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There are a lot of varying opinions when it comes to swaddling or wrapping babies. The recommendations of differnt professionals and locations cover the full spectrum from - every baby should be swaddled in the early months to never swaddle a baby. Some of these recommendations are based on tradition and experience while others are evidence based. We believe as parents you should be given the facts and decide for yourself what is best for your baby and family. If you choose to swaddle, we have provided some guidelines for swaddling safely and the information you need to make an informed choice.

What is Swaddling:  In general, swaddling is tightly wrapping your baby in a blanket to restrict the movement of his limbs.  This is often done to calm fussy babies and promote sleep.

History of Swaddling:  Swaddling has been practiced for many centuries around the world and has become more popular in North America in the past few decades. However there are many cultures that do not swaddle and instead use alternative such as holding the baby or wearing baby in a sling or wrap.

Controversy over swaddling:  There is recent research that shows that swaddling may have some harmful effects. Despite these reports, some experts continue to encourage swaddling babies and suggest that even if the baby resists, parents should force the baby into the swaddle.

The risks of swaddling include SIDS, hip dysplasia, pneumonia, and over-heating. However, if swaddling is done properly and safely many of those risks can be avoided.  See research details below.

It is true that some babies seem to do very well being swaddled, however swaddling is not the answer to every family’s sleep. It is not absolutely necessary to swaddle a baby and many babies manage very well without being swaddled.

It’s important as a parent that you make an informed choice about swaddling and follow your baby’s cues and your own instincts. If you choose to swaddle, be sure to follow these Safe Swaddling Guidelines.

Safe Swaddling Guidelines

These guidelines will help you swaddle your baby safely

• Legs and hips should not be wrapped so tightly as to restrict movement
• Legs should be free to move up and out. Consider using a roomy swaddle sack
• Arms are bound firmly but not too tight. Avoid too much pressure on her chest
• When swaddling your baby for sleep, NEVER lay her down on his stomach. There is a high correlation between SIDS and babies who are swaddled and laid on their tummy to sleep
• Be aware of her temperature. Sometimes just a diaper underneath the swaddle is appropriate
• Only swaddle to calm your baby or for sleeping. Ensure she is unwrapped during wakeful periods for movement and activity, as well as during feedings.
• Make sure breastfeeding is established before you begin swaddling. If your baby is sleeping longer intervals be sure that you wake her up to feed regularly.
• Swaddling should be discontinued if your baby is rolling or close to rolling.

This video shows the triangle technique that may be helpful to swaddle your baby without any compression issues with the hips or chest.

Pros and Cons of Swaddling

Swaddling and SIDS

The most common prevention of SIDS is to lay babies on their backs to sleep. While swaddling can help young babies (usually 4 months or younger) remain in this position, older babies who can roll over (or even younger ones who accidently manage this maneuver) actually increase their risk of SIDS by becoming stuck on their stomach. The added risks of overheating, difficulty in rousing or ending up with a blanket over their face are all other SIDS risk factors.

Benefits of Swaddling

 Please be aware that the following list of benefits assumes that your baby is swaddled safely.

• Your baby may sleep longer and deeper (this is also a risk factor)
• Can be used as a calming technique to reduce crying
• Young babies, when swaddled, cannot wiggle into compromising positions in their cribs
• Reduces the risk of your baby rolling on to stomach
• Reduces flailing arms which could startle and wake your baby
• Can help your baby feel as though she is still in utero

Risk Factors of Swaddling:

• Swaddling may impede breastfeeding. Since swaddled babies can sleep longer and deeper she may feed less frequently. This can also affect weight gain in the early days after birth.

• Can reduce the ability to self-soothe. Your baby may naturally soothe and comfort herself when tired and drowsy. This can include thumping her legs, sucking on her hands, a blanket or lovey, and rubbing her face with her hands.

• Over heating. When your baby is swaddled and her environment is too warm, she can easily overheat. If she is damp from sweat, this means that she is on the verge of overheating.

• Hyperthermia. Surprisingly, swaddled babies are not necessarily warm and cozy. Studies have shown that swaddled babies can have a lower body temperature then non-swaddled babies.

• Hip dysplasia. This joint disease can be the result of tight swaddling which immobilizes the hips and legs and forces them in a straight position for pro-longed periods of time.

• Respiratory compression leading to infection and pneumonia. When your baby is swaddled tightly it can compress her chest, not allowing the lungs to fully expand. Trapped air in the lungs can lead to respiratory infections and may cause pneumonia.

Alternatives to Swaddling:

There are other methods you can use instead of swaddling that will ultimately have the same calming effect and can help your baby fall asleep.

• Rocking
• Skin to skin contact
• Walking
• Breastfeeding your baby
• Baby wearing

Resources:

O’Mara, Peggy. “The Question of Routine Swaddling”

Bregje E. van Sleuwen, Adèle C. Engelberts, Magda M. Boere-Boonekamp, Wietse Kuis, Tom W.J. Schulpen and Monique P. L'Hoir. “A Systematic Review of Swaddling” Pediatrics 2007;120;e1097 DOI: 10.1542/peds.2006-2083

Ksenia Bystrova*1,2, Ann-Marie Widström*1, Ann-Sofi Matthiesen1, Anna- Berit Ransjö-Arvidson1, Barbara Welles-Nyström1, Igor Vorontsov2 and Kerstin Uvnäs-Moberg. “Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg” International Breastfeeding Journal 2007.

 Ksenia Bystrova*1,2, Ann-Marie Widström*1, Ann-Sofi Matthiesen1, Anna- Berit Ransjö-Arvidson1, Barbara Welles-Nyström1, Igor Vorontsov2 and Kerstin Uvnäs-Moberg. “Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg” International Breastfeeding Journal 2007.

 Bregje E. van Sleuwen, Adèle C. Engelberts, Magda M. Boere-Boonekamp, Wietse Kuis, Tom W.J. Schulpen and Monique P. L'Hoir. “A Systematic Review of Swaddling” Pediatrics 2007;120;e1097 DOI: 10.1542/peds.2006-2083

Mahan ST, Kasser JR (2008). Does swaddling influence development of dysplasia of the hip? Pediatrics, 121 (1), 177-8

Sahin F, Akturk A, Beyazova U. et al (2004). Screening for developmental dysplasia of the hip: results of a 7-year follow-up study. Pediatrics International, 46(2):162

Yurdakok K, Yavuz T, Taylor CE. (1990) Swaddling and acute respiratory infections. American Journal of Public Health, 80:873-875

Article by Andrea Strang