Baby Danger: Is Swaddling Safe?
How To Swaddle A Baby
In the hospital, babies are usually brought to their mothers for the first time, wrapped in swaddling.
What do you do with a crying baby?
You've fed the baby, put him in comfy clothes, changed his diaper, turned off the TV, took the phone off the hook, put the dog in the yard, put the "Baby Sleeping, Do Not Disturb!" sign on the front door, and the baby is still crying. What do you do next?
In my day, some mothers let their child cry it out until they fall asleep, which is something I never agreed with.
But in our house, we either picked him up and walked the floor, or we rocked in the rocker and patted his back while humming a sweet tune.
How long did we do it? As long as it took to make him happy so he'd go back to sleep.
But today's mothers are not so patient to go through all those steps. After making sure the baby is in dry clothes and has a full belly, some mothers call up their pediatrician asking for some medication for their colicky baby.
But more and more, since the 1990s, mothers are falling back on an age-old practice: They swaddle their babies, spend a little Mommy time, then put them down to sleep.
What is Swaddling?
Swaddling is an ancient practice of wrapping a baby tightly in a blanket or a sort of wrap, so that their arms and legs are restricted from movement, remaining snug inside and not exposed to the air or elements.
Since the beginning of measurable time, mothers have been wrapping their babies in swaddling clothes, a type of receiving blanket. Swaddling is used to calm the baby enough so he sleeps, to help lessen the startle reflex so often seen in new babies, and some mothers say their baby sleeps much longer when swaddled. When mothers are handed their babies to take home from hospital, they are swaddled and many mothers continue the practice when they find out it works to sooth and calm their baby.
Swaddling differs from culture to culture in technique, how many hours to leave a baby swaddled and until what age. I'm going to skip over the history of swaddling because I have provided a resource list at the end of this article.
The two things most agree on is: 1) that babies should never be placed on the stomachs to sleep and 2) that there is no one authority on swaddling that every mother should follow.
This article will:
- share an experience I had our newest grandchild with you
- share a video explaining how to swaddle correctly
- share a video how NOT to swaddle
- discuss the age of when to stop swaddling
- share a video on hip dysplasia due to swaddling
- share a video on the way one particular culture swaddles babies so you can see possible down sides
- show you the statistics of a SIDS study completed January 2014
- provide a resource list
It is January 2014 and researchers are now asking:
- Is swaddling soothing to the baby, to the mother, or to both?
- Could swaddling a baby have any relation to Sudden Infant Death Syndrome (SIDS)?
Old ways vs new ways
My daughter-in-law says all of the baby books she read are correct and my suggestions about whatever I did years ago when I had my babies is wrong or outdated.
We disagreed on how to swaddle, for how many hours a day, and up to what age. She was determined to do everything by the book, so if the book says swaddle until 4 or 5 months old, she will do it until then and not stop a day sooner.
I explained about hip dysplagia. What's that? she said, because her baby books didn't cover it.
Hands in or hands out?
Some babies like to be swaddled with their hands inside. Some babies like their hands to be outside so they can suck their fingers or fist.
Every baby is different
If the baby is already sucking his fingers, it might be a good idea to leave his hands outside the swaddling.
Leaving them inside will only make him look for them upon waking, become fussy thus awaken you too.
If he has them accessible, he can give you a bit more time to sleep and allow himself a bit more time to explore with his fingers.
If a baby has gas or is colicky, confining his legs is not going to help. Many medical professionals agree that the baby needs to have room to move his legs around so he can kick away the gas (and gas pains), as is evidenced after they break out of swaddling.
"You don't know how to swaddle a baby, Ma!"
There's another new grandchild in our family. Three years ago, our son, John, now age 39, married Angelynne, now 36 and they live not far from us in northern California. When she didn't become pregnant within six months of their wedding day, Angelynne worried that her age was working against her and convinced her GYN to start her on fertility drugs.
A year and a half later, their new baby, John Andrew was born. Angelynne's parents are not in her life. She had a baby sister who died of crib death more than 40 years ago and she has no other siblings. Our son John is one of five children and Angelynne enjoys our big family atmosphere. She lovingly calls my husband and I, Ma and Da like all the kids do.
With Angelynne being a first time mother, I told her I'm as close as the telephone and a 10 minute car ride. She assured me that when the baby came, she'd be fine because all the books she was reading covered everything.
The week before giving birth In December, Angelynne told me she was so prepared that when the baby arrived that there wouldn't be anything she didn't know. That all went out the window when it came time to give birth. She said no to a C-section, so it was a very, very difficult birth because the baby was breech .
Just before discharge, when a maternity nurse showed her how to swaddle the baby in the hospital, she told them she didn't need a lesson, she read all about swaddling. Hospitals don't keep new mothers long anymore. She asked if I would come stay for a day or two to help out, which I did gladly. I was waiting at the door when she got home with my new grandson who wasn't even 48 hours old yet.
