Background Research
The Happiest Baby potential medical cost benefit-
The cost savings of a program like this are substantial:
- diminished calls/visits to MD’s with crying, sleepless babies
- fewer ER visits and follow up doctor visits
- fewer diagnostic tests
- fewer prescriptions of drugs
- reduced incidence of breastfeeding failure ~ which results will improve infant health
- reduced incidence of postpartum depression ~ which results can reduced missed work, doctor visits, medication, etc
- reduced incidence of Shaken Baby Syndrome ~ which can reduced hospital and rehab care, legal costs, etc.
- improved parents sleep and work ability.
- probable reduced incidence of SIDS, too (decreased accidental rolling to stomach, swaddling increases infant arousability even in deep sleep).
The value of saving a single child from brain injury from SBS would pay several times over for this type of program for a year!
In 2008, the University of Arizona conducted a survey of 225 parents-to-be before and after a Happiest Baby class. Parents reported a dramatic improvement in their confidence. Pre-class ~ 40% were moderately to very worried about their ability to calm their fussy baby and handle problems. Post-class that number dropped to a mere 0.5%!
In the Colorado Department of Public Health (DPC) Manual on child abuse, THB is recommended as to help prevent child abuse.
In 2007, Boulder Colorado Department of Health, DPH found THB 98% effective in calming fussy high-risk babies. THB-certified nurses taught the 5 S’s to 42 distressed families (teens or addicted mothers, severe prematurity, etc) with fussy babies. 41/42 reported a rapid and dramatic improvement in calming their babies (many also reported an extra 1-3 hours sleep/night). The one child where the intervention failed was diagnosed with an ear infection and his crying responded to the 5 S’s after the infection was treated. This benefit persisted over the follow-up period (approximately 3 months).
FAQ – Frequently Asked Questions
Q: What type of research projects are supporting the THB program?
A: The research basis for this approach is broad. There are numerous studies showing the positive effect of movement, white noise, sucking, etc on crying and studies describing cultures where colicky crying does not exist. In addition, the DVD is a video multiple case study of the immediate effectiveness of Dr. Karp’s work. Finally, numerous research projects are ongoing or in the development stages. A controlled intervention study in Columbus, Ohio on normal first-time parents 80% completed (to measure the effect of the DVD on normal new babies sleep/cry/ and parents feelings of competence). A project is before an IRB in St Louis, MO to look at The Happiest Baby DVD as an intervention for colicky babies. Researchers at Hershey, PA are beginning to look at the DVD as a way of helping babies sleep better, researchers at Ann Arbor, MI are looking at a study to measure the impact of baby calming classes on patient visits to the ER and as an intervention by ER physicians for fussy babies, and another researcher at University of Pittsburgh is beginning to look at the DVD as an intervention to prevent Postpartum depression.
Q: The Happiest Baby program is not ANY different then what we are already teaching to soothe a baby, tell me what is different.
A: First it is very important to not only review the materials but to watch the actual DVD. What you will find is:
1) The idea of the 4th trimester is not taught in any other parenting text and it is the “ah-ha” moment that helps parents understand exactly what they need to do
2) The idea of the calming reflex is a complete innovation
3) Even though the S’s have been around…they are not being done correctly…and that leads to failure (just like doing a knee reflex incorrectly, by hitting off by 1? it doesn’t work…it looks right, but fails every time) These are reasons why The Happiest Baby has been endorsed by leaders of AAP, founder Lamaze, Surgeon General, LLLI, etc.
Q: While we enjoyed Dr. Karp’s respectful and caring attitude towards babies, we have a question for him. He refers to ‘the calming reflex‘ as it were on par with the Moro reflex and other well-documented human reflexes. Is there any scientific documentation of the existence of the calming reflex? We would be very grateful if you could direct us to any reading of a more scientific sort on this topic.
A: Good question!
You are correct…Dr. Karp is using the term to compare it to other reflexes babies have at birth, like the Moro. There is no study as of yet proving that this response is a reflex, it is his belief that it is a reflex, but the mechanism of the response has to be verified.
“Dr. Karp’s book is fascinating. It presents the top science about the development of babies in a style that is sensible and a pleasure to read. I believe it will reassure and guide new parents for many years to come.”—Julius Richmond, MD, Professor of Health Policy, Harvard Medical School, founder Head Start, former Surgeon General of the United States.
CLICK HERE FOR Contemporary Pediatrics® Archive, an article that describes The Happiest Baby in more detail.
