Do’s and Don’ts of Newborn Swaddling

We’ve all seen heartwarming images of a sleeping baby snuggly wrapped in a blanket like a cocoon. Studies show swaddling infants can extend their uninterrupted sleep and reduce startling and spontaneous awakenings. 

Yet, some serious risks are associated with incorrect infant sleeping positions and bedroom arrangements. Every year in the U.S., approximately 3,500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS). Improper swaddling can cause hip dysplasia and dislocation.

To avoid such risks, new parents and childcare providers should learn and practice the following proper swaddling and sleeping techniques. 

The American Academy of Pediatrics recently updated its recommendations to ensure your baby gets safe and sound sleep.

For at least the first six months of life, allow your infant to sleep in your bedroom, close to your bed, on a different surface designed for infants.

Swaddle your baby from day one. Or, begin swaddling regularly when you feel it could help calm your child. 

Wean your baby off of swaddling once they can roll over, which is typically by age three to four months.

Lourdes Forster, M.D., a pediatrician with the University of Miami Health System, says, “I tell parents if you continue to swaddle beyond this stage in your baby’s development, the risk for SIDS increases because the baby could roll onto their side or chest.

“Of course, rolling is a healthy and normal part of the child’s development, and you don’t want to discourage that movement.” 

This swaddling technique may help reduce your baby’s crying and encourage longer periods of safe, sound sleeping.

1. If you don’t feel comfortable using a thin, conventional cloth to swaddle a newborn or to save time, you can purchase pre-folded “swaddle sacks.”
2. If using a thin, square cloth (not a heavier blanket or cloth to avoid overheating), fold back one corner to create a straight edge, then place your baby on the fabric. 
3. The top of the fabric should be at the baby’s shoulder level. If using a rectangular cloth, you should place the baby’s shoulders at the top of the long side.
4. Depending on the child’s behavior, you can decide if your baby’s arms are swaddled in or out.
5. To swaddle the arms inside, bring the baby’s left arm down. Wrap the cloth over the arm and chest — Tuck the fabric under the baby’s right side.
6. Bring your baby’s right arm down, and wrap the cloth over their arm and chest.
7. Tuck the cloth under the baby’s left side. The child’s weight will hold the cloth in place.
8. Twist or fold the bottom end of the cloth and tuck it behind the baby, ensuring that both legs are bent up and spread apart so the baby’s hips can move.
9. Ensure that your baby is swaddled snuggly rather than loosely. It should feel snug when you slide your hand between the blanket and your baby’s chest. 

Always place your infant in a supine position (on their back, facing up) to sleep.

Always use a firm (not too soft), flat, non inclined sleep surface to reduce the risks of rolling over, suffocation, and entrapment.

While your baby is swaddled, check to see if they are overheated. Feel your baby’s ears and fingers. The child is wrapped too warmly if they’re hot, red, and sweaty. Swaddled babies should feel only slightly warm, not sweaty.

“There should not be any additional blankets over a baby who is swaddled (which I have seen),” Dr. Forster warns.

How to reduce the risk factors for SIDS and sleep-related injuries

• Don’t allow your swaddled baby to rest or sleep in a prone position (chest down) or on their side.
• Don’t use weighted swaddle blankets, clothing, or objects on or near the baby. 
• Don’t wrap your baby in a loose blanket or other fabrics, and don’t allow the swaddle to come undone.
• Don’t wrap your baby’s legs straight down and pressed together. Swaddling infants with the hips and knees in an extended position may increase the risk of hip dysplasia and dislocation.
• Don’t assume that your baby can’t be successfully swaddled just because they fuss while swaddling the first few times. Your baby may just need more time to get used to being swaddled.
• Stop swaddling your child once they show signs of attempting to roll (which usually occurs at three to four months but may occur earlier).

Don’t assume that there’s something wrong if your baby wakes up throughout the night, even when swaddled. It’s normal for newborns to wake regularly for feedings.

Dr. Forster says, “Most babies won’t sleep longer than six hours until after six months of age because of the feeding schedule, especially if you’re breastfeeding.”

Updated by Dana Kantrowitz, a contributor for UHealth’s news service.

Originally published on: September 28, 2017

Tags: Lourdes Forster, neonatal, newborn, Pediatrics, swaddling