School of Public Health

Four Talking Points on Safe Swaddling

July 2018
Author: Malka Main

In the past few years, media has dramatized research findings on the association between swaddling and sleep-related infant death. Some suggest swaddling increases the risk while others imply it reduces the the risk. Experts from the American Academy of Pediatrics (AAP) say there isn’t enough evidence to formally recommend swaddling, but everyone working with infants and their families should include swaddling in conversations about safe sleep practice.1,2 

1) Swaddling should always be combined with the ABCs of Safe Sleep. Sudden unexpected infant death (SUID) associated with swaddling is rare. But the potential risks are lowest when babies are laid to sleep Alone (without other people, blankets, or objects), on their Backs, and in a Crib (or other approved separate sleep surface).3,4,5

2) Swaddling should end when the infant is about 2 months old. The risks of swaddling outweigh the benefits once a baby learns to roll over. Experts suggest caregivers stop swaddling long before their babies develop this skill.2  Although it seems hard to believe, babies as young as eight weeks old can use their upper bodies and heads to shift position and roll onto their stomachs even while snugly swaddled.3 Swaddled infants lying face down are at twelve times the risk for SUID as an unswaddled infant in the same position.5

3) Swaddling can contribute to overheating, a known risk factor for SIDS.5,6 In warmer climates or heated environments, caregivers should reduce the possibility of overheating by dressing the baby in fewer layers and choose a lightweight blanket.1,5 Signs of overheating: rapid breathing, heat rash, damp hair, or flushed complexion.7

4) Swaddle snugness should be loose enough to fit a few fingers between blanket and baby's chest.2,7  A swaddle that is too tight can restrict breathing, but one that is too loose may unravel and put the baby at risk of asphyxiation.3,5 Caregivers can avoid this altogether by purchasing swaddle wraps with snaps or Velcro or they can follow the AAP’s six steps to a safe swaddle (infographic courtesy of Allina Health).


REFERENCES

  1. AAP TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016;138(5):e20162938
  2. Kennedy K. UNwrapping the Controversy Over Swaddling. American Academy of Pediatrics News. June 2013, Volume 34, Number 6.
  3. McDonnell E, Moon RY. Infant deaths and injuries associated with wearable blankets, swaddle wraps, and swaddling. J Pediatr. 2014;164(5):1152–1156pmid:24507866
  4. Pease AS, Fleming PJ, Hauck FR, et al. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics. 2016;137(6):e20153275
  5. Moon RY and AAP TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016;138(5): e20162940
  6. Van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TW, L’Hoir MP. Swaddling: a systematic review. Pediatrics. 2007;120(4). 
  7. Healthy Children, American Academy of Pediatrics, 2017. Swaddling: Is it Safe?