Babies, Sleep, and Swaddling: Vital Knowledge For Professionals and Curious Parents

Jul 18

Swaddling is an old practice and a longstanding tradition in some cultures. It involves tightly wrapping babies in a blanket or cloth to restrict arm and leg movements. Recently, commercial swaddles have grown in popularity.

Theoretically, this creates a cozy and secure feeling for babies, helping them sleep longer, but there is no research to support that. Recently, commercial swaddles have been marketed well. Unfortunately, research demonstrates this seemingly innocent practice can be problematic and even dangerous.

As a parent or practitioner, your primary concern is for the safety and well-being of the little ones in your care.

Please read on to discover the latest insights on swaddling so you can make an informed decision about how to care for your baby and babies in your care.

Caveat: There’s more that could be said about each of these, and if you wish, we can talk. This is not meant as personal advice or medical advice.

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Swaddling Safety Update: A Guide for Parents and Practitioners

Risks associated with Swaddling

Sleep-Related Death (SIDS):

It is normal and expected for babies to wake and feed at night for 1-3 years. Night wakings are protective against Sudden Infant Death Syndrome (SIDS). Swaddling can result in less waking, increasing the risk of SIDS. Babies usually try to “break out” of the swaddle, creating coverings that can cause suffocation.

Swaddling that restricts arm movement poses a risk if a baby rolls onto its stomach and cannot use its hands to protect its airway. Instead, allow the baby’s arms and hands to be free and accessible.

Risk: Swaddling reduces night wakings, raising the risk of SIDS. It restricts access to arms and hands, increasing the risk of suffocation if a baby rolls onto their stomach.
Preventive Measures: Keep baby’s arms and hands, free and accessible.

Interference With Breastfeeding:

Swaddling can make breastfeeding difficult for babies. Babies instinctually use their hands and arms to find the breast, and that in turn provokes maternal oxytocin. Swaddling prevents this and can lead to frustration, making babies less willing to breastfeed.

Babies communicate with their body movements and cries, but swaddling encourages them to remain still and quiet. This means swaddled babies may not effectively cue when they are hungry. That results in fewer feeds and less milk to the baby, resulting in slow weight gain and decreased milk production.

Swaddling also reduces skin-to-skin contact. This lack of physical connection may disrupt bonding, as well as reducing the chances of successful breastfeeding initiation.

Risk: Swaddling interferes with the natural process of breastfeeding, and bonding.
Preventive Measures: Prioritize skin-to-skin contact and do not restrict movement of arms and hands.

Less Skin-to-Skin Contact:

Skin-to-skin is a simple and important practice providing a baby with physical, emotional, and developmental benefits. When swaddling is used, there are fewer opportunities for skin-to-skin. Babies held skin-to-skin are calmer, cry less, and experience more parent interaction, greater bonding, and are warmer. Parents sometimes worry their baby will be cold if not bundled when, in fact, skin-to-skin helps regulate a baby’s temperature better than swaddling.

Impact: Swaddled newborns may have poorer circulation and miss out on skin-to-skin benefits.
Preventive Measures: Incorporate more skin-to-skin care to help regulate body temperature and form a closer connection with your baby, help with their brain development, and build their microbiome.

Overheating:

Swaddling may lead to overheating, especially with thick blankets in warm environments, more so when a baby’s head is covered.

Overheating is a known risk factor for SIDS. To avoid this risk, parents should look for signs of overheating in their baby, such as: sweating, flushed skin, or a hot chest or back. Only use receiving blankets or a light sleep sack with free movement of arms and legs. Skin-to-skin contact is the safest alternative.

Risk: Over-bundling can lead to overheating, increasing the risk of SIDS.
Preventive Measures: Evaluate for signs of overheating. Opt for a simple receiving blanket or skin-to-skin contact.

Slower Weight Gain:

Swaddling immediately after birth has been shown to delay weight gain in babies. Swaddled babies struggle with latching and sucking during their first feeds, wait longer to cue for feeds, and gain weight more slowly. Because swaddling can restrict movements, babies might be unable to show hunger signs like putting their hands to their mouths, leading to missed or delayed feeding times. This in turn could affect how much milk the mother produces.

Impact: Swaddled babies can delay feeding behaviors, leading to slower weight gain and potential reduction in milk supply.
Preventive Measures: To support breastfeeding initiation and duration, allow baby’s hands to move freely to signal hunger cues and help them “find” mom’s breast.

Hip Dysplasia:

Traditional, tight swaddling techniques have increased the risk of hip dysplasia. This is a condition where the hip joint does not develop correctly. The International Hip Dysplasia Institute warns that swaddling with any leg movement restriction may harm unstable hips. Parents and healthcare providers should ensure babies can always move their hips freely.

Risk: Swaddling increases the risk of hip dysplasia.
Preventive Measures: Always ensure the baby has full movement of the hips, even while sleeping.

Babies Need Their Hands:

For babies, chewing or sucking on their hands is a natural way to calm. Babies find this behaviour soothing. When babies are swaddled, their hands are tucked away, making it difficult to find comfort. This also happens when we cover their hands with mittens. While intended to prevent scratching, babies can find this very distressing. It is essential to be careful that clothing does not stop babies from doing these natural soothing activities.

