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ORIGINAL ARTICLE
Comparison between swinging and playing of white noise
among colicky babies: A paired randomised controlled trial
Emel Sezici PhD, RN, Assistant Professor
|
Deniz Yigit RN, Research Assistant
Department of Pediatric Nursing, Kutahya
School of Health, Dumlupinar University,
Kutahya, Turkey
Correspondence
Emel Sezici, Dumlupinar University, Kutahya
School of Health, Kutahya, Turkey.
Email: emel.sezici@dpu.edu.tr
Aims and objective: This study aimed to compare the effects of swinging and play-
ing of white noise on the crying and sleeping durations of colicky babies.
Background: Infantile colic (IC) is one of the most common reasons for doctor visits
among babies younger than 3 months. One of five babies older than 3 months also
experiences IC. IC, unlike gastrointestinal problems, is regarded as an individual dif-
ferentiation and maturation of the central nervous system. Providing a warm bath,
breastfeeding, swinging and playing of white noise are nonpharmacological methods.
The efficiency of these methods has been proven by various studies independently
of one another.
Design: The study is a prospective, multicentre, paired randomised controlled trial.
Methods: The study was conducted between April–December 2016. The study
sample consisted of 40 1-month-old babies with gas pains who passed a hearing
screening and their mothers. The total daily crying and sleeping durations of the
babies were determined without any intervention on the first week. On the sec-
ond week, 20 randomly selected babies (first group) were swung each time they
cried, and on the third week, they were made to listen to white noise. The other
20 babies (second group) were made to listen to white noise on the second
week and were swung on the third week. Swinging and playing of white noise
were performed until the babies stopped crying. After every intervention, the
total crying and sleeping durations of the babies were evaluated using a “Colicky
Baby’s Diary.”
Results: Playing of white noise significantly decreased the daily crying durations
(p<.05) and increased the sleeping durations of the colicky babies (p<.05) com-
pared to swinging in both groups.
Conclusion: Playing of white noise was found to be a more effective nonpharmaco-
logical method on crying and sleeping durations of colicky babies than swinging.
Relevance to clinical practice: Playing of white noise may be helpful for parents
and healthcare personnel in reducing the gas pains of babies.
KEYWORDS
baby, care, colic, nursing, swinging, white noise
Accepted: 4 June 2017
DOI: 10.1111/jocn.13928
J Clin Nurs. 2018;27:593–600. wileyonlinelibrary.com/journal/jocn ©2017 John Wiley & Sons Ltd
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593
1
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BACKGROUND
Infantile colic (IC) is a typical paediatric disorder affecting ~5%–19%
of healthy babies worldwide (Gelfand, 2016). IC, which is a common
problem among babies, is the reason for 10%–20% of paediatrician
visits of babies aged between 2 weeks–3 months (Benninga et al.,
2016; Biagioli, Tarasco, Lingua, Moja, & Savino, 2016). According to
Wessel’s rule of threes, colic is defined as crying spells lasting for
≥3 hours a day at least 3 days a week for ≥3 weeks (Wessel, Cobb,
Jackson, Harris, & Detwiler, 1954). The aetiology and pathophysiol-
ogy of colic have not been understood explicitly (Boychuk, 2003).
Crying in a variable manner or style is the most typical symptom
in infants with colic. However, such crying can also be affected by
individual differences in the central nervous system, as well as the
stress of the mother and the baby, in addition to gastrointestinal
problems (Barr, 2002). The gas/gastrointestinal causes were
observed in <5% of colicky infants with intense, high-pitched and
prolonged crying (Gormally & Barr, 1997).
Sleep and neuroendocrine functions, sleep routine and cortisol
secretion develop during the first 12 months of life. A regular sleep/
wake pattern and circadian and ultradian processes begin to develop
during the neonatal period. The circadian rhythm emerges at around
2–3 months of age, with a synchronisation of the sleep/wake cycle
in relation to light/dark cycles and social stimulants, such as feeding.
