For generations and across many cultures, parents have swaddled babies — something the American Academy of Pediatrics says can effectively aid in calming infants and promote sleep, when done correctly. That can mean precious shut-eye for parents, too, improving quality of life for all in the home.
More recently, however, researchers and clinicians have begun to unravel the wrap-and-tuck technique that turns infants into baby burritos. “It can be safe, but it can also be dangerous — it depends on how you do it,” says Dr. Corinn Cross, a spokeswoman for the American Academy of Pediatrics and pediatrician at Children’s Hospital Los Angeles.
In May, a meta-analysis of four previous studies evaluating swaddling and the risk of sudden infant death syndrome — or SIDS, where a baby’s death can’t be explained despite a thorough investigation — grabbed many headlines, but provided little clarity on swaddling risks. “If you swaddle a baby, the risk of SIDS is slightly increased compared to if you don’t swaddle a baby. However, for most babies, it’s fine,” said Dr. Rachel Y. Moon, co-author of the analysis published in the journal Pediatrics and a SIDS researcher at the University of Virginia School of Medicine in Charlottesville, in an email. However, she added: “The studies included in the analysis were very different — they defined swaddling differently and did their analyses differently — so it’s hard to make conclusive statements.” Moon, fellow researchers and clinicians not involved in the analysis say more study is needed.
[See: How to Promote Safe Sleep for Your Infant.]
The most important thing for parents who plan to swaddle is to lay the baby on his or her back, experts say — something that’s suggested whether babies are swaddled or not to reduce the risk of SIDS, which is the No. 1 cause of death for infants a month to a year old. There are about 3,500 total sudden unexpected infant deaths annually, according to the Centers for Disease Control and Prevention; that includes about 1,500 babies who die of SIDS, as well as infants who die from unknown causes or accidental suffocation or strangulation in bed. Once the baby shows signs of being able to roll, Moon says, parents should stop swaddling; this typically occurs between 2 and 4 months.
Though much still remains unknown about swaddling risks, some experts say what is becoming increasingly clear is the need to better outline proper swaddling technique and present parents with an alternative. In a recent blog post for Cincinnati Children’s Hospital Medical Center, Dr. Amy Nathan, a neonatologist and medical director of the Perinatal Institute, laid out numerous safety concerns involving improper swaddling — enough to make a bleary-eyed new mom or dad’s head spin. Among those were swaddling too tight around the chest, swaddling too loosely — such that the blanket becomes unraveled — using a heavy blanket (light is recommended), swaddling once the baby can roll and swaddling too tight around the legs or hips due to concern about the risk of hip dysplasia.
“The hip joint is a ball and socket, and the socket part of it is not finished developing when a baby is born,” Nathan says. “With tight swaddling, when the legs are straight, the head of the thigh bone doesn’t fit correctly in the socket, and therefore over time the socket may develop too shallow or in a misshapen arrangement.” Adds Cross: “If you’re consistently binding those hips, then you can end up creating this hip dysplasia — where … the hip is outside the socket.”
Though she said it’s an individual decision, Nathan suggests parents consider a sleep sack as an alternative to swaddling.
[See: 10 Ways to Make Your Childbirth Easier.]
While the AAP doesn’t take a position on swaddling — offering instead guidance to do it correctly — Cross herself used a sleep sack rather than swaddling her three children, now ages 4 to 7, when they were infants. “If you’ve never seen it, it’s basically a big sack, you put the kid in, you zip it up — the arms stick out, the heads stick out, the feet are zipped in,” she describes. It’s a cross between a blanket and pajamas — the baby essentially wears his or her blanket. Some have fastener strips with Velcro that can be used to secure a baby’s arms. Parents sometimes complain that babies are able to break free. However, even if they do, the Velcroed strips don’t ride up around the baby’s face, as a blanket could, Cross says. The strips can be secured or removed as babies get older so they can move their arms.
Experts say when it comes to getting a baby comfy for bed — swaddled or not — less is definitely best. Following suit, the movement toward improving sleep safety for infants has tossed just about everything out of the crib save the mattress.
“When we decided to put children back to sleep on their backs, that really reduced our SIDS rates — so we had a lot less infants dying suddenly in their sleep. We also realized at that time that having all the pretty things we put in the crib — like the bumpers, the pillows, the blankets — all of those could basically entangle the child, they could suffocate the child,” Cross says. “So we really tried to get all of that stuff out. The issue with swaddling is now you’re introducing a blanket back into the crib.” That’s not a problem if you’re skilled in the art of swaddle, like the well-trained nurse who does it with speed and ease, tucking all the corners with precision, Cross says. But she says new parents often struggle to swaddle correctly, and even if they do get it down, it’s often not consistent across caregivers, other family like grandparents or babysitters. Cross says that can make it easy for a baby to become unswaddled, leaving a loose blanket — a potential suffocation or entanglement hazard — lying in the crib.
“There’s no reason not to swaddle, if you’re doing it correctly and you stop by around two to three months of age,” Cross says. But given the potential for user-error, she still advises parents consider a sleep sack. Whatever parents decide to do, Nathan recommends getting babies used to a consistent routine from their first days, so they rest easier.
Experts, too, caution against going too far in pooh-poohing swaddling without more data on potential risks. That’s because in addition to still being viewed as safe when done properly, it provides an option to soothe a fussy baby to ensure everyone in the home gets rest. Clinicians say ensuring babies get ample rest is an important safety concern in itself, since sleep-deprived parents are more likely to make mistakes, and parents’ lack of rest can inhibit the care infants receive.
[See: 10 Things No One Tells You About Breast-feeding.]
“It’s a personal decision,” Nathan says of swaddling. “If [parents] use those guardrails of doing it in the proper way and not doing it past when the baby rolls over, I still think it is acceptable.”
More from U.S. News
In Vitro Fertilization Grows Up
Top Reasons Children End Up in the Hospital
The Best and Worst Exercises for Pregnant Women
Is It Safe to Swaddle Your Baby? originally appeared on usnews.com