Impact: Swaddled babies, or babies with mittens, miss out on natural self-soothing like hand sucking, affecting their comfort and instincts.
Preventive Measures: Allow babies access to their hands for self-soothing. Trim nails as needed. This is easier when baby is sleeping and moving less. Know that nail cutting/filing/clipping is an acquired skill for parents.

Safe Alternatives to Swaddling

Tips for taking care of your newborn:

Use a receiving blanket or perhaps a sleep sack that allows hip movement and access to their arms and hands.
Try skin-to-skin contact for bonding and regulating your baby’s temperature. For extra warmth, place a light blanket over your baby’s back.
Instead of using mittens, trim or file your baby’s nails regularly. Occasional scratches may indicate when to file or trim.
If your baby is already being swaddled, swaddle briefly while holding or watching baby, then unswaddle.
If your baby is swaddled, wean them off by starting with a swaddle during sleep, then opening up the arms once they are asleep. Progress to putting your baby down to sleep with free arms, then free legs. Finally, you can switch to a simple receiving blanket or sleep sack as above.
Use additional comfort measures as needed like back-patting, baby-wearing, or a warm bath. Your baby may simply need closeness and comfort.

Conclusion:

As parents and healthcare providers, the commitment to caring well for your babies is clear. Understanding the potential risks of swaddling is essential for your baby’s well-being. Consider safe alternatives like skin-to-skin contact, a lightweight blanket, or perhaps a sleep sack to provide comfort without compromising safety.

Consult an IBCLC. Contact an International Board Certified Lactation Consultant (IBCLC) to get expert help and get back on track.
You may schedule an appointment online, or email hello@lactationcare.ca.

Sources:

Clarke, N. M. (2013). Swaddling and hip dysplasia: An orthopaedic perspective. Archives of Disease in Childhood, 99(1), 5–6. https://doi.org/10.1136/archdischild-2013-304143

Bystrova, K., Ivanova, V., Edhborg, M., Matthiesen, A. S., Ransjö-Arvidson, A. B., Mukhamedrakhimov, R., Uvnäs-Moberg, K., & Widström, A. M. (2009). Early contact versus separation: effects on mother-infant interaction one year later. Birth, 36(2), 97–109. https://doi.org/10.1111/j.1523-536X.2009.00307.x

Dixley, A., & Ball, H. L. (2022). The effect of swaddling on infant sleep and arousal: A systematic review and narrative synthesis. Frontiers in Pediatrics, 10. https://doi.org/10.3389/fped.2022.1000180

Dumas, L. (2016). Why is swaddling not recommended for babies? http://www.bfiontario.ca/wp-content/uploads/2017/04/6.-Why-is-swaddling-not-recommended-for-babies-Dumas-2013-2016.pdf

Dumas, L., Lepage, M., Bystrova, K., Matthiesen, A.-S., Welles-Nyström, B., & Widström, A.-M. (2013). Influence of skin-to-skin contact and rooming-in on early mother-infant interaction. Clinical Nursing Research, 22(3), 310–336. https://doi.org/10.1177/1054773812468316

Leeds, Grenville & Lanark District Health Unit. (n.d.). Swaddling: Important Information for Parents and Health Care Providers. https://healthunit.org/wp-content/uploads/Swaddling.pdf

Moon, R. Y., Carlin, R. F., & Hand, I. (2022). Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics, 150(1). https://doi.org/10.1542/peds.2022-057990

Nelson, A. M. (2017). Risks and benefits of Swaddling Healthy Infants: An Integrative Review. MCN: The American Journal of Maternal/Child Nursing, 42(4), 216–225. https://doi.org/10.1097/nmc.0000000000000344

International Hip Dysplasia Institute (2016). New warning about swaddling. https://hipdysplasia.org/new-warning-about-swaddling/

Public Health Agency of Canada. (2023). Safe sleep for your baby. Government of Canada. https://www.canada.ca/en/public-health/services/publications/healthy-living/safe-sleep-your-baby-brochure.html

Richardson, H. L., Walker, A. M., & Horne, R. S. C. (2009). Minimizing the risks of sudden infant death syndrome: To swaddle or not to swaddle? The Journal of Pediatrics, 155(4), 475–481. https://doi.org/10.1016/j.jpeds.2009.03.043

van Sleuwen, B. E., Engelberts, A. C., Boere-Boonekamp, M. M., Kuis, W., Schulpen, T. W. J., & L’Hoir, M. P. (2007). Swaddling: A systematic review. Pediatrics, 120(4). https://doi.org/10.1542/peds.2006-2083

Thanks to the RN/IBCLCs who reviewed this. Special thanks to Dr Louise Dumas for her review.

Permission granted to use this in its entirety with © Sonya Boersma, Lactation Care. For other use, contact sonya@lactationcare.ca

Sonya Boersma

Sonya Boersma, a Master of Science, educated Registered Nurse and International Board Certified Lactation Consultant, is the Principal Consultant behind Lactation Care. Bringing evidence into practice and helping you meet your goals. These are Sonya’s overarching considerations.

https://lactationcare.ca