An investigation of thermal balance in swaddled and non-swaddled infants setting in Mongolia

Funding body:        Faculty of Health & Social Care Bursary, Grobag group Co Ltd and the United Bristol Hospitals Trust

Collaborator:          The London School of Hygiene and Tropical Medicine
                                The Institute of Child Life and Health of the University of Bristol
                                The Public Health Institute of the Ministry of Health of Mongolia

Contact:                    Bazarragchaa.Tsogt@uwe.ac.uk, bazra4@yahoo.com

Traditional infant care in Mongolia includes tight swaddling in multiple layers, including partial head covering throughout the winter when outdoor temperatures commonly fall below -40°C. Swaddling is usually continued until around 7 months of age. Many families live in traditional circular single-room tents called “Ger”.

This study investigated thermal balance of infants at home in a Mongolian winter, and compared the effects of swaddling with use of an infant sleeping bag of equal thermal resistance.

1274 healthy term newborns were randomly allocated to swaddled or non-swaddled groups (using sleeping bags of equivalent thermal resistance), within 48 hours of birth. Digital recordings of infants’ core, peripheral, environmental and micro-environmental temperatures at 30-second intervals, were made from 40 swaddled and 40 non-swaddled infants over 24 hour periods, at ages 1 and 3 months. Mothers recorded logs of infant activity and wrapping.

A very wide range of indoor temperatures was recorded in Gers, where night time room temperatures below 0°C, and daytime temperatures above 25° C were seen, but infants’ temperatures were within the normal range. In apartments, room temperatures remained between 16°C and 22°C, but parents used similar wrapping. Despite the temperature differences between Gers and apartments (p<0.0001) infant core, peripheral and micro-environmental temperatures were no different, and no differences were found between swaddled and non-swaddled infants. Diurnal falls in overnight infant core temperatures, with larger falls in older infants, were not affected by the minimum indoor temperatures.

Traditional infant care practices in the harsh environmental conditions of the Gers, or the conditions in the apartments, which were very similar the previous measurements in homes in the UK, did not compromise thermal balance for healthy infants, despite very heavy wrapping, head covering, and bedsharing. The overnight pattern of the core temperature change was only shown in the environment of wide diurnal temperature variation. Swaddling has no thermal advantages over sleeping bags during the coldest time of day, and may present overheating of babies during the day.