Safe swaddling for babies

The Pediatric Insider

© 2013 Roy Benaroch, MD

Swaddle ‘em right, and it can help babies sleep and relax. Swaddle ‘em wrong, and you can mess up their little hips and get you arrested. Yikes!

As usual, too much of a good thing ends up being…. less of a good thing. I like swaddling, and I like to demonstrate a good swaddle for new parents, especially they’re a little anxious about knowing how to soothe their new baby. A nice swaddle can help  everyone relax.

But something you shouldn’t do is wrap up 7 – 12 month old babies so tight they can’t move, use knots to hold them in place, and throw blankets on their heads. That didn’t work out well for these two sisters, who used to run a daycare in California before they were arrested for child abuse.

What you can do is a simple, easy swaddle as demonstrated in videos on this page, from Children’s Healthcare of Atlanta. Safe swaddling involves holding the upper body still and in place, while allowing the legs and hips to move. Though they’re stylish, you don’t need a special blanket to do it right. Once babies start to wiggle out of swaddles (typically by four months), it’s probably a good time to stop swaddling altogether.

Some states have banned any kind of swaddling in day care centers, for fear that it can increase the risk of SIDS. One study did show that, but it didn’t look at the position babies had been left in—and we know that back-sleeping protects against SIDS. That study also found the strongest predictors of SIDS were parental use of alcohol or drugs,  cosleeping, or smoking during pregnancy. Other studies have refuted the SIDS-swaddling link, include ones that show that swaddled babies are less likely to sleep in unsafe positions, and one that showed better arousal in swaddled babies despite overall improved sleep patterns.

The best ways to avoid SIDS are outlined here, and current evidence certainly isn’t strong enough to convict swaddling as a cause. I’d also guess that since swaddling helps parents get better sleep themselves, that may end up actually being protective against SIDS and post-partum depression as well.

Apart from the (unsubstantiated) fear of increasing SIDS, the other concern with swaddling is that it can contribute to hip problems, specifically developmental dysplasia of the hips. But this really has only been seen in cultures that bundle up legs to hold them fixed and extended—that’s rarely done in the US. The current swaddling fad has not led to an increase in hip problems here. Still, review the video above, and make sure that if you do swaddle, Junior’s legs and hips are free to move around.

Swaddling is a safe and effective way to soothe a young baby, and parents can safely do it with a brief lesson and a little common sense. That’s one fewer thing to worry about!

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2 Comments on “Safe swaddling for babies”

  1. Lissette Woodward Says:

    Would you recommend swaddling at night onlt or also during day naps?


  2. Dr. Roy Says:

    Young babies can be swaddled both for naps and bedtime to help establish routines and provide safe sleep cues.


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