It is clear that synchronisation of the sleep/wake cycle also emerges
with an increasing IC; however, there is no clear-cut pattern of sleep
in infants with IC as compared to healthy controls (Brand, Furlano,
Marc, Schulz, & Holsboer-Trachsler, 2011, 2014).
In the colic perceptive, pharmacological treatments, diet and
behavioural therapy methods can be used (Bahrami, Kiani, & Noras,
2016; Savino, Ceratto, De Marco, & di Montezemolo, 2014). The
behavioural approaches are the most commonly acknowledged treat-
ment practices against colic. Further, many nonpharmacological
methods, such as touching, cuddling, kangaroo caring, using of paci-
fiers, administration of glucose and playing of white noise, have been
scientifically proven to be effective in the pain control among colicky
babies (Balci, 2006; Bonetto et al., 2008; Latimer, Johnston, Richie,
& Clarke, 2009).
Swinging, which is described as “repetitive and rhythmic”move-
ments, is beneficial for colicky babies because it stimulates the
vestibular system and puts babies to sleep. At the same time, swing-
ing relieves pain in babies through stimulating endorphin secretion
(Yilmaz & Arikan, 2015). White noise consists of a mixture of various
frequencies coming from the environment and is a constant, mono-
tonous noise that covers all disruptive noises coming from the exter-
nal environment. It also includes intrauterine voices; therefore, it is
likened to uterus sounds when heard. There is proof that after
babies are born, they are relieved from anxiety and pain when they
hear such a rhythm (Karakoc & Turker, 2014; Kucukoglu et al.,
2016; Standley, 2001).
IC is an important problem that is amenable to nursing interven-
tions (Arikan, Alp, G€
oz€
um, Orbak, & Karaca Cifci, 2008). Paediatric
nurses are responsible for relieving the pain of colicky babies and for
teaching parents how to relieve such a pain. In the light of this
knowledge, the study aims to compare the effects of swinging and
playing of white noise on babies’gas pains and to contribute to the
literature in this sense. In this study, two hypotheses were sug-
gested: (i) there are differences in the crying and sleeping durations
between the colicky babies who are swung and who are made to lis-
ten to white noise, and (ii) there is no difference in the crying and
sleeping durations between the colicky babies who are swung and
who are made to listen to white noise.
2
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METHODS
2.1
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Trial design
This study is a prospective, multicentre, paired randomised con-
trolled trial. An informed consent form from the participants, institu-
tion permission and ethics committee approval were obtained.
Figure 1 describes the study flow. The design, conduct and reporting
of this study adhered to the Consolidated Standards of Reporting
Trials guidelines.
2.2
|
Participants
The study was conducted in the three largest public health centres
in K€
utahya, Turkey. One-month-old babies who passed a hearing
screening and experienced gas pain participated in the study with
their volunteer mothers.
2.3
|
Interventions
The data of the study were collected between April–December
2016. To determine the colicky babies before the study during the
first week, without providing any intervention to relieve their gas
pain, the daily crying and sleeping durations of the babies were
What does this paper contribute to the wider
global clinical community?
•IC, which is a common problem among babies, negatively
affects both healthy babies and their parents. Families
should then be supported with family-centred care as a
nursing approach to IC; they should be taught on the
duration and severity reduction treatment methods of
colic.
•The study findings revealed that compared to swinging,
having colicky babies listen to white noise decreased
their crying durations and increased their sleeping dura-
tions.
•To relieve pain, decrease crying durations and increase
sleeping durations, it is beneficial to play white noise to
babies.