Q: With THB’s technique’s recommendation of swaddling the babies arms down can it be dangerous and would it make babies feel ‘vulnerable’?
A: We are unaware of any study that has shown that swaddling with the arms of a full term baby at the side leads to any ill effect. The only recommendation for arms up swaddling is for preemies…this helps them be more alert and neurologically organized. However, this is not a concern for term babies who are being swaddled to improve sleep and to soothe crying.
This is why this approach has received the overwhelming support of all groups in the US…from the doulas (DONA) to the Surgeon General, from the founder of Lamaze to La Leche League, from Prevent Child Abuse America to Attachment Parenting International.
Most of Native Americans swaddled their babies with the arms down until ~6 months and they were well known to be brave and independent. The evidence of swaddling with arms down shows overwhelmingly that babies have more relaxed heart rates and respirations and that they sleep better (longer…yet they are more arouseable so they are less at risk for death-SIDS).
This approach (with arms down) is showing great promise for improving breast feeding success rates and lowering the incidence of depression, marital stress, shaken baby syndrome, and even SIDS.
Q: We had a class last week where a couple questioned swaddling for sleep. They indicated that at the hospital birthing classes they are told to have NOTHING in crib, including blankets. The baby should only have pajamas. What would be your answer to this? If done correctly, swaddling should be done so the baby cannot get out of the blanket. Any info from you would be helpful.
A: Please feel free to inform the recommendations below from the American Academy of Pediatrics. In addition, parents need to be reminded to feed their baby 8-12 times a day.
1) the AAP says not bulky blankets but they CLEARLY state they are OK with the use of thin blankets (they prefer the blanket tucked in, but do not recommend against swaddling)
2) Swaddling may decrease the rate of SIDS for several reasons: Patricia Franco and her group reported that swaddled infants sleeping on the back have approximately a 1/3 reduced risk of dying from SIDS.
Snug swaddling may reduce this risk of SIDS for 4 reasons:
1) Swaddling increases a baby’s responsiveness during sleep – It is generally believed that the risk of SIDS increases in certain babies because of decreased responsiveness to stimuli during sleep. Researchers have reported that swaddled babies have an increased responsiveness to auditory stimuli during sleep and therefore are likely to be at reduced risk for SIDS. The reason for this increased arousability is unknown (the constant touching of the skin by the blanket may act as a continuous stimulation – tactile “white noise”). (Gerard; Franco)
2) Swaddling prevents rolling onto stomach – Babies who accidentally roll onto the stomach during sleep are at a dramatically increased risk of SIDS. This rolling is largely prevented by snug wrapping. (Oyen; Mitchel; Li)
3) Swaddling prolongs sleep – Many exhausted parents place their babies to sleep on their stomachs because they sleep longer in that position. Researchers have shown that swaddled babies sleep as well on their backs as unswaddled babies sleep on their stomach. Hopefully, this will persuade some exhausted parents to stop their risky behavior. (Gerard; Franco)
4) Swaddling can prevent many bed sharing risks – Babies who bed share may suffocate if they move during the night and lodge their faces in pillows or wedge their heads between the mattress and the wall or headboard. Snug swaddling dramatically reduces a baby’s mobility and can prevent these accidents.
These 4 factors argue for the routine use of swaddling.
The AAP Task Force recommends that parents place babies in bed without a blanket OR to use a thin blanket that is snugly tucked.
The AAP recommends tucking the blanket under the mattress, however it presented no evidence of the benefit of their wrapping technique and it ignored the growing evidence that snug swaddling may be protective against SIDS.
Parents who swaddle should avoid three situations that might possibly increase a baby’s risk of SIDS: 1) overheating – swaddled babies should be dressed lightly in warm weather and parents should be informed that babies with hot ears and sweaty necks should wear only a diaper when wrapped or not to be wrapped at all ; 2) bulky blankets thick blankets are a suffocation hazard; and 3) loose sheets or thin blankets covering a baby’s face. Parents will be most successful if they snuggly swaddle their babies in a light blanket that is large enough to allow secure wrap all around the baby so it does not unravel during sleep.
Franco P, et al Increased cardiac autonomic responses to auditory challenges in swaddled infants. Sleep. 2004 Dec 15;27(8):1527-32
Gerard CM, Harris KA, Thach BT. Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics. 2002;110, e70 Gerard CM, Harris KA, Thach BT. Physiologic studies on swaddling: an ancient child care practice, which may promote the supine position for infant sleep. J Pediatr. 2002;141:398-403.
