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Expert Q&A:
Should we be concerned if our 4-month-old won't fall asleep without being swaddled?

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Thomas DeWitt
Answered by Thomas DeWitt M.D.
"Understanding each unique family situation, how it influences parenting decisions, and helping families make the right decision is the essence of the practice of pediatrics," says Thomas DeWitt. A pediatrician and academician for almost 30 years, Dr. DeWitt believes that "the greatest professional reward is still the privilege of sharing the challenges of parenting, medically and behaviorally, with families." 

Dr. DeWitt is the Carl Weihl Professor of Pediatrics, director of the Division of General and Community Pediatrics, and associate chair for education in the Department of Pediatrics at the Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine. He received his M.D. degree from the University of Rochester and did his residency, chief residency, and Robert Wood Johnson General Pediatrics Academic Development Fellowship at Yale-New Haven Hospital. He has more than 75 publications, is a senior editor of a pediatric textbook, and is a peer reviewer for many medical journals, including Pediatrics, the New England Journal of Medicine, and the American Journal of Public Health. Having served as president of the Ambulatory Pediatric Association and chaired both the Steering Committee of the American Academy of Pediatrics Pediatric Research in Office Settings (PROS) network and the Committee on Pediatric Education, he currently sits on the United States Preventive Services Task Force and the Accreditation Council for Academic Medical Education Residency Review Committee for Pediatrics. He is nationally and internationally known for his publications and presentations in the areas of faculty development and community-based education and research.

Dr. DeWitt is the father of three young adult children who have taught him much about parenting and perspectives on life. He lives in Cincinnati with his wife, a pastoral counselor, and a wonderful mixed breed dog.


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Question


I really understand your frustration with your 4-month-old not tolerating not being swaddled, resulting in her being awake all night. It must be hard on you and your baby to not get much sleep at night. There are at least two things to consider in dealing with this issue. The first relates to the theory of why swaddling helps children go to sleep. It is thought that swaddling replicates the close quarters of the womb and reduces the simulation of both environment and body movement. The challenge you face is not so much "breaking" of her being swaddled but weaning her from it. I would suggest that you gradually reduce the tightness of the swaddling so that the change is not abrupt.

Answer


I really understand your frustration with your 4-month-old not tolerating not being swaddled, resulting in her being awake all night. It must be hard on you and your baby to not get much sleep at night. There are at least two things to consider in dealing with this issue. The first relates to the theory of why swaddling helps children go to sleep. It is thought that swaddling replicates the close quarters of the womb and reduces the simulation of both environment and body movement. The challenge you face is not so much "breaking" of her being swaddled but weaning her from it. I would suggest that you gradually reduce the tightness of the swaddling so that the change is not abrupt.

The other factor that may be contributing to the problem is that it is common for young infants to have a normal body reflex, a total body or myoclonic "jerk," that happens as they fall off to sleep. As a matter of fact, there are a fair number of older children and adults who will also have this reflex (though less pronounced) when they are falling asleep. The good news is that as babies get older, this reflex tends to diminish. This, in addition to the gradual un-swaddling suggested, may mean that you will have fewer sleepless nights in the near future.

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