594
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SEZICI AND YIGIT
recorded in a “Colicky Baby’s Diary”(normal follow-up), and the
“Information Form Related to Crying”was filled out by their moth-
ers. The babies determined to have colic during the normal follow-
up, and their mothers were included in the study. On the second
week, 20 randomly selected colicky babies (first group) were swung
whenever they cried. On the third week, they were made to listen
to white noise. The other 20 colicky babies (second group) were
made to listen to white noise on the second week and were swung
on the third week. The level of white noise was determined as
55 dB based on the studies related to music therapy in babies; white
noise was played 30–50 cm away from the babies (American Acad-
emy of Pediatrics Committee on Environmental Health 1997, Balci,
2006; Committee to Establish Recommended Standards for New-
born ICU Design 2007, Karakoc & Turker, 2014). The mothers were
taught when and how to have their babies listen to white noise at
home. The swinging and playing of white noise interventions lasted
until the babies stopped crying. Following each intervention, the
total crying and sleeping durations of the babies were recorded in
the Colicky Baby’s Diary. At the end of each week, the researcher
interviewed the participant mothers (by meeting with those who
could come to the health centre and by making phone calls or visit-
ing those who could not come to the health centre) and assessed
the forms.
2.4
|
Outcomes
The main outcome measures for this study were the total daily cry-
ing and sleeping durations of the babies. The daily crying and sleep-
ing durations of the colicky babies were monitored using the Colicky
Baby’s Diary filled out by their mothers. Every form included the
babies’daily crying and sleeping durations. The mothers were asked
to write down how many minutes and during which hours their
Assessed for eligibility (n = 82)
Excluded (n = 13)
♦Not meeting the inclusion criteria
(n = 0)
♦Declined to participate (n = 13)
♦Other reasons (n = 0)
Analysed (n = 20)
♦Excluded from the analysis (give reasons)
(n = 0)
Lost to follow-up (withdrawn) (n = 15)
Discontinued intervention (give reasons) (n = 0)
Allocated to undergo the intervention of playing
of white noise (n = 35)
♦Received allocated intervention (n = 35)
♦Did not receive allocated intervention (give
reasons) (n = 0)
Lost to follow-up (withdrawn) (n = 14)
Discontinued intervention (give reasons) (n = 0)
Allocated to undergo the intervention of
swinging (n = 34)
♦Received allocated intervention (n = 34)
♦Did not receive allocated intervention (give
reasons) (n = 0)
Analysed (n = 20)
♦Excluded from the analysis (give reasons)
(n = 0)
Allocation
Analysis
Follow-up
Randomised (n = 69)
Enrolment
FIGURE 1 CONSORT 2010 flow diagram. CONSORT, Consolidated Standards of Reporting Trials
SEZICI AND YIGIT
|
595
babies slept or cried. The crying and sleeping durations of the babies
were recorded in minutes every day for a week. During the analysis,
the daily average of the total crying and sleeping durations in
1 week was obtained. The resulting value has been converted to
hours. The statistical analyses were conducted after this conversion.
2.5
|
Sample size
Eighty-two babies with colic visited the public health centres
between April–December 2016. Among them, 69 babies who met
the study criteria and their mothers participated in the study. For
the determination of study groups, the simple randomisation method
was employed by deriving random numbers on a computer. How-
ever, 29 mothers have withdrawn from the study. In the experimen-
tal studies and parametric measures in the literature, it is suggested
to determine a sample size of at least 30 individuals (Sumbuloglu &
Sumbuloglu, 2000). Therefore, the study continued with the remain-
ing 40 babies. The sample size was determined via convenience sam-
pling. The power of the study was 0.984.
2.6
|
Randomisation and blinding
At the beginning of the study, all of the colicky babies were followed
up normally for 1 week. Later, the babies were divided into two
groups via computer randomisation at a ratio of 1:1. The babies in
the first group were swung on the second week and were made to
listen to white noise on the third week. Those in the second group
were made to listen to white noise on the second week and were
swung on the third week. There was no blinding in this study.
