Indian Journal of Traditional Knowledge

Vol. 13 (3), July 2014, pp. 445-452

Traditional practices frequently used for the newborn in Turkey:

A literature review
Nurcan Özyazıcıoğlu*& Sevinç Polat**
*Nurcan Özyazıcıoğlu, Ph D, RN, Associate Professor, Uludağ University, School of Health, Bursa, Turkey;
**Sevinç Polat, Ph D, RN, Associate Professor, Bozok University, School of Health, Yozgat, Turkey
E-mails: nurcanozyazicioglu@yahoo.com.tr; nurcanoz@uludag.edu.tr; sfpolat@mynet.com

Recived 07.01.14, revised 04.03.14

The aim of this study is to identify some traditional practices used for the newborn babies in Turkey and to discuss the
possible effects of these practices upon the health of the babies. The traditional care practices (salting, swaddling, holluk,
starting breastfeeding late, practices against newborn jaundice, making the forties, etc.) reported to be most prevalent
between January 2008 and October 2012 were examined. Possible risks of these practices were identified as follows:
Hypernatremia due to salting the newborn, tetanus because of wrapping the newborn in holluk, hypoglycemia owing to
starting breastfeeding late, hip dysplasia due to tight swaddling of the newborn, and kernicterus as a result of delaying the
medical treatment of jaundice. Making the forties was regarded positive in terms of psychological relief but negative in
terms of infection.

Keywords: Traditional practices, Newborn, Turkey, Literature review, Nursing

IPC Int: Cl.8: A47K 3/024, A47K 3/034, A47K 3/064, A47K 3/074, B62B 7/00, B62B 9/00, A41D 27/26, AO1D 7/31,
AO1D 23/21, AO1D 23/07- AO1D 23/11, AO1D 23/13, AO1D 20/00

