A comparison between the effects of swaddled and conventional bathing methods on some behavioral responses in premature infants

Document Type: Original Article


1 School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Community Based Psychiatric Care Research Center, Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Science, Shiraz, Iran

3 Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Science, Shiraz, Iran

4 Department of Pediatrics, Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Background: The newborn’s first bath, performed in Neonatal Intensive Care Units (NICU), is believed to be a stressful situation, especially for the premature infants. As a developmental care approach, swaddle bathing is a low-stress bathing method for vulnerable preterm neonates. Given the limited number of the studies examining this bathing method, the present study was conducted with the aim of comparing the effects of swaddle and conventional bathing methods on some behavioral responses in premature infants.
Methods: This study was a randomized clinical trial conducted on 50 premature neonates admitted to NICU. The neonates, who met the inclusion criteria, were randomly assigned into experimental and control groups. The infants in the experimental group received swaddle bathing and those in the control group were given conventional bathing. To record the behavioral responses, the infants' faces were filmed in close-up during the bathing. The data were analyzed, using Chi-squared test, independent samples t-test, and Mann-Whitney U test.
Results: The results demonstrated that the occurrence rates of such behaviors as facial grimace (P<0.001), mouthing/yawing movements (P<0.001), tongue extension (P=0.017), eyes open (P=0.027), and fussing/crying (P<0.001) were significantly lower in the experimental group than those in the control group. In addition, the percentage of eyes closed was higher in the experimental group, compared to the control group (P=0.006).
Conclusion: According to the findings of this study, swaddle bathing can reduce the neonatal stress during bathing. Consequently, this kind of bathing can be used as an appropriate, low-stress, and pleasant method for the preterm neonates in NICU.


  1. World Health Organization. Born too soon: the global action report on preterm birth. Geneva: World Health Organization; 2012.
  2. Als H. Reading the premature infant. In: Goldson E, editor. Nurturing the premature infant: developmental interventions in the neonatal intensive care nursery. United Kingdom: Oxford University Press; 1999. P. 18-85.
  3. Hamilton KE, Moore R, Naylor H. Developmental care: the carer’s perspective. Infant. 2008; 4(6):190-5.
  4. Maree C, Becker P. The effect of developmentally supportive positioning (DSP) on preterm infants stress levels. Health SA Gesondheid. 2008; 12(1):3-11.
  5. Hall K. Practising developmentally supportive care during infant bathing: reducing stress through swaddle bathing. Infant. 2008; 4(6):198-201.
  6. Peters KL. Bathing premature infants: physiological and behavioral consequences. Am J Crit Care. 1998; 7(2):90-100.
  7. Tapia-Rombo C, Morales Mora M, Alvarez Vazquez E. Variations of vital signs, skin color, behavior and oxygen saturation in premature neonates after sponge bathing. Possible complications. Rev Invest Clin. 2003; 55(4):438-43.
  8. Liaw JJ, Yang L, Yuh YS, Yin T. Effects of tub bathing procedures on preterm infants' behavior. J Nurs Res. 2006; 14(4):297-305.
  9. Quraishy K, Bowles SM, Moore J. A protocol for swaddled bathing in the neonatal intensive care unit. Newborn Infant Nurs Rev. 2013; 13(1):48-50.
10. Fern D, Graves C, L'Huillier M. Swaddled bathing in the newborn intensive care unit. Newborn Infant Nurs Rev. 2002; 2(1):3-4.

11. Edraki M, Paran M, Montaseri S, Razavi Nejad M, Montaseri Z. Comparing the effects of swaddled and conventional bathing methods on body temperature and crying duration in premature infants: a randomized clinical trial. J Caring Sci. 2014; 3(2):83-91.

12. Liaw JJ, Yang L, Chang LH, Chou HL, Chao SC. Improving neonatal caregiving through a developmentally supportive care training program. Appl Nurs Res. 2009; 22(2):86-93.

13. Liaw JJ, Yang L, Chou HL, Yang MH, Chao SC. Relationships between nurse care‐giving behaviours and preterm infant responses during bathing: a preliminary study. J Clin Nurs. 2010; 19(1‐2):89-99.

14. Lee HK. Effects of sponge bathing on vagal tone and behavioural responses in premature infants. J Clin Nurs. 2002; 11(4):510-9.

15. Als H. Newborn individualized developmental care and assessment program (NIDCAP): new frontier for neonatal and perinatal medicine. J Neonat Perinat Med. 2009; 2(3):135-47.

16. Bryanton J, Walsh D, Barrett M, Gaudet D. Tub bathing versus traditional sponge bathing for the newborn. J Obstet Gynecol Neonatal Nurs. 2004; 33(6):704-12.

17. Morrow C, Hidinger A, Wilkinson-Faulk D. Reducing neonatal pain during routine heel lance procedures. MCN Am J Matern Child Nurs. 2010; 35(6):346-54.

18. Sinpru N, Tilokskulchai F, Vichitsukon K, Boonyarittipong P. The effects of clinical nursing practice guideline for swaddling on pain relief from heelstick in neonates. J Nurs Sci. 2009; 27(1):32-45.

19. Campos RG. Soothing pain-elicited distress in infants with swaddling and pacifiers. Child Dev. 1989; 60(4):781-92.

20. Neu M, Browne JV. Infant physiologic and behavioral organization during swaddled versus unswaddled weighing. J Perinatol. 1997; 17(3):193-8.

21. Ohgi S, Akiyama T, Arisawa K, Shigemori K. Randomised controlled trial of swaddling versus massage in the management of excessive crying in infants with cerebral injuries. Arch Dis Child. 2004; 89(3):212-6.