I didn't know about her swaddling incident at the hospital, so when I unwrapped the baby to take his "coming home outfit" off and put on the new kimono I had bought and freshly laundered, we had our first run in about baby care.
No kimonos. She wanted him in a onesie that she had bought. Oh, okay, I said, no problem. After I put the onesie on, she watched me wrap him in the receiving blanket. I did it snugly but not so snug that he wouldn't be able to move his arms and legs. He wasn't crying so I assumed he was comfortable.
She unwrapped the baby and told me, "You don't know how to swaddle a baby, Ma!"
By the time she was done wrapping him as tight as a drum, John Andrew was confined in a maximum security prison.
On my way home, I stopped at Babies 'R Us and bought 3 Swaddler Sleepsacks, which was the 2014 version of the Grow Bag I had used in the 1970s and 1980s. She had received a few of them as shower presents but she returned them to the store. I kept my new purchases in my car until a good opportunity presented itself, which it did the very next day. After a few more go-arounds with the new mother, John Andrew now enjoys being sprung from the prison garb, and he is still swaddled. With him comfortably sleeping, we came to the computer and we both got an education on swaddling!
Video 1: How To Swaddle A Baby
Your swaddling knowledge
Did you know what it meant to swaddle a baby before reading this article?
Video 2: How to swaddle using a baby wrap or baby bag
Video 3: How NOT to swaddle a baby. If someone was this rough with me, I'd scream bloody murder too
Video 4: This Dad was doing great, until he got to the shaking part because some people mistaken "shake" with "shaking." Other than that, he did a good job!
It's a cultural thing and even though we respect other cultures, the evidence speaks to the consequences
DDH: Evaluate leg creases on back of thighs
How common is hip dysplasia?
At the risk of insulting Angelynne's new-found knowledge from her reading material, I forged ahead to explain that the whole time John Andrew was inside her womb, his legs were folded up against his belly - the fetal position. Partly this was because there wasn't much room inside and partly because this was comfortable for mother and child. If he were to keep his legs straighter in the womb or kick and thrash about a lot, he would be agitated and she would have been more uncomfortable while pregnant.
Now that John Andrew is out of the womb, he needs to be able to move his legs around so he can start to grow but also so that his hips don't develop dysplasia which can happen due to swaddling, especially incorrect swaddling (see video). After the baby is unwrapped from a tight swaddle, when he straightens his legs, the joints can loosen after being confined so long and the soft cartilage in his hip sockets can become compromised.
Because John Andrew was a breech baby, he is predisposed to Developmental Dysplasia of the Hip (DDH), which is when the space between the legs look a little wider than usual, when one leg on the side of the dislocated him looks shorter, or when the leg on the side of the dislocated hip turns outward. The video below (#5) explains it in more detail.
Video 5: How To Correctly Swaddle and Still Protect Baby's Hips
Video 6: Treatment options for hip dysplasia
How To Swaddle A Baby
Here are some steps to help in swaddling a baby:
- Put a soft cotton blanket on a flat surface and fold down the top corner a little bit.
- Put the baby on the middle of the blanket, with his head on the fold.
- Wrap the right part of the blanket over the baby and tug it under his back beneath his left arm.
- Then take the left corner and wrap it over your baby and tuck it under his back on his right side.
- If you want one or both of your baby's arms to be free, just swaddle him the same way, but under the arm(s).
- Don't swaddle your baby too tightly; it's just supposed to be cozy.
Swaddling and SIDS
From 2004 to 2011, the Consumer Product Safety Commission (CPSC), conducted a study to collect data on injury or death regarding swaddling. The data was based on the position the baby slept in, the type of injury or death and the known SIDS risk factors (like exposure to other smokers in the house while baby is asleep, soft or removable bumpers or bedding, hyperthermia and exposing the child to excessive heat by clothing, swaddling or use of heat in the house.) Altogether 36 infants ranging from 3 days old to 15 months old were evaluated. The results are:
- 5 cases involving wearable blankets had 1 death, 2 injuries, 2 potential injuries
- 18 cases involving swaddle wraps 8 deaths and 10 potential injuries
- 1 death involving an unspecified product - either a swaddle wrap or wearable blanket
- 12 deaths involving swaddling in ordinary blankets.
In infant deaths using wearable blankets or swaddle wraps, 7 out of 10 infants were placed to sleep supine, but the swaddled infants rolled to the prone position and death was attributed to positional asphyxia.
Of those infants swaddled in standard blankets, 6 died when they rolled to the prone position. In cases using swaddling blankets or standard blankets, parts of the blanket were found covering the dead infant's nose and mouth.
The report concluded that swaddling in ordinary blankets is not a safe practice beyond the immediate newborn period. An ordinary blanket is hard to keep securely in place, and with very little movement, it ends up becoming a loose piece of bedding in the infant's sleeping environment. It is extremely unsafe.
