Introducing a new bathing technique for newborns

Swaddle immersion bath’s calming result is leading to the option being offered at more UCHealth hospitals.
July 20th, 2017
Newborn Alexa Crimando gets her first swaddle immersion bath with help from her parents and a Poudre Valley Hospital nurse. A swaddle immersion bath is bathing the newborn while they are loosely swaddled in a blanket. The newborn and the blanket are immersed together into a tub of water in which the water covers both baby and blanket to the baby’s shoulder. Each limb is then individually unswaddled, washed, rinsed and reswaddled. They baths are shown to be less stressful to baby and parents.

A new bathing option for babies born at UCHealth Poudre Valley Hospital Women’s Care Unit is making newborns and their parents much happier.

PVH doesn’t recommend bathing a child in the first 24 hours because babies are born with a white, lotion-like substance called vernix caseosa, and it helps a baby stay warm after birth, fights off skin infections and promotes healthy skin growth, according to Geri Tamborelli, associate chief nursing officer at PVH.

As a Baby Friendly-certified hospital, PVH supports the first hours after birth being used for skin-to-skin time and establishing breastfeeding

When a family chooses or is ready to bathe their newborn, PVH provides a swaddle immersion bath, which has been found to be a better experience for a baby and caregivers.

During a swaddle immersion bath, a baby is loosely swaddled in a blanket. The newborn and the blanket are immersed – up to the baby’s shoulder – in a tub of water. Each limb is then individually unswaddled, washed, rinsed and reswaddled.

Newborn Alexa Crimando. A swaddle immersion bath is bathing the newborn while they are loosely swaddled in a blanket.

“Alexa loved it,” said mother Kelley Crimando, who delivered Alexa, 7 pounds and 18.5 inches, via C-section at PVH earlier this year. “She didn’t cry and basically was sleeping the whole time — and we had a fussy baby the first few days, so this was a whole different experience.”

Parents are now offered these options: a head wash, a swaddle immersion bath or instructions on how to do a swaddle immersion bath at home, after their child is 24 hours old.

“Babies seem so much calmer; they don’t cry as much; it takes less time; and they seem so much warmer and cleaner than with a sponge bath,” said Shelli Calkins, RN and charge nurse on PVH Women’s Care Unit. “I love how much happier they (newborns) are.”

Previously, a traditional sponge bath was done in the bassinet, near a sink. The newborn was not submerged in water but was naked and cleaned with a wet cloth or sponge. Studies show that the traditional sponge bath causes an increase in stress for both the baby and parent.

“Most of the time with a sponge bath, the baby will cry, and you see the parents turn away,” said PVH Women’s Care Unit RN Edna Sailer, who spearheaded the new protocols for the healthy term newborn. “It can be a bit dramatic for both parent and baby.”

Sailer’s study shows that only 38 percent of babies cried during a swaddle immersion bath compared to 93 percent who cried during a sponge bath. Among those who cried during their swaddle immersion bath, nurses recorded that the baby showed signs of hunger or cried very little. The metric for patient satisfaction was crying at any level during the bath. Like Crimando, parents reported positive feedback with the experience, Sailer said.

Sailer said the swaddle immersion study showed that babies and their parents were less-stressed during the swaddle immersion bath. The study also showed that it took less time and fewer steps to complete when compared with a traditional sponge bath. The increase in satisfaction had a domino effect on the rest of the patients’ experiences at the hospital, from latching for breastfeeding and sleeping to the confidence the parents had when going home with their newborn, she said.

“The swaddle bath sounded intriguing, and we thought it was a good opportunity to learn while in the hospital,” Crimando said. “But we (she and her husband) were both a little nervous about the bath. (Newborns) are so small and fragile, and I had heard they would cry and be unhappy. But as soon as we started doing it, it took a lot of my nervousness away. We dried Alexa off and swaddled her back up. When we got back to the room, she slept for two hours and was very relaxed. It was such a cool experience to give her the bath and see how content and peaceful she was afterwards.”

It has been recommended that a newborn not be given a traditional bath until the umbilical cord falls off, usually at three to four weeks of age. But studies show there is no increase in infection or bacterial colonization of the umbilical cord with immersion baths, so they can be given at 24 hours.

It is not necessary to bathe a baby every day; two to three times a week is more typical, and once a week is sufficient, Sailer said.

“Daily bathing can cause skin irritation and remove the baby’s natural moisture barrier,” she said. “Daily, gentle wiping of genital and rectal areas at each diaper change with warm water, and washing their face and neck areas after feedings, also with warm water, is enough.”

Newborn Alexa Crimando gets her first swaddle immersion bath with help from her parents and a Poudre Valley Hospital nurse.

Here are Sailer’s swaddle bath how-tos:

  • A swaddle immersion bath for your newborn can be a relaxing and bonding experience. However, newborns do not require frequent bathing; once a week is sufficient.
  • Gather all your supplies near your bath area ahead of time, using baby bath products. Swaddling your newborn with a receiving blanket during the immersion bath will help your baby feel more secure.
  • NEVER leave your baby alone in the tub. The bath should take about 5 to 10 minutes.
  • Bathwater should be between 99.9 and 103.9 degrees Fahrenheit, or comfortably warm — not hot. The water should feel comfortable to the inside of your arm.
  • Support your baby throughout the bath.
  • Wait at least 24 hours after circumcision to give your baby boy an immersion bath.

Because of Sailer’s positive study results, UCHealth plans to implement swaddle immersion bath protocol starting in the near future at its UCHealth Medical Center of the Rockies.

The PVH Neonatal Care Unit also is using swaddle baths and plans to implement the practice soon at MCR, said Beth Teschler, an occupational therapist with UCHealth who supports the NICU.

“Today in our NICU, we use a bath to encourage bonding with a baby and parent, especially considering all the difficult things — pokes, procedures, tape, diaper changes — that parents and babies endure,” she said. “We sometimes take a lot of first-time experiences away from NICU parents, and baths are a great first experience for them as a family. A bath is calming, babies enjoy them and parents get to participate a lot with baths, and there is typically a good snuggle time that follows.”