash.
With three
The three-diaper technique is used most often. To perform this method you will need one diaper of size 80*120 and 2 square diapers. We straighten the rectangular one and place it on the changing table. We fold the other into a triangle and place it on the table so that the triangle appears upside down. Fold the third diaper several times until you get a tight rectangle.
We put the baby on the table. We stretch a rectangular diaper between the legs and fix it with the ends of the triangular diaper. The lower end should envelop the upper edge of the rectangular diaper. The side ends are fixed on the baby's tummy. A large diaper is needed to secure two diapers in one position. The side edges are wrapped around the baby's belly. The bottom edge hangs freely. Then it is folded and fixed above the baby’s navel.
Using a disposable diaper
If the baby does not have irritation and diaper rash in the area of the external genitalia and anus, then disposable diapers can be used.
In this case, the diaper will replace one of the three diapers (folded into a rectangle) during the wide swaddling process. To make swaddling easier, there are currently special panties for wide swaddling, which can be purchased at an orthopedic store. They are very easy to use as they resemble disposable diapers. Their application is no different.
The only difference is the thicker lining of the panties, for a stronger separation of the legs and their fixation. Panties can also be used from 3 months of age.
Freyka's pillow
This device can be used from the first month of life. Frejka's pillow consists of a strong bandage, which should be located between the legs and ties. The pillow is fixed on the baby's belt and shoulders. This device may have a high back, in which case the bandage continues at the back.
Freyka's pillow must have individual sizes for a specific child.
How to use the case?
The cover is located between the legs and is fixed on the sides and on the shoulders of the child. It can be worn over ready-made orthopedic structures, over diapers, or a diaper. Its main purpose is to improve fixation.
Necessary equipment
To properly wrap the baby, the mother will need thin flannel diapers, which are used to wrap the baby’s legs in the hips and lower back. For children over 1 month old, it is recommended to use a Frejka pillow for wide swaddling: the device is located between the thighs and allows you to maintain the correct position of the legs.
For fixation, you can sew a special cover with side ties, shoulder straps and a thick insert.
Cloth diapers
For wide swaddling, several diapers made of soft natural fabric are used. Cotton, chintz, flannel, flannel, cambric are suitable. Before wrapping your baby, you can put on disposable diapers or make reusable cloth ones.
Panties are sewn from the cut; Velcro or fabric ties are needed to secure them. The necessary devices can be purchased in children's specialized stores, pharmacies, and ready-made products are also sold there.
Case
It can be made from flannel fabric folded in several layers. The design has an elongated rectangular shape with sewn ribbons, with the help of which the product is secured at the waist. The wide swaddling product itself is placed between the baby's legs.
Freyka's pillow
This is a soft orthopedic device that holds the legs in an abducted position. It is recommended to use the bandage in the first 1–3 months; less often, treatment is continued for up to a year. Pillows are sold in different sizes, which allows you to choose the right option for each child. When purchasing the product, you should take into account the distance between the popliteal fossae, which is formed when the limbs are fixed in the correct position. The device must be worn constantly; it is removed only during changing clothes, water procedures, and massage.
Features of caring for babies who need wide swaddling
Because some babies are required to wear special devices 24 hours a day, special attention must be paid to the care of the child. Several layers of diapers, pillows, and diapers allow air to pass through rather poorly, so these children often develop irritation and diaper rash. If diapers or diapers are dirty, wash the child immediately and change the diapers.
It is important to observe places where friction from structures is possible. If diaper rash is detected, you need to add baby powder, zinc paste or Bepanten cream to your care products, depending on the condition of the skin.
Diagnosis of dysplasia
A timely, careful examination will help to make a correct diagnosis of the baby. If the child lies on his back, his legs are always bent at the knees and slightly spread apart. In a healthy baby, with a little pressure on them, the legs easily spread and lie on the table.
