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 recommendations.
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
- To
swaddle, spread the blanket out flat, with one corner folded down.
- Lay
the baby face-up on the blanket, with her head above the folded corner.
- 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.
- Then
tuck the right arm down, and fold the right corner of the blanket over her
body and under her left side.
- Fold
or twist the bottom of the blanket loosely and tuck it under one side of
the baby.
- 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.”
