Baby Swaddling was an art that I practiced for hours upon hours years ago when I was an overnight baby nanny and when I became a Postpartum Doula- way before I was a Parent Coach and Educator. This was when swaddling first came back into fashion. It was all the rage! It was helping babies sleep longer and then sleep sacks were released to the market as a way to have something to contain a now bigger baby when they were too wily to stay in a swaddle. But it turns out that both of these were causing some problems.
Helping families with infant sleep specifically for over 10 years now, I have become less fond of swaddles and sacks. And everyone is asking me, “Should we, or shouldn’t we, swaddle or use a sleep sack?” The answer isn’t super clear, even for me. Each family and baby is unique and truly some babies really love to be swaddled or in a sack. But do I recommended to every family? Recently, three different swaddle or sleep sack companies have asked me to endorse them. That could be financially beneficial to me but I’ve said no thank you and here’s why:
1) Possible Hip Dysplasia. In 2011, a study by the National Resource Center on Child and Health Safety (NRC) and the American Academy of Pediatrics (AAP) concluded that swaddling can increase the risks of “serious health outcomes” and they concluded that “swaddling is not necessary or recommended” in any childcare setting. Those serious health outcomes concluded that swaddling had long carried a known risk of hip dysplasia. Hip dysplasia used to be very common until swaddling went out of fashion in the 80’s. These new recommendations by the AAP were meant mainly for daycare centers but were otherwise mostly ignored and we see at least 10 new swaddle products on the market each year.
2) Restriction of movements. A baby may be able to roll from back to tummy while swaddled but then they will not have the use of the limbs to roll into an airway-unrestricted position. This is a sleep death risk. Once a baby can roll over, he needs full use of his entire body, both in order to know how to use it to his advantage day and night, and this includes to help him turn his body away from something else which might be suffocating him.
3) Baby cannot find fist. Unrestricted movement includes finding the fist (which is really the only way that new babies will ever “self-soothe”).
4) The chest wall can become compressed. Which can impede breathing. One example of one of these very tight swaddles is the Woombie. when you swaddle, make sure you can easily get two fingers between the chest fabric and the baby’s skin but that is isn’t much more loose than that.
5) Possible suffocation. With a blanket swaddle, babies DO get hands free. That hand could bring the swaddle blanket up over the face which is a suffocation risk.
A sleeping sack is generally used for older babies after a swaddle no longer works, and for older babies, this is a much safer option- the blanket cannot get pulled over the head, the arms are free etc. A sleeping sack not tight and is not effective though for the hug swaddling that some babies love.
6) Though swaddling helps babies sleep more deeply, that deep, long sleep is associated with increased risk of sudden infant death. Swaddling is not needed or helpful if baby is kept close to mother and breast-feeds with skin-to-skin contact. Breastfeeding itself is proven to soothe babies and help them get to sleep much better than swaddling can.
7) Lack of weight gain in breastfed and swaddled newborns. One Russian study showed lack of weight recovery in newborns who were breastfed and swaddled compared to not swaddled. These infants were not nursing as well or as frequently and eventually needed formula supplementation. This likely has to do with a lack of rousing to eat frequently. http://www.ncbi.nlm.nih.gov/pubmed/16716541
We have a long fear that baby will self-harm if not restricted. We have a fear that baby will move about and not just sleep. We have a fear that baby will somehow escape. And we have a deep-seated belief that babies must be contained and as well as that, babies need STUFF to help them sleep.
While the reasons not to restrict baby in a swaddle or sleep sack above area actually dangerous, the next one is simply…frustrating.
8) It becomes a strong sleep association and dependency from which your child must be weaned– which can be difficult. One third of my sleep clients come to me with the goal to get out of the swaddler or sleep sack but are not sure how. I can help, but let’s not get there in the first place, shall we? Baby no longer has the strong startle reflex that these sleep aids were meant to help with, but baby now is not sure what to do with the limbs and is either frustrated by their movement or preoccupied in playing with the toes (hehehe). And more often, baby is moving around in the crib and getting twisted and frustrated- does not have the ease of movement he has during the day. When I was first an infant overnight nanny and a postpartum doula- I witnessed this frustration often in more mobile babies.