Patricia Franco, MD, PhD*, et al Influence of Swaddling on Sleep and Arousal Characteristics of Healthy Infants Pediatrics 2005:115.1307-1311
Oyen N, Markestad T, Skjaerven R, et al. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the Nordic Epidemiological SIDS Study. Pediatrics. 1997;100:613– 621
Mitchell EA, Thach BT, Thompson JM, Williams S. Changing infants’sleep position increases risk of sudden infant death syndrome. New Zeal and Cot Death Study. Arch Pedi atr Adol Med. 1999; 153: 1136 –1141
Li DK, Petitti DB, Willinger M, et al. Infant sleeping position and the risk of sudden infant death syndrome in California, 1997–2000. Am J Epidemiol. 2003;157:446 – 455
Patricia Franco, MD, PhD*, et al Ambient temperature is associated with changes in infants’ arousability from sleep. Sleep. 2001 May1;24(3):325-9
Q: Does anyone know if swinging aggravates a babies reflux?
A: Swinging is done in a semi upright position which lessens reflux. It also lessens reflux because it helps babies to stop crying….crying causes babies to tighten their stomach muscles and reflux more.
The movement does not increase spitting up…it actually allows a burp to jiggle out without pushing all the milk out.
Q: “How long does it take for a newborn’s ear drums to thin to the point where they hear as well as we do?”
A: Normally adults can hear down to 5-10 decibels…15 is the cutoff for children’ s hearing tests. At birth the cut off for a baby’s hearing test is 30 dB (if a baby can’t hear that level we worry about a hearing problem)…some babies already have pretty good hearing (20dB) at a couple of weeks, but for some it takes up to 3 months for the hearing to improve to where they can reliably hear 20 db. At that point they can be said to have “normal hearing” they hear voices perfectly well.
20 dB is 10 times quieter than 30 db…10 is a breath sound…30 is a whisper.
The fluid in the baby’s middle ear clears within day’s of birth, the vernix may stay in there for weeks and the walls of the ear canal stay fleshy and thick for a few months…this dampen’s hearing a tiny bit too. Finally, the TM thins over about the first 2-5 months…
In terms of white noise, it is recommended that we should not listen to 90db for more than an hour, or 75 db for more than 8 hours straight (this is the sound of a vacuum). So if the white noise is the intensity of an irritated librarian that would make it around 65-70 (remember 75 is 4x louder than 70 and 10x louder than 65)
Q: “One question that parents frequently ask is in regards to swaddling. According to First Candle/SIDS Alliance, they recommend swaddling for no more than 6-8 weeks. According to THB DVD, it states that swaddling is safe for 4…, 5…, 6…, 7…,8…months, for sleep.
Parents question safety in swaddling, especially with the new Velcro Swaddlers on the market. Additionally, they find it difficult to find blankets in the dimensions recommended in THB DVD.
Can you give some suggestions as to how we may accurately counsel our parents?”
A: First Candle has no basis for their recommendation of 6-8 weeks. The AAP does not limit swaddling and the recent research by Gerrard and Thach (J Peds 2002) and Patricia Franco et al (Peds 2005) both support the benefits of swaddling to lessen the risk of SIDS (swaddled babies sleep longer…but they are more arousable…we believe increased arouse ability is associated with decreased SIDS! In essence babies sleep longer…and safer. Probably the swaddling is like continuous tactile “white noise” keeping the baby calm but slightly stimulated all night)
Also, we now know that babies who sleep prone have a 2x increased risk of SIDS…but babies who sleep supine and accidentally roll over have an 8x increase in SIDS! Swaddling helps keep babies safe by preventing rolling onto the stomach.
Also, the AAP task force on SIDS report (Peds 2005) stated that the rate of SIDS is no longer decreasing in the US…in part they say that is because so many parents are putting their babies to sleep in the stomach (even though they know it is more dangerous) because they don’t sleep well on the back. Swaddling (and white noise) is demonstrated to allow babies to sleep as well on the back as unswaddled babies sleep on the stomach…so this should lead to a decrease in SIDS.
Finally, for parents who co sleep…the swaddling keeps the baby from moving around in the bed…so the child is less likely to get stuck on a pillow or blanket.
The only caveat with swaddling is that parents need to be taught not to overheat their babies and to make sure they swaddle snuggly in a big thin blanket…so there are no loose wraps in the bed.