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The baby is then turned onto his tummy on the changing table. Upon careful examination of dysplasia, the asymmetry of the folds under the buttocks and in the knee area is striking. The skin fold on the side where there is dysplasia and subluxation or dislocation will be located higher than on the healthy side. There may also be an additional fold.
The leg on the affected side may be slightly shortened, which is also associated with subluxation of the femoral head. However, all these changes are typical only for a situation where the pathology is one-sided. If it affects both joints at the same time, additional studies will help make the correct diagnosis:
- Ultrasound;
- X-ray of joints.
Doctors give greater preference to the ultrasound method in children, since it is not as dangerous as X-ray - the baby is not exposed to dangerous radiation. In addition, it allows you to examine the condition of the cartilage, tendons, and joint capsule.
Wrap with three diapers
So, another wide swaddling. How to do it correctly? You will need three diapers with the following dimensions: 80 x 120 cm, 80 x 0 cm and 80 x 90 cm (you can choose any size).
- Place the largest diaper on the changing table, fold its top edge 10 cm;
- on top of it place one that measures 80 x 90 cm, folded in half into a triangle - the right angle is directed downwards;
- In the center of the second diaper, place a cushion made from the third diaper;
- put the toddler on the roller, and thread this roller between its legs;
- The baby's legs should be wrapped with the side corners of the middle diaper, and its lower corner should be raised between the legs;
- wrap the sides of the first diaper around the chest and tummy of the toddler;
- Direct the lower part upward, wrapping the remaining corners around the baby’s body.
Swaddling methods
One of them, natural, is considered to be a newborn wearing only rompers and light blouses. The diaper is simply placed under the baby, without limiting freedom of movement in any way. Doctors' opinions on natural swaddling differ significantly. Some believe that this contributes to a more correct formation of the musculoskeletal system and strengthening of the ligamentous-tendon system. But many doctors also notice undesirable consequences of not wrapping the child. These include:
- problems falling asleep;
- impaired tactility;
- frequent stressful conditions.
The resulting disturbances are explained by excessive freedom of movement, which causes a feeling of insecurity.
Loose swaddling means wrapping only the lower limbs, leaving the arms free. This method is not used in the treatment of not only dysplasia, but also immaturity of the hip joints. With a sudden movement of the leg, the femoral head can pathologically shift in relation to the acetabulum.
Tight swaddling is still widespread, although pediatricians have long explained to parents its harm and even danger. There have been repeated suggestions about this method of wrapping as the cause of “sudden infant death syndrome.” Tight swaddling provokes:
- circulatory disorders;
- insufficient oxygen supply to cells;
- weakening of the body's defenses;
- delays in physical development.
It is also not used in the treatment of dysplasia. In the position of straightened and tightly pressed legs to each other, restoration of the hip joint does not occur.
Wide swaddling has gained popularity due to the frequent detection of dysplastic changes of varying severity. This does not mean that previously children were less likely to suffer from pathology. Modern diagnostic techniques make it possible to detect dysplasia or immaturity of joints in the first days of a child’s birth when examined by an orthopedist and immediately begin therapy. Wide swaddling is called therapeutic, painlessly correcting pathologies. Pediatricians recommend that parents use it as an auxiliary method of treatment for testicular hydrocele (accumulation of serous fluid) in boys. It is used to normalize muscle tone in weakened children.
Duration of treatment with this type of swaddling
Mommy should swaddle her baby this way every day. The toddler needs to stay with his legs spread almost all day long. Unswappling is allowed for a very short period of time - to bathe, do gymnastics and massage.
There will not be a quick effect, which most parents usually expect, with such swaddling. Moms and dads need to stock up on a fair amount of patience and come to terms with the fact that they will be in this mode for many months. In addition, we must not forget that the baby must be shown to a pediatric orthopedic doctor from time to time. After all, it is this specialist who has the right to decide whether to extend such treatment or to cancel it. You cannot do this on your own due to the fact that in the future the older child may have serious health problems.
