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Does swaddling your newborn increase or decrease the risks of SIDS?

Infant and Children | June 28, 2016 | Author: The Super Pharmacist

sleep, infants, SIDS, swadling

Does swaddling your newborn increase or decrease the risks of SIDS?

Swaddling is the practice of wrapping babies from the neck downwards, entirely in a cloth or thin blanket, with the aim of pacifying or calming them. It has been used widely around the world in many different countries and is based on the belief that the feeling of being ‘contained’, recreating the restricted and comforting space of the womb, can help babies to feel more settled and subsequently improve sleep. 

Like many aspects of parenting, swaddling remains a contentious issue due to a range of different theories around what is best for a newborn baby. Critics of swaddling have pointed to a number of risks it increases such as an increased risk of cot death (SIDS), reduced breastfeeding at birth, and increased early weight loss (1).

Certain swaddling styles have also been criticised for increasing the risk of developmental hip dysplasia, overheating, and acute respiratory infections (2), whilst its advocates point to its role in improved sleep and helping to foster the parent-child bond.

What is the evidence

Much of the formal evidence base regarding swaddling does not relate to quality of sleep or baby and parent experience of swaddling. It largely focuses on the medical risks of poor swaddling and its relationship with delayed development.  

There is evidence highlighting poorly swaddled babies  having increased chance of developing hip dysplasia, due to being unable to maintain a natural ‘frogs leg’ position.

The use of heavy materials instead of lighter muslins or cloths has also been shown to increase the risk of dysplasia and overheating. 

In the UK, both the National Health Service (NHS) and the Royal College of Midwives advise against certain forms of swaddling. 

Other advice includes:.

  • Do not leave swaddled infants alone on their stomach either in play or in sleep. This significantly increases the risk of cot death. 
     
  • Be careful not to cover baby's mouth or nose whilst being swaddled and carried in a sling. There have been some incidences of babies who have been swaddled and left in slings, having suffered fatal accidents. The risk seems to be when a baby’s airway beomes obstructed from their chin resting on their chest, or their mouth and nose are covered by their parent’s skin or clothing.

Sudden Infant Death Syndrome (SIDS)

There is a growing interest in infant care practices in the sleep environment to determine its relationship with Sudden Infant Death Syndrome (SIDS), with most studies concentrating on swaddling, the use of a dummy/pacifier at night-time, and mothers who smoke.

There is no unequivocal evidence linking swaddling with an increased risk of SIDS, unless the baby is left on its stomach in which the chances of a fatality dramatically increase (3).

Colic​

A number of commentators have suggested that the incidence of swaddling has increased dramatically due to its perceived effect on promoting sleep and the management of colic (the medical term for excessive and frequent crying in a baby who appears to be otherwise healthy).  However, there is no evidence to suggest that swaddling relieves colic.

ColicThe main finding of studies investigating the relationship between swaddling and colic was actually its potential to cause hip dysplasia, despite this not being the initial hypothesis of the experiments (4). 

As the cause of infantile colic remains unknown, it is difficult to attribute any success in reducing its symptoms to swaddling. 

 

Some experts recommend loosening a swaddle, or removing the child from being swaddled, during breast feeding. It is thought that this improves the ability of the child to latch to the breast, as well as allowing their hands to be able to explore and touch.

The Positive

A group of paediatricians, publishing in the American Journal of Paediatrics, found that swaddled children would typically sleep longer and rouse less than babies who were not.

However, the study also points out that there are a range of confounding variables that are not accounted for in regards to these findings, and that the number of studies that met the criteria for review were so small as to not be statistically significant (5). The study also found that swaddling can help regulate temperature, but it can also cause hyperthermia when misapplied and that swaddling too tightly does increase the risk of babies developing respiratory infections. 

The study found unequivocally that swaddling with the child laying on their front side increased the risk of SIDS, and also advises all parents to stop swaddling the moment that a baby begins to show an inability to turn over onto their front.

When to Stop Swaddling

It is recommended that swaddling is discontinued altogether once a baby is able to roll onto their own stomach to sleep.

How to Swaddle Safely

How to Swaddle SafelyAlthough everyone seems to have their own technique, a common method to swaddle a baby is by placing a large cot blanket on the floor, laying it in a diamond shape, and folding the top point over to create a flat edge for the baby’s shoulders to lie among. One corner is brought across to tuck under the baby’s bottom, and the bottom point up to tuck into the wrap. The other top corner secures the material in place.  

Baby's legs should be able to move into a ‘frog position’ rather than being held straight.

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References

1 Bystrova K, Matthiesen AS, Widstrom AM et al (2007) The effect of Russian maternity home routines on breastfeeding and neonatal weight loss with special reference to swaddling J Early Hum Dev 83(1):29-39

2 Narangerel G, Pollock J, Manaseki-Holland S, Henderson J (2007) The effects of swaddling on oxygen saturation and respiratory rate of healthy infants in Mongolia J Acta Paediatric 96(2):261-5

3 Pease AS, Fleming PJ, Hauck FR et al (2016) Swaddling and the risk of SIDS: A meta-analysis J Pediatrics 137(6)

4 Johnson JD, Cocker K, Chang E (2015) Infantile Colic: Recognition and Treatment J Am Fam Physician 92(7):577-82

5  van Sleuwen BE, Engelberts AC, Boere-Boonekamp KM, Kuis W, Schulpen TW, L’Hoir MP (2007) Swaddling: a systematic review J Pediatrics 120(4):e1097-106

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