Do’s and Don’ts of Newborn Swaddling

We’ve all seen heartwarming images of a sleeping baby snuggly wrapped in a small blanket like a cocoon.

Yet, research from the American Academy of Pediatrics (AAP) suggests there are some risks associated with swaddling infants incorrectly.

The AAP says, “Swaddling may increase the risk of SIDS [Sudden Infant Death Syndrome], as swaddled infants have fewer spontaneous arousals from sleep and increased sleep time, particularly during quiet sleep, which is a state of reduced arousability. … Swaddling may also increase an infant’s risk for developmental dysplasia of the hip (especially if not applied well), hyperthermia, pneumonia and upper respiratory tract infections.”

To avoid such risks, new parents and child care providers should learn the following guidelines for swaddling safety.

Do:

  • Use the following swaddling technique to reduce your baby’s crying and encourage longer periods of sound sleeping.
  1. If using a square cloth, fold back one corner to create a straight edge.
  2. Place your baby on the cloth. The top of the fabric should be at the baby’s shoulder level. If using a rectangular cloth, the baby’s shoulders should be placed at the top of the long side.
  3. Bring the baby’s left arm down. Wrap the cloth over the arm and chest. Tuck the fabric under the baby’s right side.
  4. Bring your baby’s right arm down and wrap the cloth over his or her arm and chest.
  5. Tuck the cloth under the baby’s left side. The child’s weight will hold the cloth in place.
  6. Twist or fold the bottom end of the cloth, and tuck it behind the baby, ensuring that both legs are bent up and out so the baby’s hips can move.
  7. Place your infant in a supine position (on his or her back, facing up) to sleep.
  • Swaddle your baby from day one. Or, begin swaddling regularly when you feel it could help calm your child. Most babies are ready to be weaned off swaddling by 3 to 4 months of age or stopped once the baby can roll over.
  • Make sure that your baby is always swaddled snuggly rather than loosely. When you slide your hand between the blanket and your baby’s chest, it should feel snug. Ensure that the swaddle does not come undone, which can be life threatening.
  • Check to see if your baby is overheated while he or she is swaddled. Feel your baby’s ears and fingers; if they’re hot, red and sweaty, the child is wrapped too warmly. Swaddled babies should feel only slightly warm, not sweaty.

Dr. Lourdes Forster, a leading pediatrician at the University of Miami Health System, says, “I tell parents to stop swaddling as soon as their baby is able to roll over while swaddled.

“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.”

Don’t:

  • Allow your swaddled baby to rest or sleep in a prone position (chest down) or on his or her side. This can cause SIDS (Sudden Infant Death Syndrome).
  • Wrap your baby in a loose blanket or other fabrics. This can lead to infant death.
  • 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. Allow the hips to spread apart and bend up.
  • Assume that your baby can’t be successfully swaddled just because he or she fusses while swaddled the first few times. If you wait a while before giving swaddling a try, your baby may just need more time to get used to being swaddled.