Unravelling the Swaddling Issue

Ann Caird, postnatal Doula and infant sleep consultant

This month Ann focuses on the issue of infant swaddling. For new Mums this can be a contentious issue with well meaning advise coming from all angles. We hope that Ann’s article can help to add some rationale and evidence to the swaddling debate. 

There is so much research indicating both positives and potential risks of swaddling associated with health and SIDS that no wonder parents end up confused! So, let’s look at the benefits, potential risks and related recommended guidelines associated with swaddling according to relevant research and the ISPID

Swaddling has been widely used as an infant care practice since ancient times and although the practice declined in Europe during the 20th century, it’s becoming increasingly popular again. Why? Well, it has the great benefit of reproducing the safe, confined womblike conditions the newborn baby has just left! Swaddling helps a new baby feel safe, secure and comforted, and further, a swaddled baby startles less… As all new parents know, new babies can often startle and disturb themselves due to their startle (or moro) reflex which is present from birth and evident throughout the first few months of life. So, swaddling helps to calm babies, induce sleep and increase sleep duration and overall, swaddled babies cry less which impacts positively on the parent-child relationship. Further, premature babies demonstrate improved neuromuscular development, better motor organisation and less physiological distress when swaddled.

There are though potential health risks associated with swaddling. While many would believe that restricting a baby’s motor activity could be detrimental to reaching motor developmental milestones such as walking and crawling, there is no research evidence to suggest this. However over tight swaddling carries potential risks. Tight swaddling around the baby’s hips may put the baby at risk of developmental dysplasia of the hip; tight swaddling around the chest may increase the risk of respiratory infection, and there is also a risk of swaddled babies overheating. These potential risks can be reduced by following recommended guidelines for swaddling.

What about swaddling and SIDS? Well, swaddling can be protective against SIDS if babies are swaddled and placed on their backs (supine position) to sleep; it restricts motor activity so reducing the chance of babies covering their head and face with bedding, and it’s also effective in helping parents keep their baby sleeping in the safe Back to Sleep position. Placing your baby prone (on tummy) to sleep increases the risks considerably. There has been concern regarding the possible association between swaddling and suppressed arousal, although evidence clearly demonstrates that swaddling and supine positioning decreases SIDS risk more than using supine positioning unswaddled due to the above described potential hazards. A recent influential study (abstract) highlights the importance of familiarity with swaddling and routinely swaddling from birth; a decrease in arousability and cortical arousal was demonstrated in 3 month old infants who were unfamiliar with being swaddled… coinciding with the peak age for SIDS.

Bearing in mind the risks then, here are recommendations for safe infant swaddling.

  • To prevent overheating, use light cotton materials for swaddling and avoid covering your baby’s head; refrain from swaddling if your baby is unwell and has a temperature.
  • Swaddle with your baby’s hips and knees in a neutral position, and wrap so legs have room to flex.
  • Avoid over tight wrapping; keep it snug so it doesn’t become loose but doesn’t restrict breathing.
  • Always place your baby on her back to sleep, never on her tummy. Recommendations suggest discontinuing swaddling at about 3 months or when your baby starts to roll onto her tummy.
  • Swaddling routinely from birth is safest; avoid starting to swaddle in later infancy particularly around the age of 3 months; always inform secondary care givers of your baby’s sleep routines, habits and environment.
  • Swaddle for sleeping times and when your baby is unsettled, always allow swaddle free times for play, movement and kicking!

 

Sources and Further Reading.

Horne, R. ISPID Physiology Working Group. To Swaddle or not to Swaddle?

Richardson, H., et al. Influence of Swaddling Experience on Spontaneous Arousal Patterns and Autonomic Control in Sleeping Infants. J Pediatrics. 2010 Jul; 157 (1):85-91. Epub 2010 Mar 15.

Safe Swaddling and Healthy Hips: Don’t toss the Baby with the Bath Water

Van Sleuwen et al, Swaddling: A Systematic Review. Pediatrics 2007; 120;e1097. DOI:10.1542/peds.2006-2083

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