2.7
|
Statistical methods
Statistical analyses were performed using the IBM SPSS Statistics 21
software (IBM Corp., Armonk, NY, USA) for Windows
â
. The assess-
ment of the findings, descriptive statistics (average and standard
deviation), was used. Normality tests (Kolmogorov–Smirnov) were
performed on all continuous variables. For the socio-demographic
variables of the families, the chi-square test was used. An indepen-
dent ttest was used to compare the crying and sleeping duration
averages of the babies on the first, second and third week between
the groups (first and second group). In the intragroup comparison,
variance analysis (repeated measures ANOVA) and Tukey’s post hoc
test were used to compare the crying and sleeping durations on the
first, second and third week. The Tukey’s test was used to identify
the intragroup differences. A pvalue of <.05 was considered statisti-
cally significant.
3
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RESULTS
3.1
|
Sample description
The study groups were homogeneously distributed. No significant
differences were detected between both groups in terms of the
socio-demographic variables and crying characteristics (p>.05)
(Tables 1 and 2).
3.2
|
Effects of the interventions
There were no differences in the average of the crying durations
(p=.733) and sleeping durations (p=.781) between the groups on
the first week (before the intervention). After the intervention, there
were statistically significant differences found in the crying durations
(p=.041) and sleeping durations (p=.002) between the groups on
the second week and third week (p=.027 and p=.000, respec-
tively) (Table 3).
The crying and sleeping durations of the colicky babies in the
first group were statistically significant on the second and third week
when compared with those on the first week. All variables in the
repeated measures ANOVA in the first group were statistically sig-
nificant (F=356.896, p=.000; F=79.765, p=.000). All pairwise
differences between the first, second and third week were found to
be statistically significant after further analysis (Table 3).
In the second group, all variables in the repeated measures
ANOVA showed statistically significant results (F=663.366,
p=.000; F=208.799, p=.000). After further analysis, this differ-
ence was found to be significant between the first–second week
(p=.000) and between the first–third week (p=.000). There was
no significant difference between the second–third week (p=.381
and p=.699) (Table 3). On the week when white noise was played,
the decreased crying duration and increased sleeping duration were
found to be statistically significant in both groups compared with
those on the previous week (p<.05) (Table 3).
4
|
DISCUSSION
Many nonpharmacological methods, such as touching, cuddling,
kangaroo caring, using of pacifiers, administration of glucose and
playing of white noise, are frequently used in colicky babies. It is
of significance to reveal the efficiency of these methods in pain
management among colicky babies and to have nurses employ
these methods. In our study, the comparative effects of playing
white noise and swinging on the crying and sleeping durations of
the colicky babies were investigated, and the former was found to
be more effective than the latter. We could not search for any
studies conducted on the effectiveness of both methods in colicky
babies. Thus, we believe that the results of this study will
contribute to the existing literature.
Two hypotheses were formulated. We expected that there are
differences in the crying and sleeping durations between the colicky
babies who are swung and who are made to listen to white noise
(first hypothesis); the independent ttest and repeated measures
ANOVA analyses confirmed this expectation. For this reason, our
second hypothesis has not been confirmed.
On the second and third week of intervention, the crying dura-
tion decreased, and the sleeping duration increased in both groups.
596
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SEZICI AND YIGIT
It is emphasised in the literature that as swinging stimulates endor-
phin secretion through “repetitive and rhythmic”movements, it is
beneficial in relieving pain in babies and helpful in putting them to
sleep through stimulating the vestibular system (Yilmaz & Arikan,
2015). In the studies of Ourth and Brown (1961) and Gordon and
Foss (1966) comparing nonpharmacological methods to relieve pain
among newborns, it was suggested that swinging crying babies is
effective in decreasing their crying duration. Mathai, Natrajan, and
Rajalakshmi (2006) indicated that swinging and using pacifiers were
more effective nonpharmacological methods than breastfeeding,
providing distilled water or sucrose, or massaging. According to
other studies, mothers were found to use swinging to console and
put their babies to sleep (Abdulrazzaq, Al Kendi, & Nagelkerke,
2009; Cansever, Tasar, Sahin, Camurdan, & Beyazova, 2012;
Howard, Lanphear, Lanphear, Eberly, & Lawrence, 2006), which is
in accordance with the present study’s findings. These findings
emphasise that swinging is an effective method in colicky babies.
