Swaddling

Should I wrap my baby tightly in a blanket?

Swaddling, the practice of wrapping a baby tightly in a blanket, is used to can calm babies and help them sleep, but there are problems with long sleeps. They may prevent babies from letting you know they are hungry, resulting in infrequent feeding, poor growth, and problems with breastfeeding. Swaddling increases the risk of sudden infant death syndrome, or SIDS, and may cause hip problems if it is not done properly. Babies should not be swaddled if there are any concern about the baby’s milk intake or sleepiness, or if the baby was born with abnormal hips. Babies should not be swaddled if the baby is trying to roll over, if the swaddling clothes may move and cover the baby’s face, or if the baby has an increased risk of SIDS.

A) Describing swaddling

Swaddling is the practice of tightly wrapping a baby in a blanket or other swaddling material. It essentially immobilizes the baby’s arms and legs. It is still practiced worldwide but materials, tightness, and duration vary greatly. It fell out of favour in Europe and North America but has recently become slightly more popular.

Swaddling is not the same as skin-to-skin care or kangaroo mother care.

B) Risks of swaddling

1) Hip abnormalities

Swaddling the legs is strongly associated with hip abnormalities (hip dysplasia) (Nelson 2017). 

2) Increasing infant sleep and related risks

A small amount of research has shown that swaddling may calm babies and encourage longer sleeps (Gerard 2002; Pease 2016). However, long sleeps may prevent babies from letting you know that they are hungry, resulting in infrequent feeds and poor growth (Bystrova 2007). 

3) Lack of brain stimulation

Swaddling prevents babies from using their hands. They use their hands to calm and stabilize themselves, to explore their environment, and in doing so, they develop their skills.

Swaddling keeps babies from using the skills they have. For example, during breastfeeding, they massage the breast, which increases the milk let-down (Matthiesen 2001). Keeping a baby swaddled while breastfeeding prevents this normal behaviour.

4) Increased risk of lung infection

Babies who are swaddled have been shown to have a higher risk of chest infections (Nelson 2017; Yurdakok 1990). It is possible that this is caused by the lower levels of vitamin D also found in swaddled babies or by limiting the baby's ability to take deep breaths when the chest is compressed by swaddling clothes.

5) Risk of death

Swaddling increases the risk of sudden infant death syndrome (SIDS). The risk is highest if the baby is placed on the stomach to sleep but still exists if the baby is on the back (Blair et al.2009; Pease et al. 2016). Swadding can result in a baby being too hot and in accidental head covering which increases the risk of SIDS.

Swaddling materials may cause strangulation (McDonnell 2014). 

C) Choosing to swaddle the baby

If you choose to swaddle your baby, make sure the baby can remain in the frog-leg position with the knees bent up and out from the hips. This will minimize the risk of hip abnormalities (hip dysplasia).

Do not swaddle a baby if (van Sleuwen 2007):

  • There is any concern about the baby’s milk intake
  • The baby is a newborn and quite sleepy.
  • The baby was born with abnormal hips.
  • The baby is at an increased risk of abnormal hips if:
    • The baby has a close family member with abnormal hips (Gkiatas 2019).
    • There was a low level of amniotic fluid around the baby in the uterus.
    • The baby was in a breech (feet first) position during pregnancy.
    • The baby was born large.
  • The baby is trying or able to roll over (AAP 2016).
  • The swaddling clothes may move and cover the baby’s face.
  • The baby has an increased risk of SIDS.

References

Blair PS, Sidebotham P, Evason-Coombe C, et al. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ. 2009 Oct 13;339:b3666
 
Bystrova K, Matthiesen AS, Widström AM, et al. The effect of Russian Maternity Home routines on breastfeeding and neonatal weight loss with special reference to swaddling. Early Hum Dev. 2007 Jan;83(1):29-39
 
Gerard CM, Harris KA, Thach BT. Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics. 2002 Dec;110(6):e70

Gkiatas I, Boptsi A, Tserga D, et al. Developmental dysplasia of the hip: a systematic literature review of the genes related with its occurrence. EFORT Open Rev. 2019 Oct 1;4(10):595-601

Matthiesen AS, Ransjö-Arvidson AB, Nissen E, et al. Postpartum maternal oxytocin release by newborns: effects of infant hand massage and sucking. Birth. 2001 Mar;28(1):13-9

McDonnell E, Moon RY. Infant deaths and injuries associated with wearable blankets, swaddle wraps, and swaddling. J Pediatr. 2014 May;164(5):1152-6 

Nelson AM. Risks and Benefits of Swaddling Healthy Infants: An Integrative Review.
MCN Am J Matern Child Nurs. 2017 Jul/Aug;42(4):216-225
 
Pease AS, Fleming PJ, Hauck FR, et al. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics. 2016 Jun;137(6). pii: e20153275

TASK FORCE ON SUDDEN INFANT DEATH SYNDROME (AAP). SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2016 Nov;138(5):e20162938

van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, et al. Swaddling: a systematic review. Pediatrics. 2007 Oct;120(4):e1097-106

Yurdakok K, Yavuz T, Taylor CE. Swaddling and acute respiratory infections. Am J Public Health. 1990 Jul;80(7):873-5