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20160510 swaddle

I don’t know if I would have made it out of the newborn period with any of my three children without swaddling.  It was like magic for my kiddos…as soon as the last piece of velcro was fastened and they were picked up for a gentle swinging and shushing session, they were asleep.  Swaddling is something that I often discuss at newborn visits as a great way to calm down a fussy baby, so you can imagine my surprise to see the headlines this week stating “Swaddling may increase the risks of SIDS.”  Should parents run to immediately get rid of those swaddle blankets? Not so fast.

The greatest increase SIDS risk was in those infants who were swaddled and placed to sleep on their side or stomach or in older swaddled infants.

The headline came after a study which will be published in the June edition of Pediatrics looked into the risk of sudden infant death syndrome (SIDS) and swaddling (click here to see the full article).  This present study evaluated data from 4 previous studies that were conducted between 1998-2006 in 3 areas of the world: England in the UK, Tasmania in Australia, and Chicago, Illinois here in the US.  The outcome of this analysis showed that the risk of SIDS was much higher in infants who were swaddled and placed on their side or on their stomach to sleep, and the risk of SIDS in swaddled infants increased with the age of the infant.  Swaddling, while not clearly defined in this article, generally means wrapping of a baby from the shoulders down with a blanket of some kind.  The idea behind swaddling is to recreate the tight, comforting feel of the womb and help to eliminate the startle reflex that newborns have while they are sleeping that is often the culprit of waking them up.  

First and foremost, BABIES SHOULD BE PUT TO SLEEP ON THEIR BACKS

There are a few important points to make with regards to this study and these flashy news headlines.  If you just happen to see this come across your newsfeed without reading the details of the study, one could infer that swaddling, in general, has been linked to SIDS.  However, again as pointed out above, the greatest increase SIDS risk was in those infants who were swaddled and placed to sleep on their side or stomach or in older swaddled infants.  It is not hard to see why swaddling an infant and then placing them on their stomach is a bad idea as their arms would be “pinned” in which would keep them from being able to really have any leverage to move their upper chest and head around.  When you are considering older infants, especially those around 4 months of age, they are beginning to roll over.  If an infant has the ability to roll over AND they are swaddled, they again would end up on their stomach with their arms “pinned” in.  Another important point I want to make is that SIDS, by definition, is the death of an infant under 1 year of age for an unexplained reason.  In this study, it seems to me that if an infant is swaddled and then found face down on a mattress, suffocation must be entertained as the cause of death and then therefore, it would mean that it is not “unexplained.”  This might only be semantics, but I think it is an important point to make.  

I think the biggest take home message for parents is to understand safe sleep and swaddling practices.  First and foremost, BABIES SHOULD BE PUT TO SLEEP ON THEIR BACKS!!!!  Once a child can get themselves to their stomach, they can stay there, but until then BACK to SLEEP ALWAYS (can you tell how important I think this is??)!  Ok moving on…if you are going to swaddle your infant, here are things to keep in mind:

  • Make sure you are using a material to swaddle that is going to stay in place-even with those Houdini babies-and not end up covering their face.  My favorite swaddle blankets are those that have velcro or a zipper to help them stay in place (like these here).
  • You do not want your infant to get too hot if they are in a swaddle blanket so plan accordingly when it comes to their clothing.  Here in Louisiana (especially with the upcoming summer months), there is no need for fleece swaddle blankets.  I would recommend a single cotton article of clothing with either a cotton or muslin swaddle blanket.
  • When swaddling your infant, the swaddle should be wrapped snug enough that there are no loose pieces of fabric while at the same time, it is important that the wrap should not be so tight as to completely limit movement, especially of the lower extremities.  Recent studies have shown that tight swaddling of the hip area may increase the risk for hip problems, specifically developmental dysplasia of the hip.  Your “ideal” baby burrito swaddle would have a nice snug wrap across the upper body (but below the chin) and at the same time, be loose enough on the lower body so that the legs are free to move at the hips.
  • Swaddling is ok UNTIL your infant begins to even think about rolling over.  There is no set age for when this will occur.  Most infants begin being able to maneuver to their side between 3-4 months of age, but since every baby is different, your little one could certainly beginning rolling much sooner than that.  At the first sign of your baby getting from their back to their side, let alone to their stomach, you must “wean the swaddle.”  If going cold turkey out of a swaddle is not going happen, I would recommend swaddling with one arm in and one arm out for a few nights, and then swaddle with both arms out (so the wrap is across the chest and under the armpits).  
  • Once your previously swaddle-loving little one has been forced to wean from their tight cocoon wrap, they can sleep in a sleep sac that allows their arms to be free as long as they wish.  Again, the important thing is that their arms are free so that they can maneuver themselves around if needed.

For many, foregoing swaddling all together would likely lead to newborns who are not sleeping well as they startle themselves awake, which then leads to more sleep deprived parents, which then leads to unsafe sleep practices such as bed sharing or infants sleeping on the chest of their well meaning parents on a nice comfy, cozy couch or recliner.  This new study certainly helps to shed light onto safe swaddling (and again, sleep) practices.  In case you skipped the earlier paragraph, babies should always be put to sleep on their back!!  If you have concerns about swaddling or just need a tutorial on how to safely swaddle your bundle of joy, talk with your pediatrician, and make sure to check back very soon for a video of me demonstrating safe swaddling techniques.