The newborn infant doesn't need to be swaddled to be put down to sleep. Swaddling is a primarily a parenting choice, like breastfeeding or solid food. The infant can be dressed appropriately to the season, home temperature, weather, and placed in supine position with no wrapping.
Other studies show that the correctly swaddled infant in supine position sleeps longer. If the child is swaddled too tightly or with the legs extended and bound, it can cause developmental dysplasia of the hips.
If the child is swaddled and has on a hat, hyperthermia can occur. Tight swaddling can compromise the baby's lungs and it is in this situation that the respiratory rate increases, causing reduced function.
Some reports say that swaddling lowers the accidental death risk but this study found that swaddled children placed in prone position are unable to use their arms to push themselves off the mattress if they end up in asphyxiation. Many children in this study were still being swaddled only during sleep times at 4 months and older which is too old even if it is just for sleeping. There will always be disagreements about when to stop swaddling Dr. Rachel Moon, who is also lead author of the American Academy of Pediatrics Safe Sleep guideline, chairwoman of the Task Force on SIDS, and co-author of this study believes that babies should not be swaddled past 2 months of age.
Swaddling made easy!
Does he have a temperature or is he just hot?
The more layers on a baby, the harder it is to determine when a baby is truly ill.
TIP: If you take the baby's temperature under the arm before swaddling, and then again immediately after unwrapping swaddling, you will be able to tell if the baby has too many swaddling layers and thereby causing the child's body temperature to increase and compromising his respiratory system.
Years ago, the practice was to layer the swaddling around an infant, sometimes as many as 4 layers. Today's thinking says a child doesn't need a lot of layers of swaddling.
Alternatives to swaddling:
- Choose appropriate weight and type of material of sleepers and clothing that can be worn without the need for additional covers, swaddling, or blankets.
- If a child is still using wearable wraps or blankets past two months of age, the parent should be watchful for signs that the child is near being ready to roll over, either partially or totally from his back to his side in a rocking motion or an actual turn.
- Once he attempts to do this, according to the National Institute of Health, swaddling should be discontinued because just his attempt can unravel the swaddling and possibly contribute to a SIDS death.
- Swaddling a child for a complete night's sleep where you do not check on him while sleeping is considered unsafe sleep practices.
- Insecurely wrapped or incorrectly wrapped swaddling can unravel and cause obstruction of airway or even strangle the baby.
Swaddling is a choice made by parents. Swaddling is not necessary to put a child to sleep, but when done correctly, your child can have a longer restful sleep.
Video 7: This type of swaddling, although cultural, is still not recommended (legs straight, wrap tied in knot)
Kimono type gown
Does anyone remember "grow bags?"
I know I'm showing all of my 67 years, but does anyone remember grow bags? I used them for each of my five babies. I haven't seen them in the stores lately so I don't even know if they still make them. But they were pretty cool.
The bags had sleeves for their arms, a zipper at the bottom that concealed excess material so that as the baby grew, you could lengthen the bag so he could still move his legs around. After you opened the last zippered bottom area, the child wouldn't fit in the grow bag anymore - usually about 6 months of age.
The main reason for using grow bags was their fleece material so I didn't have to put a blanket in the crib or playpen. Some of the grow bags I used for sleeping were mostly for warmth because I wasn't crazy about putting a blanket inside the crib or cranking up the heat to make for a hot house. I also removed the bumper pads by about 3 to 4 months of age because my babies were pretty active.
I kept 7 grow bags. As each one got wet or soiled, there was always a spare. I gave them all away once my kids outgrew them. Now I wish I had put them away just like I put away their christening outfits.
I swaddled for about two weeks after I brought each baby home, and only for about 6 hours total out of every 24. For the other hours of the day, I used size appropriate kimonos with a drawstring at the bottom so the baby could still move his legs and kick out any gas or frustration. Kimonos came in all materials, so my winter-born babies wore fleece kimonos and my summer-born babies wore cotton t-shirt material kimonos.
Each baby is different, as is their sleep environment. Each baby's body temperature regulates differently. Some babies will fuss and become so overheated from fussing that when parents go to wrap them to calm them down, they immediately choose a material that is conducive to the heat of the room, and not the baby's temperature, sometimes making for a hotter baby.
My feelings on this topic:
- You do what works for the baby.
- The baby's body language will help you make the right decision for your baby.
- Remember that not all babies are "textbook babies."
- Most pediatricians and medical providers give parents the same advice about swaddling and general baby care which may not always up to date, depending on their continuing education participation.
What is your opinion on swaddling?
© Rachael O'Halloran. March 18, 2014. All Rights Reserved.
No part of this article may be reproduced without prior permission from the author.
© 2014 Rachael O'Halloran