Healthline

What Is Swaddling and Should You Do It?

by Ashley Marcin

Medically reviewed by Meredith Wallis, MS, APRN, CNM, IBCLC

Published: October 28, 2019

Source: Swaddling: Definition, How To, Safety, and More (healthline.com)

 

Parenthood How-To: Swaddle

Is there anything cuter than a tiny little baby burrito? Adorable or not, new and seasoned parents alike may have heard that swaddling their young babies can be the key to potentially longer stretches of sleep.

Don’t know how to do it? Keep reading! We’ve got you covered from the basics of how to wrap your little one snug as a bug to when you might want to wean away from this beloved practice. You’ll even learn some other safe sleep tips that will hopefully help your whole family rest better at night.

 

In its most basic form, swaddling involves wrapping baby securely in a blanket so that only their head is peeking out. The rest of their body is comfortably snug inside the blanket, which may help the youngest infants feel like they’re still inside the womb.

Some 90 percent of babies in North America are swaddled in the first weeks of life. Wrapping babies to sleep has been around since ancient times. And its impact on babies has been studied for decades or more.

The key to a good swaddle is keeping it snug. Some studies call this a type of “motor restraint,” which is just a technical way of saying that it restricts a baby’s movements so they don’t set off their moro or “startle” reflex.

This reflex is present at birth, lasts until between 12 weeks and 6 months of age, and causes baby to startle with loud noises or large movements. As you can imagine, startling may jolt a baby enough to wake from slumber.

You may have heard that swaddling has the potential to be unsafe. And that’s true, if it isn’t practiced correctly. That’s why it’s important to understand how to swaddle, what situations may make it unsafe, and when to stop swaddling altogether.

Related: How long does the startle reflex last?

Is swaddling safe?

In short, usually swaddling your baby is safe. The caveat: You must do it the right way and follow some simple guidelines.

Situations that make swaddling dangerous might include:

  • wrapping the blanket too tightly or too loosely
  • bundling baby in too many hot layers
  • continuing to swaddle when baby can roll onto their stomach
  • binding legs and hips too tightly, causing hip development issues.

There are a few studies that address safety concerns with swaddling. In one 2016 review of studies, the results showed that swaddling was connected to a “small but significant” risk of sudden infant death syndrome or SIDS. This risk increased with age, when swaddled babies were able to roll onto their sides or stomachs to sleep.

Experts also explain that traditional swaddling, particularly binding of the legs, may be a risk factor for developing hip dysplasia. This condition happens when a baby’s hip joints do not form properly or when they dislocate easily.

To prevent this from happening, always make sure your baby’s hips and knees can move around while swaddled or consider using swaddle sacks that allow baby’s legs to move freely.

Keep in mind that in the first hours and days after birth your primary concern should not be with mastering the swaddle, but allowing time for skin-to-skin contact.

Skin-to-skin promotes breastfeeding success, as noted in this 2007 studyTrusted Source. Another 2007 studyTrusted Source found that swaddling in the first few days after birth may result in breastfeeding delays and delayed recovery of initial baby weight loss, even among formula-fed babies. You’ll have plenty of time for swaddling in the days and weeks to come.

Start by choosing the type of swaddle — generally a square piece of fabric or blanket — you want to use. You can find anything from flannel or cotton swaddles to thin gauze to stretchy jersey knit material (see some suggestions for options below).

Basic swaddling:

  • Lay your swaddle fabric out onto a flat surface so it makes a diamond shape. You’ll want to fold the top corner down about a third of the way toward the middle of the blanket.
  • Gently place your baby — face up — onto the blanket with their head above the corner you just folded down.
  • While holding your baby in place, straighten their right arm and then bring the same-side (baby’s right) corner of the blanket over their body. Then tuck the blanket between the left side of their body and their left arm.
  • Securely fold the bottom of the swaddle up toward the body. Be sure to leave plenty of space for your baby’s legs to move and groove.
  • Then grab the (baby’s) left corner of the blanket and bring it around the right side of their body to snug them in.
  • Now you’ll want to check to see if the swaddle is too tight or not tight enough. To do this, try slipping your hand between your baby’s chest and the blanket. Note how it feels. Experts advise leaving two fingers of space between baby’s chest and the swaddling blanket.

Your baby may not like having both arms swaddled. Or maybe they’re getting older and you’re starting to wean away from swaddling. Whatever the case, here’s how to swaddle your baby with both arms out. (Also check out this video.)

Arms out swaddling:

  • Lay your blanket on a flat surface and fold the top corner about halfway down toward the middle of the blanket.
  • Place your baby onto the blanket with their shoulders above the fold.
  • Grab the (baby’s) right corner of the blanket and wrap it around the left side of their body, under the armpit.
  • Pull the bottom corner of the blanket up over your baby’s feet.
  • Then grab the (baby’s) left corner of the blanket and wrap it around the right side of the body, under the armpit, to snug them in tight.
  • Again, check to see the swaddle is tight, but not so tight it might restrict breathing or the legs/hips.

Supplies

There are various swaddling blankets and other supplies you can find at stores and online. You may want to try a variety of blankets to see which works best for your baby.

Consider the season you’re in and how you’ll be dressing your baby underneath. For example, thinner blankets may work best for warmer conditions.

Top-rated blankets include:

If you want to wrap your baby but don’t feel confident with your swaddle skills, swaddle sacks are a great alternative.

