HOW TO SWADDLE A BABY

Swaddling: Is it Safe?

New parents often learn how to swaddle their infant from the nurses in the hospital. A blanket wrapped snuggly around your baby’s body can resemble the mother’s womb and help soothe your newborn baby. The American Academy of Pediatrics (AAP) says that when done correctly, swaddling can be an effective technique to help calm infants and promote sleep.

But if you plan to swaddle your infant at home, you need to follow a few guidelines to make sure you are doing it safely.

Back to Sleep

To reduce the risk of Sudden Infant Death Syndrome, or SIDS, it’s important to place your baby to sleep on his back, every time you put him to sleep. This may be even more important if your baby is swaddled. Some studies have shown an increased risk of SIDS and accidental suffocation when babies are swaddled if they are placed on their stomach to sleep, or if they roll onto their stomach, says Rachel Moon, MD, FAAP, chair of the task force that authored the AAP’s safe sleep recomm​endations.

When to Stop Swaddling

“I would stop swaddling by age 2 months, before the baby intentionally starts to try to roll,” Dr. Moon says. “If babies are swaddled, they should be placed only on their back and monitored so they don’t accidentally roll over.”

Know the Risks

Parents should know that there are some risks to swaddling, Dr. Moon says. Swaddling may decrease a baby’s arousal, so that it’s harder for the baby to wake up. “That is why parents like swaddling – the baby sleeps longer and doesn’t wake up as easily,” she said. “But we know that decreased arousal can be a problem and may be one of the main reasons that babies die of SIDS.”

AAP Safe Sleep Recommendations

The AAP recommends parents follow the safe sleep recommendations every time they place their baby to sleep for naps or at nighttime:

• Place your baby on her back to sleep, and monitor her to be sure she doesn’t roll over while swaddled.
• Do not have any loose blankets in your baby’s crib. A loose blanket, including a swaddling blanket that comes unwrapped, could cover your baby’s face and increase the risk of suffocation. 
• Use caution when buying products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the AAP.​
• Your baby is safest in her own crib or bassinet, not in your bed. 
• Swaddling can increase the chance your baby will overheat, so avoid letting your baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and rapid breathing. 
• Consider using a pacifier for naps and bedtime. 
• Place the crib in an area that is always smoke-free.

Keep Hips Loose 

Babies who are swaddled too tightly may develop a problem with their hips. Studies have found that straightening and tightly wrapping a baby’s legs can lead to hip dislocation or hip dysplasia, an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.

The Pediatric Orthopaedic Society of North America, with the AAP Section on Orthopaedics, promotes “hip-healthy swaddling” that allows the baby’s legs to bend up and out.

How to Swaddle Correctly

1. To swaddle, spread the blanket out flat, with one corner folded down.
2. Lay the baby face-up on the blanket, with her head above the folded corner.
3. Straighten her left arm, and wrap the left corner of the blanket over her body and tuck it between her right arm and the right side of her body.
4. Then tuck the right arm down, and fold the right corner of the blanket over her body and under her left side.
5. Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
6. Make sure her hips can move and that the blanket is not too tight. “You want to be able to get at least two or three fingers between the baby’s chest and the swaddle,” Dr. Moon explains.

Swaddling in Child Care

Some child care centers may have a policy against swaddling infants in their care. This is because of the increased risks of SIDS or suffocation if the baby rolls over while swaddled, in addition to the other risks of overheating and hip dysplasia.

“We recommend infants wait to enter a child care center until they are about three months old, and by then swaddling should have been phased out because the babies are more active and rolling,” said Danette Glassy, MD, FAAP, chair of the AAP Section on Early Education and Child Care and the AAP representative on a panel that wrote guidelines for child care providers. 

The guidelines, Caring for Our Children, National Health and Safety Performance Standards, which are jointly published by the National Resource Center for Health and Safety in Child Care and Early Education, the AAP and the American Public Health Association, do not ban swaddling in child care centers, but they say swaddling is not necessary or recommended. As a result, some child care centers, and the states where they are located, are implementing more forceful recommendations against swaddling in child care settings.

“Compared to a private home, where one or two people are caring for an infant, a child care center usually has a number of caregivers, who may have variations in their swaddling technique,” Dr. Glassy says. “This raises a concern because studies show babies who are not usually swaddled react differently when swaddled for the first time at this older age.” They may have a harder time waking up, which increases their risk of SIDS.

“The difference in the advice for swaddling at home or the hospital nursery, versus in a child care center, really comes down to the age of the child and the setting,” Dr. Glassy says. “A newborn can be swaddled correctly and placed on his back in his crib at home, and it can help comfort and soothe him to sleep. When the child is older, in a new environment, with a different caregiver, he is learning to roll, and perhaps he hasn’t been swaddled before, swaddling becomes more challenging and risky.”