The knowledge, belief and values of the society as
well as the living place and cultural features affect the
practices used for the children and the babies1 . These
beliefs and practices may be rational or irrational and
may become useful or harmful behaviors depending
on their objectives and outcomes2,3 . Some of these
practices cannot be explained exactly in medical
terms and their effects are not known accurately. The
traditional practices used at times of either health or
disease of the newborn since birth may cause a delay
in the healing process or even death due to the
aggravation of the disease because the basic causes of
the diseases are ignored.
In Turkish culture, the newborn children are held
very precious. Women want to have a baby as soon as
they get married. However, while they bring up their
babies, they tend to opt for many traditional practices
the results of which are often unknown4. The
frequently used traditional practices for the babies are
as follows: salting the baby, swaddling the baby,
wrapping the baby in holluk, waiting for some time to
start breastfeeding the baby, and trying various
treatment methods meant to cure newborn jaundice 5-13.
——————
*Corresponding author
According to the 24th article of UNICEF Convention
on the Rights of the Child, it is emphasized that
appropriate and effective measures should be taken in
order to terminate traditional harmful practices for the
health of the children14.
Pediatric nurses should be aware of their own
cultural values, accept the cultural differences of the
society, and should have the ability to tailor their
practical skills in ways to accommodate for the cultural
structure of the children and their families in order to
provide care in a culturally competent manner15.
Awareness of this issue on the part of the nurses is
important in terms of holistic nursing approach and the
quality of the care.
There are different studies aimed at identifying
traditional practices common in Turkey and across the
world but only a small number of these studies mention
the potentially positive or negative outcomes of these
practices.
Objectives of the study
1 To identify some traditional practices used in
Turkey for the newborn.
2 To discuss the potentially useful and harmful effects
of these practices on the health of the newborn.
446 INDIAN J TRADITIONAL KNOWLEDGE, VOL 13, NO. 3, JULY 2014
Methodology
Sources of data
For the aims of the current review; the topic of the
study was examined in detail in the databases of
Pubmed and Google Scholar via different keywords
relevant to the subject. The methods and findings of
medical and nursing studies which are believed to
have affected the health of the newborn and which
were performed during January 2008 and October
2012 in Turkey were included in the study. In Turkey,
traditional care practices such as salting, swaddling,
holluk, starting to breastfeed late, making the
forties, and taking traditional measures against
jaundice are common. Information obtained from
relevant descriptive studies, reviews, evidence-based
researches and books is utilized in the Discussion and
Results part of the study.
The review of literature was achieved out of three
phases of data collection research. In the first phase,
the studies conducted in Turkey and published in
either Turkish or English language were sought using
bilingual keywords such as Turkey, newborn, and
traditional neonatal care practices. The most relevant
14 articles in full text (6 articles published in Turkish
and 8 articles in English) were included in the study.
In the second phase, commonly used practices for the
newborn were screened. In the third phase, literature
information that can cater for the Discussion part was
gathered from the search through the keywords
“newborn, salting, swaddling, making the forties,
holluk, jaundice, starting to breastfeed late” was used
in the study. Special attention was paid to include the
most recently conducted articles at the time of the
current study. Full text articles referred in this study
were accessed online via the libraries of Bozok
University and Uludağ University.
General results
Many articles were found in PUBMED and Google
Scholar. Articles published from 2008 and on were
assessed in order to refine them and also the word
“Turkey” were added in the sought words.
Database searches
A total of 343 articles were identified using the
search terms (Fig. 1). Initial scan of the titles and
abstracts led to the exclusion of duplicates, editorial
and conceptual pieces. Following this, 116 full-text
articles were read for inclusion. At the last stage of
review, 329 articles were excluded because of
incomplete reporting of effects and/or outcomes of the
Fig. 1—Criteria for the selection of the articles used in the study
traditional practices applied on the newborn, leaving a
number of 14 articles eligible for the aims of the
current study.
Results
The main focus of this study is the basic health
problems and issues faced in the newborn in Turkey.
Some of the rituals and traditional treatment methods
used for the newborn are identified as follows: salting
the baby, swaddling the baby, wrapping the baby in
holluk, starting to breastfeed the baby late, making the
forties, and various treatment methods against
jaundice (Table 1).
As seen in Table 1, the most commonly used
traditional practices were (a) salting the baby, (b)
swaddling the baby and (c) various treatment methods
used against jaundice.
In the studies of Işık et al. (2010) and of Çetinkaya
et al. (2008), salting the baby was the most widely
used practice (86.5% and 74.2%, respectively)10,12 .
Swaddling is the most commonly used traditional
practice for the newborn in Turkey. Alparslan &
Demirel (2012) reported that this practice was applied
for % 84 of the newborn babies5. Similarly, in the
study of Ayaz & Efe (2008) swaddling was found to
be widely practiced (% 81)13. Wrapping in holluk and
starting breastfeeding late were the least commonly
used practices. As shown in Table 1, holluk, primarily
practiced in middle and southern parts of Turkey, was
found to be used for % 35 of the newborn in Ayaz &
Efe (2008), the highest rate to be reported among all
the studies screened13. Starting breastfeeding late,
which is already applied in small scales, is becoming
less and less common in all parts of Turkey. The
highest rate for this practice (%19.2) was reported in
 Özyazıcıoğlu & Polat: TRADITIONAL PRACTICES FOR NEWBORN IN TURKEY 447

Table 1—The rates of the use of the traditional practices identified in previous studies
Traditional Practices (%)

