Is Swaddling Your Baby Safe? The Great Debate

Swaddling — wrapping your baby in a lightweight, snug blanket — is a godsend to many parents looking for an easy and effective way to soothe their babies and help them get a good night’s sleep. Lots of infants enjoy being swaddled because the coziness mimics the close comfort of the womb.

Some swaddles fasten with Velcro, which make wrapping a snap; others are more traditional blankets that require skillful wrapping and double as lightweight blankets or nursing covers.

Although swaddling has been done for centuries, the popular practice of wrapping up your baby like a burrito does come with some risks when it’s not done properly.

What the Research Says

About 90 percent of infants in North America are swaddled during the first few months of life, according to a 2014 study published in the Archives of Disease in Childhood.

It’s easy to understand why. A systematic review of research published in the journal Pediatrics showed that swaddled babies wake up less often and sleep for longer stretches of time. There are also benefits for preterm infants, which include improving neuromuscular development and reducing distress.

Do babies really need to be swaddled? (Getty Images)

However, when it comes to preventing sudden infant death syndrome (SIDS), the research on swaddling is conflicting.  A swaddled baby can potentially roll over and then be unable to roll back, causing suffocation. In a 2014 study published in the journal Pediatrics, researchers noted that the risk of infant death goes up more than tenfold if a swaddled baby is either placed in or rolls to a face-down position, much more so than with a baby who is lying face-down and not swaddled. However, the same study noted that sudden unexpected death in infants is rare. To reduce the risk of SIDS, the American Academy of Pediatrics (AAP) recommends that parents place babies to sleep on their backs. This may be even more crucial if your baby is constrained by a swaddle.

Swaddling can also increase the risk of hyperthermia, or overheating, which is another SIDS risk.  That’s why it’s important to keep the bedroom cool and watch for the signs which include sweating, flushed cheeks, rapid breathing, and heat rash, according to the American Academy of Pediatrics (AAP).

On the flip side, another study argues that properly-swaddled babies may actually be protected from SIDS since they can’t crawl into “dangerous asphyxiating environments” for example, if they pull the bedding over their heads.

There are also risks that come with overzealous swaddling. Swaddling too tightly around the hips and legs (rather than allowing room to move around, increases the risk of developing hip dysplasia, in which the hip joint doesn’t form normally. Also, wrapping up your baby too snugly around his chest can dangerously hamper breathing.

What the Experts Say

“We know it increases sleep and reduces crying,” Harvey Karp, pediatrician, swaddling advocate, and author of The Happiest Baby On the Block, told the Washington Post. He also adds that a calm baby benefits the entire household. “Those are extremely important goals. Exhaustion and persistent crying are the chief triggers for marital conflict, postpartum depression, child abuse, over-treatment with medications, unsafe sleep practices and obesity.”

However, not everyone agrees with the popular practice. “To have them pinned down by a tight blanket doesn’t make a lot of sense,” Susan Guest, a clinical nurse specialist in Maternal Newborn Care at Mount Sinai, told The Globe and Mail. “You need to know that, developmentally, they need to move, they need to be able to put their hand in their mouth.”

Others feel that swaddling at home under the watchful eye of a parent is fine, but that it shouldn’t be done in daycare settings because of safety concerns. When the National Resource Center for Health and Safety in Child Care and Early Education published the third edition of its National Health and Safety Performance Standards in 2011, it said that swaddling wasn’t recommended in childcare centers. This is namely because there are multiple caretakers for each baby and not everyone is trained on how to swaddle properly.

There are also strong opinions on when parents should stop using swaddles. “I would stop swaddling by age 2 months, before the baby intentionally starts to try to roll,” Rachel Moon, MD, chair of the task force that wrote the American Academy of Pediatrics’ sleep recommendations, told the AAP. However, other experts say that most babies can stay swaddled longer than that, until around 3 to 4 months old.

If your baby attempts to roll over while snugly swaddled, you can transition her to a sleep sack — not a loose blanket, which can get tangled around the face or neck and cause suffocation — since a fitted wearable blanket won’t inhibit movement.

What the Parents Say

“I swaddled my boys. It was essential and a lifesaver. We used the ones with Velcro to get a snug hold, and it absolutely helped them sleep better.” —Jennifer Teeman.

“I swaddled my daughter — or attempted to anyway. For some reason, she needed one arm out of the wrap at all times…so we started using a sleep sack instead. One pro for me with swaddling, though, was knowing she was all bundled up, which made it easier to hold her until I got used to the itty bittiness of her.” — Stephanie Klein.

“We felt, as most parents do, that swaddling would help our son feel secure, having just met the world. We found that to be true and definitely saw it as a benefit to helping him not to injure himself while he slept. However, not too long afterward, he started pulling at least one arm out. We realized how futile our efforts were and stopped swaddling.” — Mary Dail.

The Bottom Line

If you choose to swaddle your infant, wrap it snugly while leaving some room for bent legs, always put your baby to bed on his back, check to make sure he’s not overheating, and stop swaddling between 2 to 4 months old or the moment you spot him trying to roll while he’s swaddled.

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