The observed differences in the crying and sleeping durations of
TABLE 1 Socio-demographic variables of the family (n=40)
Socio-demographic variables
1st Group 2nd Group
x
2
pn %n%
Mother’s age
Ages 20–30 16 80 15 75 0.143 .705
31 and older 4 20 5 25
Mother’s educational background
Primary school 4 20 5 25 0.151 .927
High school 13 65 12 60
University 3 15 3 15
Mother’s employment status
Employed 7 35 11 55 1.616 .204
Unemployed 13 65 9 45
Number of children
1 8 40 8 40 0.750 .687
2 7 35 9 45
3 5 25 3 15
Assistance with child care
Mother with assistance 9 45 15 75 3.750 .053
Mothers without assistance 11 55 5 25
Family type
Nucleus 14 70 15 75 0.125 .723
Extended 6 30 5 25
Baby’s gender
Girl 12 60 11 55 0.102 .749
Boy 8 40 9 45
Nutrition style
Breast Milk 12 60 9 45 0.902 .342
Breast Milk +Formula Milk 8 40 11 55
Baby relieving process
Changeable 9 45 5 25 3.276 .351
Difficult 9 45 9 45
Very difficult 1 5 4 20
S/he definitely never get relieved 1 5 2 10
Baby’s behaviours while trying to relieve him/her
When I start to relieve him, he relaxes. 2 10 2 10 0.000 1.000
My efforts to relieve him do not work. 7 35 7 35
My efforts to relieve him make him cry even more. 4 20 4 20
During my efforts to relieve him, he arches his back. 7 35 7 35
SEZICI AND YIGIT
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597
the babies who were swung might stem from the comfort coming
from the rhythmic movements and the relaxing effects of being
swung.
The most prominent and observable reaction to pain in new-
borns is crying. In the literature, parents emphasised that playing of
white noise was quite beneficial in relieving pain among crying col-
icky babies (Balci, 2006). In their studies, Kucukoglu et al. (2016)
Karakoc and Turker (2014) revealed that the pain scores of the new-
borns who were made to listen to white noise were observed to
decrease compared with those of the newborns in the control group.
Malinova, Malinova, and Krusteva (2004) stated that playing of
music decreases the agitation and crying rates among newborns. In
the study of Balci (2006), it is understood that having colicky babies
listen to white noise decreases their crying durations and increases
their sleeping durations. In his study, Schwartz (1997) had preterm
newborns listen to their mothers’voices and relaxing music similar
to uterus sounds. It is emphasised that this music helped decrease
stress symptoms in the babies and positively affected the babies’life
findings. Studies have shown that the crying levels of infants
decrease and their sleeping state improves after they listen to classi-
cal music, lullabies and songs (Butt & Kisilevsky, 2000; Malinova
et al., 2004). In this sense, the study findings are in accordance with
those in the literature. In the present study, the effects of swinging
and playing of white noise were compared among colicky babies.
Both of the methods showed positive effects on the colicky babies.