Articles Salting Swaddling Holluk Starting Newborn Making the

Breastfeedi jaundice forties
ng late
Alparslan & Demirel 2012 Aim: to identify the traditional neonatal 45.3 84 29.3 - - 62.4
care practices applied Sample: 263 married mothers Area: urban
( Eastern region of Turkey - Sivas)
Yalçın 2012 Aim:to identify traditional practices of pregnancy, 63.0 66.1 23.5 - 55.3 64.1
birth and puerperality and baby care and their correlation with
socio-demographic status Sample:195 women who had at least
one pregnancy or birth Area: urban- (inner region of Turkey-
Karaman)
Yılmaz et al. 2012 Aim:to investigate the practice of swaddling by - 47.3 - - - -
Turkish mothers residing in different areas of the country Sample:
598 mothers Area: rural and urban- (inner region of Turkey-
Ankara) Ankara Hospital Polyclinics
Kahriman et al. 2011 Aim: To evaluate traditional baby care 31.5 31.3 - 0.5 - -
practices employed by mothers Sample: 384+ mothers Area: urban
areas (North east region of Turkey - Trabzon)
Çalışkan & Bayat 2011 Aim: To determine mothers’ baby care 17.5 56.3 8.2 - 48.9 -
practices and the affecting factors Sample: 320 mothers Area:
urban (inner region of Turkey -Nevşehir)
Taşar et al. 2011 Aim: To determine the practices of 21.6 1.4 1.2 - 15.0 -
"Complementary and Alternative Medicine" used for the children
of the families with low income levels Sample: 345 mothers Area:
urban areas (inner region of Turkey-Ankara)
Işık et al. 2010 Aim:To determine the traditional practices used for 86.5 51.9 21.1 - 46.1 50.0
mothers and the newborn during pregnancy, birth, and puerperality
period. Sample: 54 mothers aged ≥ 50 Area: rural or urban-
(southern region of Turkey-Mersin)
Beşer et al. 2010 Aim: To determine traditional child care of the - - - 7.2 31.4 14.3
mothers with babies aged < 1 year. Sample: 70 mothers with
babies aged < 1 year. Area: urban areas (western region of Turkey
-Izmir)
Aliefendioğlu et al. 2009 Aim:To examine traditional baby care 0.7 27.2 0.2 2.8 0.8 -
practices Sample:974 mothers Area: urban areas (inner region of
Turkey-Kırıkkale)
Bölükbaş et al. 2009 Aim:To determine traditional practices of - 53.2 - 19.2 12.4 3.5
child care used by mothers with babies aged 1-12 months Sample:
203 mothers visiting maternity and birth hospital. Area: rural and
urban- (north region of Turkey -Ordu)
Çakmak et al. 2009 Aim:to describe the regional healing methods - - - - 41.9 -
and mothers’ beliefs in and attitudes toward Neonatal Jaundice.
Sample: 224 mothers of infants 1 to 21 days of age attending a
university hospital pediatrics department. Area: rural and urban-
(the south eastern region of Turkey -Şanlıurfa)
Geçkil et al. 2009 Aim: to gain an understanding of traditional - - - - 89.0 -
postpartum practices for women and babies, and to investigate the
factors influencing such practices. Sample: 273 women who gave
birth at the Maternity and Children's Hospital in Adiyaman city.
Area: rural or urban- (South Eastern Turkey- Adıyaman)
Çetinkaya et al. 2008 Aim: To determine women’s traditional 74.2 60.4 - 14.6 6.4 73.7
practices used for the newborn during postpartum period. Sample:
382 mothers Area:urban (western region of Turkey-Manisa)
Ayaz & Efe 2008 Aim: to identify potentially harmful practices of 40.0 81.0 35.0 17.0 - -
married women during pregnancy, delivery and postpartum
Sample: 121 women Area: rural (inner region of Turkey-village of
Ballikuyumcu, Ankara)
448 INDIAN J TRADITIONAL KNOWLEDGE, VOL 13, NO. 3, JULY 2014
the study of Bölükbaş et al. (2009)16. Although it is
typically used in each part of Turkey, traditional
measures taken against the newborn jaundice was
reported to be most common in Southern Turkey
(%89) and Middle Anatolia region (%55.3). Making
the forties was most commonly observed (%73.7) in
the West Anatolia regions according to Çetinkaya
et al. (2008)12. The studies shown in Table 1 were
conducted in cities and rural regions in all parts of
Turkey or contained data obtained from the patients
who went to the policlinics.
Discussion
The differences observed in Table 1 in frequencies
(in percentages) of the traditional practices may be
due to different times (year of the study) and settings
of the studies (the regions, urban vs. rural areas). The
geographical characteristics of Turkey considerably
differ from region to region (e.g. northern and eastern
parts of Turkey are very mountainous). Particularly in
eastern regions, winter is harsh and long and people
usually have inadequate socio-economical facilities,
which results in insufficient and poor use of health
care services and an increase in the use of traditional
