Reconsidering the 5 Ss

Trends in baby management come and go, but one that has stuck around for awhile has been Dr. Harvey Karp’s Happiest Baby on the Block 5s method. Dr. Karp developed this method as a way to soothe fussy babies by mimicking how a baby feels in the womb by swaddling, putting the baby on a side/stomach position, swinging, shushing, and giving a baby a pacifier to suck on.

Babies do love to lay on their sides and especially their stomachs. One thing that babies love is to be placed on a grownup’s chest, and it’s even better if this is done skin to skin. Skin-to-skin contact facilitates breastfeeding in a myriad of ways, and babies feel secure while on their stomachs. That’s a win-win. Swaying is a natural way of soothing a baby, and probably feels good to all parties involved. These two Ss are pretty great, and work without the use of the others.

But three of the five 5s are not so neutral and, I think, not so compatible with breastfeeding. Are they overwhelmingly bad and should never be used? No, but some consideration of the benefits and risks is warranted.


Swaddled babies are ubiquitous, so we might get the impression that it’s necessary and without risk. On the contrary, swaddling that constricts the legs or hips in any way might lead to hip dysplasia. Too-tight swaddling could impair respiration (this journal article specifically points to Karp’s method as suggesting a tight swaddle).

Searching for images of swaddled babies, I don’t need to go farther than looking at my own.

When it comes to breastfeeding, a baby’s hands might seem to be getting in the way, but those seemingly random or detrimental hand movements serve a purpose. In this overview of the literature about infant hand use published in Lactation Matters, the authors state:

Almost all breastfeeding instructions include restraining the baby’s arms. However, we’ve observed that if left unhindered, infants from birth to at least 3–4 months of age use their hands during the attachment process.

Consider, also, that a baby sleeping longer than he would without swaddling will be waking less often to feed, and this can negatively impact milk supply.

Even more discussion on swaddling can be read on Nancy Mohrbacher’s blog.


Shushing, or providing any white noise, is not without its risks. Recent research considered whether white noise machines might be harmful to a baby’s auditory development and determined that white noise machines exceed the noise limit for infants in nurseries while at their maximum volume. While it’s probably obvious that most babies aren’t having white noise machines blasting at them at all hours of the day, it’s worth considering that white noise machines aren’t neutralizing sounds, but adding more sound to the environment. The cumulative effect of noise at one time and throughout the day should be considered when we’re thinking about how much noise an infant is exposed to and how that might affect auditory development. The shushing of Karp’s method is sometimes done by a mouth right next to an ear; I’m going to guess that if it works, it’s not because it’s soothing, but because the infant is shutting down to avoid being overwhelmed.

Dr. Karp’s website says, “The right type of white noise can instantly add 1-3 hours to a swaddled baby’s sleep.” Is that something beneficial for a baby who is already possibly sleeping through feeds?


The “sucking” of Karp’s method is sucking on a pacifier, not a breast. There is a lot that I could say about pacifier use, but summarizes it all well. The first, and most important, point made is, “Never substitute a pacifier for a feeding at the breast or try to hold the baby off longer between feedings with one.”

That one sentence can apply to the 5 Ss as a whole. It can be and is used as a way to hold babies off longer between feedings. Babies, especially breastfed ones, eat often and, not only is breastfeeding about food, it is about comfort. Dr. Karp says, “As odd as it may sound, one of the main reasons babies cry is because they are born three months too soon,” but here’s the thing: Babies are born when they’re supposed to be born, and once they are born, their natural environment becomes mother’s breasts. That is where they want to be. Let’s change our thinking a bit. Breastfeeding isn’t done every two to three hours or whenever baby is hungry. It is done on demand, whenever baby is hungry—or whenever baby wants to feel safe, secure, and calm.

The 5 Ss may be useful tools for non-breastfeeding parents or other caregivers, but, as I said earlier, there are elements to the 5 Ss that work whether a baby is swaddled, on his side, swinging, shushed, and sucking. I suggest that we not make it our end goal to soothe babies as quickly as possible, using whatever methods possible, and that we make it our goal to be there for our babies, even if what we’re doing is not bringing immediate relief, and use breastfeeding as the parenting tool it can be, instead of just a feeding method.