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Sharp Health News

Infant swaddling and the risk of SIDS

June 7, 2016

Infant swaddling and the risk of SIDS

One of the first skills parents-to-be learn in anticipation of the arrival of a new baby is swaddling. Used to calm infants and help them sleep, swaddling — snuggly wrapping an infant in a blanket or wrap designed specifically for swaddling — is thought to have been practiced as early as 2600 B.C.

However, a paper published by the American Academy of Pediatrics (AAP) in the journal Pediatrics examined whether swaddling may be related to incidence of sudden infant death syndrome, also known as SIDS. The report was an analysis of four different studies from a 20-year period that examined the risk of SIDS for various infant sleep positions.

The results indicated that there was a slight increase in risk when babies were swaddled and placed on their backs to sleep and an even greater risk when swaddled and placed on their sides or stomachs, or if they were age 6 months or older.

Dr. Resham Batra, a Sharp Rees-Stealy Medical Group board-certified pediatrician, found the study to be limited and cautions that parents should carefully interpret the findings.

"There were some age limitations to the conclusions, essentially saying if the child is old enough to break out of the swaddle or roll to the side or roll over when not swaddled, then they should no longer be swaddled for sleep," she says.

Another important caution when swaddling your baby, is to make sure his or her hips are loose. Studies have found that straightening and tightly wrapping a baby's legs can lead to hip dislocation or hip dysplasia, an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.

To swaddle a baby correctly, use the following steps:

  1. Spread the blanket out flat, with one corner folded down.
  2. Lay the baby face-up, on the blanket, with her head above the folded corner.
  3. Straighten her left arm, and wrap the left corner of the blanket over her body. Tuck the blanket between her right arm and the right side of her body.
  4. Tuck the right arm down, and fold the right corner of the blanket over her body and under her left side.
  5. Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
  6. Make sure her hips can move and that the blanket is not too tight. You want to be able to get at least two or three fingers between the baby's chest and the swaddle.

Dr. Batra offers the following tips for general sleep safety:

  • Follow the NIH's " Safe to Sleep® Campaign" message and always place your baby on his or her back to sleep
  • Provide your baby with his or her own firm sleeping surface
  • Keep the sleeping area free of any loose bedding, toys, blankets, bumper pads, sleep wedges or positioners
  • It is OK to offer your infant a pacifier during sleep
  • Your baby is safest in his or her own crib or bassinet, not in your bed
  • Place the crib in an area that is always smoke-free

Additional recommendations include immunizing infants, breastfeeding when possible, not covering an infant's head during sleep, and providing supervised tummy time during a baby's wakeful hours to support development.

If you have questions about safe sleep practices, talk to your child's pediatrician.

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