practices.
Salting babies
As indicated in Table 1, the study of Işık et al.
(2010) revealed salting practice as the most widely
used practice, the reason for which may be that the
study group involved older women (aged ≥ 50
years)10. Salting practice includes rubbing the baby’s
body with moist salt and putting the salting in his
mouth for about one hour. Different methods of
salting are used in Turkey as well as other parts of the
world such as Middle East, India, China. This practice
was performed with the assumption that it would (a)
avoid the bad smell of the body sweat of the newborn,
(b) decrease sweating, (c) strengthen the muscles and
bones, (d) prevent infections, and (e) ensure that
injuries would heal fast. Believed to deter
supernatural beings and evils, salt is traditionally used
with the assumption that it would not bring disease
and death5, 13, 17.
Studies in the previous literature revealed that
extensive amount of salt may cause absorption of the
sodium through skin and thus epidermolysis and
hypernatremia, which is a life-threatening disease
with symptoms of dry or burnt-like skin18. In many
cases of salting in which the newborn babies were
brought to hospitals, it has been observed that
numerous medically dangerous conditions such as
hypernatremia, renal failure as a complication of
hypernatremia, dehydratation, neonatal convulsion19,
20
, skin lesions, hyperbilirubinemia, intracranial
bleeding, and even death17 can occur. Fournier's
gangrene cases have also been observed among the
newborn babies due to salting21. As dehydratation that
develops after hypernatremia may endanger the life of
the baby, nurses should be attentive to salting practice
and its results while in their evaluation of the
newborn.
Swaddling
Swaddling is the practice of wrapping infants in
blankets or similar cloth so that movements of the
head and limbs are tightly restricted. Swaddling is
known for ages. The oldest practice of swaddling
dates back to the time of Soranus of antique Rome
(around 100 AD)22 . Later, in Sweden, in a painting
belonging to the New Age, it was discovered that a
picture depicted a baby swaddled23. Rejected by
modern medicine, swaddling is still applied as part of
a tradition in Turkish society.
As can be observed in Table 1, the studies of
Alparslan & Demirel (2012) and Ayaz & Efe (2008)
exposed swaddling as the most widely used practice.
It is a possibility that swaddling was meant to protect
the babies from cold5,13 owing to the heating problems
caused by high altitude, cold climate and low socio-
economical status of the places where the studies
were conducted. People swaddle the babies as tightly
as possible assuming that the more tightly they
swaddle the babies the stronger they will become.
Swaddling also aims at keeping the baby’s body in
symmetry and preventing the baby doing dangerous
movements5-13, 16, 24, 25.
In the studies investigating the effects of
swaddling, it was demonstrated that the practice of
tight swaddling was harmful because it trigger hip
dislocation among those with a tendency of congenital
hip dysplasia as well as causing feelings of unease
and unrest for the newborn16, 23, 26. Besides these,
swaddling prevents skin contact between mother and
her baby, which fosters mother-baby interaction,
decreases baby-cry and thus positively affects their
health22, 27.
In the guiding study of Van Sleuwen et al. (2007)
on swaddling, it was emphasized that the position of
hips and legs tightly and straightly wrapped in a
conjoined way would lead to hip dysplasia as well as
 Özyazıcıoğlu & Polat: TRADITIONAL PRACTICES FOR NEWBORN IN TURKEY
lack of vitamin D, tendency for acute respiratory
infections, risks of overheating and SIDS (if laid or
turned in prone position)28.
The experimental study of Manaseki-Holland et al.
(2010) reported that swaddling did not have a
significant effect upon mental and psycho-motor
growth of the children during the first years of life29.
The experimental study of Meyer & Erler (2011)
indicated that swaddling provided a more peaceful
sleeping30. The study of Karp (2008) pointed out that
wrapping the lower extremities in a loose way caused
the babies to wake up less and decreased their colic
cry while swaddling in supine position decreased the
risk of sudden infant death syndrome31.
As a result, although partial and loose swaddling
practice may be used in cold regions during winter, it
should be born in mind that tight swaddling – as done
in some regions of our country- is medically
unacceptable due to above mentioned dangers.