These generally involve a sleep sack with extra fabric to wrap the arms quickly and easily. Some options even allow you to detach the swaddling component and use as a normal sleep sack as baby grows.

Top-rated choices include:

As with many things parenting, there are both benefits and risks to swaddling. While wrapping babies is relatively common, always check with your healthcare provider to make sure swaddling is safe to practice with your baby.

Benefits

  • Again, swaddling dulls baby’s startle reflex.
  • Helps baby sleep. Mimicking the coziness of the womb and dulling the startle reflex may help baby relax better into longer sleep stretches.
  • Soothes baby. It may be especially calming for babies with colic.
  • Supports preterm babies. A 2007 review of studiesTrusted Source showed that swaddling babies born prematurely helps with neuromuscular development, motor organization, and feelings of distress.
  • May reduce bed-sharing. According to Dr. Harvey Karp at the popular website Happiest Baby on the Block, swaddling helps baby sleep better and may — in turn — reduce the chances that baby will be placed in bed with parents. Sleeping on soft surfaces is dangerous for babies and there’s a risk that parents may fall into a deep sleep and accidentally roll onto their infants.
  • Supports breastfeeding. Karp further explains that swaddling may help with breastfeeding because it soothes babies. If a baby cries less, moms may feel more confident that their babies are getting enough to eat and continue on with breastfeeding.

Risks

Along with hip dysplasia, the main risk of swaddling is doing it incorrectly and leading to situations that may cause sudden infant death syndrome.

  • Rolling. Again, the AAP specifically notes that swaddling can contribute to SIDS if a baby is placed on his side or stomach for sleep or if he rolls to that position while sleeping.
  • Overheating. This is a risk if you dress your baby too warmly and then swaddle using warm or thick blankets.
  • Restricting airflow. Swaddling a baby too loosely may be dangerous because the blankets can cover their face and make breathing difficult.
  • Swaddling too tightly can also lead to respiratory issues.
  • Swaddling too early can negatively impact establishing breastfeeding. In the early days, skin-to-skin should be encouraged.

Experts say you should stop swaddling by the time your baby can roll. For this reason, the American Academy of Pediatrics guidelines say to stop swaddling by the time your little one is 2 months old.

Before you commit this bit of information to memory, understand that all babies are different. If you have a little one who is rolling early, you’ll want to stop swaddling sooner. Be sure to bring up this question with your pediatrician to get more specific guidelines for swaddling with your baby.

Around 3,500 infants die each year in the United States from what are called sleep-related deaths. Some of these deaths are caused by SIDS. Others may be due to unsafe sleep practices.

Here are some tips for how to practice safer infant sleep:

  • Where baby sleeps is important. Babies should room-in with parents or other caregivers until they are 6 months old, but preferably until age 1, according to 2016 safe sleep recommendations from the AAP.
  • The surface baby sleeps on matters, too. Place your baby in their own sleep space onto a firm surface. This may be a crib in your room, a bassinet, or, alternatively, a side-car sleeping device like the Arm’s Reach Co-sleeper.
  • And how you put your baby to sleep is yet another consideration. Remember: Always place baby on their back to sleep.
  • Those extras are cute, but they aren’t safe. Remove any quilts, bumpers, stuffed animals, pillows, or blankets from the sleep space. Same goes with wedges and baby positioners. A tight-fitting sheet is all baby needs.
  • Encourage tummy time during the day. Your baby may not love lying prone on a mat during awake hours, but keep at it. Strengthening their muscles helps with development and with safer sleep.
  • Speaking of development, keep up with those well check appointments. A 2007 review of studies even showed that vaccinations may halve the risk of SIDS.
  • ResearchTrusted Source finds that sucking may help reduce SIDS and provide additional soothing. If your baby will take one, try introducing a pacifier for naps and bedtime when they are about 4 weeks old, according to the AAP.

You might also examine your own habits surrounding bedtime and otherwise. Part of safe sleep is staying alert and keeping the home free from smoke and other harmful substances. This means eliminating exposure to things like smoking or misuse of alcohol or drugs.

If you need help, call the Substance Abuse and Mental Health Services Administration helpline at 1-800-622-HELP (4357) or visit their website.

What about swaddling at child care centers?

The National Center on Early Childhood Quality Assurance explains that some day care centers that receive payment through the Child Care and Development Fund do not allow swaddling babies down to sleep. Some require written permission from a doctor.

Further, the National Resource Center For Health and Safety In Child Care and Early Education notes that “in child care settings, swaddling is not necessary or recommended.”

Why? Some of the reasoning surrounds swaddling in a group child care setting. The idea is that it may be hard to practice safe swaddling and sleep practices when there are multiple children to care for. It’s best to contact your daycare center directly to find out their rules regarding swaddling.

While not all babies may respond to swaddling in the same way, it’s certainly worth a try — especially if it means better sleep for your baby (and you!).

If you’re feeling nervous, simply double check your swaddle before turning in. Look at your baby’s mouth and nose to see they aren’t covered by excess fabric. Check their hips and legs to make sure they’re free to move.

And go through your mental checklist to ensure you’ve followed other safe sleep practices, like placing them on their back to sleep.

Still pregnant? Consider trying out your swaddling skills on a baby doll or stuffed animal. You may also have the opportunity to hone your abilities at birth and newborn classes offered at hospitals or through childbirth educators in your community. Ask your healthcare provider for information on classes near you.

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