However, it was found that compared to swinging, playing of white
noise was a more efficient method in decreasing crying durations
and increasing sleeping durations of colicky babies (Table 3). As for
the reason for such findings, two opinions are put forth, one of
which asserts that babies are influenced by their mother’s heartbeats
even while still inside their mother’s womb (Kawakami, Takai-Kawa-
kami, Kurihara, Shimizu, & Yanaihara, 1996; Standley, 2001), and the
TABLE 2 Socio-demographic variables of the babies (n=40)
Feature
1st Group 2nd Group
tpMin.–Max. Mean SD Min.–Max. Mean SD
Birth week 37–41 38.90 0.968 37–41 39.45 1.099 1.680 .101
Birthweight (g) 2300–3900 3247 425.591 2800–4100 3300 403.733 0.633 .531
Current weight (g) 3600–5450 4687.50 469.007 4000–5400 4883.25 397.049 1.425 .162
Total crying durations (hr) 3–6 3.80 0.894 3–6 4.05 0.759 0.953 .347
Number of the days when crying lasts
more than 3 hr
3–5 3.80 0.696 3–5 3.40 0.598 1.949 .059
Time spent with baby (hr) 14–24 19.95 2.982 14–24 19.25 2.971 0.744 .462
TABLE 3 Comparison of crying and sleeping durations of colicky babies (n=40)
Groups
1st Group
Multiple comparisons
2nd Group
Multiple comparisons t
a
pMean SD (hr) Mean SD (hr)
Crying duration in the 1st
week
4.8763 0.5778 1 week vs. 2 week =0.000
2 week vs. 3 week =0.012
1 week vs. 3 week =0.000
4.8250 0.3364 1 week vs. 2 week =0.000
2 week vs. 3 week =0.381
1 week vs. 3 week =0.000
0.343 .733
Crying duration in the 2nd
week
2.3312 0.2058 2.1931 0.2075 2.113 .041
Crying duration in the 3rd
week
2.1410 0.1521 2.3185 0.3031 2.341 .027
F
b
=356.896; p = 0.000 F
b
=663.366; p = 0.000
Sleeping duration in the 1st
week
10.5852 1.8215 1 week vs. 2 week =0.000
2 week vs. 3 week =0.000
1 week vs. 3 week =0.000
10.4545 1.0035 1 week vs. 2 week =0.000
2 week vs. 3 week =0.699
1 week vs. 3 week =0.000
0.281 .781
Sleeping duration in the
2nd week
14.2425 0.8351 15.0666 0.7559 3.272 .002
Sleeping duration in the
3rd week
15.6588 0.7630 14.7927 0.6124 3.959 .000
F
b
=79.765; p= .000 F
b
=208.799; p= .000
a
Independent sample ttest.
b
Repeated measures ANOVA.
Values in bold type if p<.05.
598
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SEZICI AND YIGIT
second claims that after birth, rediscovering this familiar sound and
rhythm creates a relaxing effect (Karakoc & Turker, 2014; Ovali,
2005).
4.1
|
Limitations
Although the study has reached its aims, there were several limita-
tions present. First, the participation rate in the study was relatively
low, as it required a 3-week follow-up and practice. For this reason, it
would be helpful to spend more time in the data collection phase of
the study. Second, the reliability related to how the participant moth-
ers interfered with their babies and in their records of crying and
sleeping durations was not measured. There was then the possibility
of a record bias, as the mothers were responsible for recording the
crying and sleeping durations. Independent assessors may be needed
in the evaluation to remove such a bias. However, as babies need 24-
hr continuous follow-ups, it is considered more appropriate to have
these assessments conducted by their mother. Third, the researcher
was not blinded to the study information, as the researcher was
responsible for the randomisation and matching of the study groups.
Finally, the validity and reliability of the data collection tools used in
this study were not assessed before. The validity and reliability of
such data collection tools should be assessed in future studies.
5
|
CONCLUSIONS
Swinging and playing of white noise among colicky babies are some
of the nonpharmacological care attempts used. The study results
demonstrate that both methods (swinging and playing of white
noise) decreased the babies’crying durations and increased their
sleeping durations compared to the control week. However, com-
pared to swinging, playing of white noise was found to be a more
effective nonpharmacological method on the crying and sleeping
durations of colicky babies.
6
|
RELEVANCE TO CLINICAL PRACTICE
The study findings indicate that having colicky babies listen to white
noise is an appropriate attempt to decrease their crying durations
and to increase their sleeping durations. Healthcare personnel and
parents can be recommended to play white noise, which is a non-
pharmacological method, to decrease babies’gas pains.
ACKNOWLEDGEMENTS
We thank all doctors, staff of public health centres and interviewees
who participated in the study.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interests.
AUTHORS’CONTRIBUTIONS
Study design: ES, DY; data collection and analysis: ES, DY;
manuscript preparation: ES, DY.
ORCID
Emel Sezici http://orcid.org/0000-0002-6325-6607
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