Wrapping the baby in holluk
The highest rate of wrapping the baby in holluk
occurred in the study of Ayaz & Efe (2008)13. The
fact that this study was conducted in rural regions on
an earlier date than the other ones may have affected
this result. Holluk is a kind of soil which does not turn
into mud easily, which feels like silt and which
contains clay. Holluk is heated up to a certain degree
not to harm the skin of the baby. It is manually
scattered on a piece of a second cloth placed on
swaddling cloth and the baby is swaddled in a manner
that holluk can touch lower parts/hips of the body.
Holluk, with its high rate of absorption, eliminates
dampness causing nappy-rash and therefore prevents
both mothers and the babies from being restless and
uneasy. It is also believed that holluk is also useful
because it warms up the baby against common cold6,
32
. When compared to baby nappy, holluk is a pure
example of self devotion in terms of its difficult and
time-consuming preparation5, 6, 8-11, 13.
The aim of wrapping the baby in holluk comes
from the idea that baby can get strength from the soil
and adapt himself to the nature. However, if it is not
burned before use, it can lead to fatal infections,
especially tetanus, due to microorganisms living in
the soil11. In a study made by Özen & Özgör (2006), it
was reported that every two of the three children
wrapped in holluk and brought to hospital due to
severe infection caused by different pathogenesis died
of tetanus or Eschericiacolisepsia33.
449
Waiting for some time to start to breastfeed the baby
The study of Bölükbaş et al. (2009) indicated that
nearly one fifth of Turkish mothers start breastfeeding
their babies late16. A vast majority of the mothers in
Turkey breastfeed their babies. Traditionally,
however, there are very different starting times for
breastfeeding such as after 1-8 hrs, 1 day, 1 week
after birth or 3 or 5 azans (a kind of call to prayer
made five times a day)7,11-13,16,25,34. There are different
opinions within the society about feeding the
newborn. Clinical guides emphasize that supplement
food is not needed even if the newborn cannot be fed
adequately for 24-48 hrs but in cases of severe
illnesses of mothers and babies supplementary food
may be required together with breastfeeding. This is
recommended in order to prevent insufficient
breastfeeding and compensating this through
supplementary food in early stages35.
It is stated in the literature that breastfeeding the
baby right after birth plays a vital role in secretion of
milk from mammary glands and in the continuity of
breastfeeding36. Starting to breastfeed late may
decrease lactation and duration of breastfeeding of
mothers and may hinder development of the
emotional bond between mother and baby in the early
period. With premature babies with low birth weight,
late breastfeeding can increase the risk of
hypoglycemia and hypothermia, causes of early
neonatal death37, 38.
A randomized controlled study of Garcia et al.
(2011) with Indian mothers with newborn babies
revealed no correlation between breastfeeding and
neonatal mortality within the 1st hour and 12th hour of
birth but it was demonstrated that breastfeeding
applied later than within the first 12 hrs due to various
reasons may increase neonatal mortality39.
In Turkey, the first foods given to babies after birth
differ, too. Sugared water/fruit juice, baby
food/ground rice, zemzem water (water believed to be
sacred for Muslims and to spring around Mecca),
dadak (bread dipped into tea), honey, sweetened fruit
juice are given to the newborns in Turkey after
hodjas’ (muslim priests) prayers pleading for the baby
a religious and gentle and kind life. These foods given
to the babies affect breastfeeding negatively.
Literature points out that giving prelacteal foods to
the newborn before colostrum may cause allergy,
diarrhea and other infections4, 37.
Newborn jaundice
The highest rate of use of various traditional
treatment methods against jaundice emerged in the
450 INDIAN J TRADITIONAL KNOWLEDGE, VOL 13, NO. 3, JULY 2014
study of Geçkil et al. (2009) (89.5%)40. These
practices were as the following: putting a yellow
cover on the baby’s face, using yellow objects (gold,
yellow beads, yellow clothes), stopping breastfeeding,
cutting the forehead, upper lips, or lower part of
tongue for a little bleeding, prayers of hodjas and
bathing the babies with water ornamented with golden
objects8-12,16,34,40,41.
In a study conducted to explore the same issue in
Iran, it was reported that mothers, in order to treat the
newborn jaundice, stop breastfeeding, and do not give