It seems from all of this like nobody should swaddle- but wait, don’t throw the baby out with the bath water, so to speak. Just because it is possible to use a swaddle incorrectly- that does not mean you should not use it if you can do so correctly. And I’m not here to tell you that you should take a baby who sleeps well or is soothed by a swaddle right out of that thing! One size does not fit all families. I believe that parents get to make choices for their children and that children’s individual needs are unique (and sometimes those choices don’t always jive with what the AAP or professionals think). Like so many things in pediatrics- the second there is an issue from misuse of a product, everyone is told whey should not use the product. And like so many things in parenting, you balance your own understanding of risks and benefits So… Here’s When I DO recommend a baby be swaddled:
A) For newborn babies who are crying a lot, having a hard time adjusting to the new world, and you have found that swaddling works wonders. In fact, that’s the only way baby will relax and the only way you all can sleep? Great. Do this only up until 2.5 months and gradually take the hands out, then legs. Only use a swaddle product like the Ollie Swaddle, not a blanket that could come loose and be pulled over the face. This swaddle is designed so the hips are not constricted and so that baby won’t overheat.
B) If your newborn baby is crib-sleeping on her back and has a strong startle reflex. Make sure nothing but the swaddle is in the crib. And make sure baby isn’t wearing too many layers under the swaddle. A thin layer of cotton with socks is enough.
Why end swaddling at 2.5 months? By 3 months, baby can roll over and has a greater chance of suffocating. Doctors weigh in: http://aapnews.aappublications.org/content/34/6/34.full
What should you do if you don’t want to use a swaddle or sleep sack and your baby has a hard time sleeping on her back or has a strong startle reflex?
Though side-sleeping in a propped position is not considered as safe as back sleeping, many pediatricians recommend a propped side-sleeping position for newborns in cribs because it helps with the startle reflex (and can also help with gastrointestinal upset and GERD). So ask your pediatrician if they might recommend this for your family. Other family risk factors for infant sleep death should be considered because there is a small chance that an improperly bolstered side position would cause baby to roll onto his tummy. Side sleeping with a roles blanket or wedge like this should be done only when baby is rooming with you in a crib, aka co-sleeping, which is fortunately now recommended by the AAP- so you can keep an eye on the sleep position.
Dr. Bob Sears on Side Sleeping Safety:
“To lessen the chances of a side-sleeping baby rolling onto his tummy, stretch his underneath arm forward. This arm can act as a stabilizer to keep baby from rolling onto his tummy. If the baby’s arm stays closely tucked into his side, it will be easier for him to roll onto his tummy. Wedges to keep baby sleeping on his side are helpful, but never use just a back wedge. Rolling up a towel as a wedge between baby’s back and the bed may encourage baby to roll from side to stomach rather than from side to back. Be sure not to use props that totally restrain the infant’s movement. Freedom of breathing implies freedom to adjust body position as needed. I’m concerned that the multitude of commercial baby wedges may be more restrictive than necessary, and they have not been proven either safe or effective. For these reasons, SIDS organizations and researchers do not endorse these products. If you choose to use a wedge to keep baby on his side, it seems the most sensible to use a front wedge only, which allows baby to roll onto his back if desired.”
If your newborn is unsettled and crying a lot, you can also get help from an IBCLC lactation consultant, a cranio-sacral therapist for infants, see a naturopath to think about the dairy or gluten in your diet that your baby may be sensitive to.
The origins and history of swaddling is in ancient Greece first. Europe and the West is riddled with child neglect and misguided notions about the needs of babies and their development. You can read a slide show about it here: http://www.bflrc.com/ljs/documents/SwaddlingImpactUSLCAwebinarFeb2011SMITH.pdf
It’s important to know the modern history of infant sleep- that for many decades American Pediatricians recommended tummy sleeping above all else because it was the most natural sleep position for babies and because it helped babies sleep for longer periods of time, because the startle reflex was not present in this position. This means that when they came out of REM at the end of each sleep cycle, they would not startle awake and would more likely go right back into another sleep cycle without calling out, as long as they weren’t hungry. We now believe that there are major sufocation risks associated with tummy-to-sleep. Still, it’s important to realize that we have been dealing with thwarting the startle reflex and helping to make babies comfy and to sleep better – since at least ancient Greece.
Note: SWADDLES AND SLEEP SACKS should NEVER BE USED WHILE BED SHARING WITH BABY! Many people do not know this. Swaddles and sleep sacks are only for cribs. (They are also not for sofas or sleeping on you or your bed, not for swings or carseats or strollers!) For many of the reasons listed above, especially inability to turn away from smothering them and overheating.
Each baby is soothed in a different way. Here’s hoping you find yours! My advice is just to wean from sleep aids early, as they become more of a strong sleep association over time.
Love, Moorea www.SavvyParentingSupport.com