Swaddling

Question: Please could you inform me re safe wrapping of a baby. Your SUDI presentation talks about unsafe wrapping.Would be good to advise re safe wrapping. (November, 2009)

Response: Thanks for the question. Swaddling has documented benefits and harms1,2. It can reduce crying, improve sleep and help babies settle as well as suppress arousal, influence mobility and effect thermal control. How people swaddle makes it a safe or unsafe practice. Depending on how it is practiced, swaddling can either increase or reduce sudden infant death rates.

Better infant sleep and healthy infant arousal seem to work against each other. Yet helping babies settle is a driving concern for parents and coroner reports too often describe parents resorting to unsafe practices in order to achieve this. If parents choose to swaddle their babies what is paramount is that the baby is sleeping face-up (on the back) and with a clear face that will stay clear throughout the sleep. These safe sleep principles support people to make a safety assessment whatever the situation. The protective effect of face-up sleeping on healthy arousal appears to override the risk effect of swaddling, in relation to prevention from sudden infant death.

If swaddling leads to a changed position (no longer on the back) or a covered face it becomes dangerous. More specifically, if the swaddling material is bulky and leads to overheating, the wrapping too loose and covers the face, or too tight and the baby cannot breath against the tightness; if the baby is swaddled and on the side, propped on pillows, the bed is sloping or mattress tipping; if the baby is also already more vulnerable e.g. due to smoking in pregnancy, or is not used to being swaddled; if the baby is still swaddled at a stage in their development where they can get into situations but not out of them - then these factors, in isolation or in combination, can make swaddling dangerous. 

Safe Swaddling guidelines for sleeping babies (developed by Change for our Children)

  • Position: only for babies on their back
  • Material: only if lightweight
  • Wrapping: only if firm but not tight (firm enough to prevent a covered face, and enable easy breathing movements)
  • Co-sleeping: only when sleeping in own 'baby bed'
  • Developmental stage: only until a baby attempts to turn (then stop or use arms free wrapping)
References
1 van Sleuwen BE et al. Swaddling: A Systematic Review. Pediatrics 2007;120(4);e1097-e1106
2 Richardson HL et al. Minimizing the Risks of Sudden Infant Death Syndrome: To Swaddle or Not to Swaddle? J Pediatr. 2009 Oct;155(4):475-81.