colostrum - a yellowish and thin fluid42. Dressing the
baby with yellow clothes is not recommended because
it may prevent the mothers from detecting baby’s
yellowish discoloration. The practice of cutting the
forehead, lips or the lower part of tongue is dangerous
as it may lead to infection34,43.
Another practice is doing nothing but waiting so that
the jaundice will heal spontaneously without seeing
doctor. Sreeramareddy et al. (2006) found out that
2.7% of the mothers do so44. This practice is accepted
dangerous because it delays the treatment of newborn
jaundice and causes kernicterus and even death.
Making the forties
The frequency of the practice of making the forties
in Turkey was found to be the highest (73.7%) in the
study of Çetinkaya et al. (2008)12. In the Turkish
society, as part of a tradition, mothers and their babies
are not allowed to go out for forty days and the babies
are not shown to strangers. In addition, the newborn is
bathed on either the 3rd, or the 20th, or the 40th day
following birth. It is believed that babies become
stronger and are saved from evil spirits when mothers
and their babies have a bath at the end of the 40th day.
Although it is thought that this belief may provide a
psychological relief, waiting for bath as long as for 40
days may cause infections. Similar practices are seen
in Chinese, Indian and Iranian societies, too and
mothers and their babies are not allowed to go out
before the ritual of forties is held45.
There are also other practices about the first
bathing of the newborn such as reading the Mevlit (a
kind of praise poem for prophet Mahomet) prayer
onto the bath-water, and putting a stone, fork, a piece
of broom, nigella, a peel of an onion, golden ring, or
40 barley corns, 40 wheat kernels, 40 peas, 40 lentils
and 40 stones and fragrant green leaves into the
baby’s bathing water5, 6, 10,12,25,34.
In the studies conducted in Turkey; it was
understood that mothers’ old age, low income level
and low educational status, their living places (rural
vs. urban, mountainous areas, etc.), their staying with
elder members of the family increase the frequency
rates of using traditional newborn practices5,9,12,13.
Likewise, in the studies conducted in other countries,
it was noted that high socio-educational level of
mothers increased the possibility or mother’s taking
the newborn diseases seriously, rejecting traditional
practices, and opt for medically appropriate
interventions instead44, 46, 47.
Conclusion
Traditional practices used for the newborn have
been found to have the following negative effects on
their health:
1 Hypernatremia may occur due to salting the
newborn.
2 Risk of tetanus may emerge because of wrapping
the newborn in holluk.
3 Hypoglycemia may happen owing to starting
breastfeeding late.
4 Hip dysplasia may occur as a result of tight
swaddling of the newborn.
5 Kernicterus may occur due to delaying medical
treatment of jaundice.
6 Despite providing psychological relief, bathing the
newborn late as part of the rituals of the forties
may lead to infection risks.
The current review of literature indicated that,
though not widely used, traditional practices for the
newborn babies are still common in the Turkish
society despite the advancements in health services.
The necessary interventions should be made to
preserve healthy traditional practices and to terminate
the harmful ones in collaboration with the Turkish
society under the supervision of health authorities and
institutions.
Nurses and midwives, on the other hand, should
learn cultural values, modern and traditional practices
used in the regions they work in, should encourage
the mothers to make medically proper choices in the
care of their babies and organize training programs to
help mothers become aware of the outcomes and side
effects of the traditional newborn practices35, 48.
Particularly, the training programs to be provided for
the mothers in rural areas during prenatal and
postnatal periods should be planned in a way to
include wide populations and should be advertised
and promoted by means of the instruments of the
mass media, posters and school announcements
because so that these educational projects and
 Özyazıcıoğlu & Polat: TRADITIONAL PRACTICES FOR NEWBORN IN TURKEY
campaigns can reach to wide a wide range of people
from all walks of life49, 51. It is recommended that
mothers should be warned against the widely-used
harmful traditional practices before hospital discharge
as part of the holistic patient care given to them.
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