Swaddling for Sleep
Swaddling is an ancient practice of wrapping our babies up in a thin blanket or cloth and has many benefits. While little burrito wrapped babies are super cute and it does serve a purpose, we need to be mindful of how we swaddle in order to do it safely and also transition out at the appropriate time. All good things must come to an end!
Swaddling refers to the restrained movement of their arms.
If their arms are free, they are not swaddled, even if they’re wrapped around the chest as a product intends. People refer to this as “chest compression” but there should literally be no chest compression (you should allow for 2 fingers to fit between swaddle and baby) and this doesn’t prohibit baby from moving in/out of positions like restraining their arms would. I find it is important to make that distinction!
All of this and more and will be covered in the blog, including:
What are the benefits of swaddling?
Are swaddling blankets safe?
Can swaddling cause SIDS?
Can swaddling restrict breathing?
Can swaddling help colic or reflux?
When swaddling doesn’t work
Swaddling when rolling over
Why stop swaddling at 8 weeks?
Swaddling to what age?
Will swaddling help baby sleep?
Will swaddling overheat my baby?
Does swaddling help babies sleep through the night?
Can swaddling cause hip dysplasia?
Can swaddling cause sensory processing disorder?
Swaddling and feeding
When to stop swaddling and use sleep sack?
How to transition out of the swaddle?
What are the benefits of swaddling?
There are many many benefits to swaddling, and certainly aren’t limited to the following:
Swaddling helps your little one to feel safe and secure outside of the womb.
It muffles the moro reflex to prevent them from flailing their limbs and waking themselves up unnecessarily (this blog goes into detail about the Moro reflex)
It keeps them warm until they can regulate their temperature better
Improves sleep (but be realistic about newborn sleep-- here is a blog for more info!)
Swaddling decreases anxiety
Keeps baby from scratching their face
Eliminates the need for other objects in the crib like a lovey or loose blanket
Swaddling mimics touch
Helps to maintain the back to sleep safe sleep rule
Swaddling soothes colicky babies
Swaddling can improve maternal mood; from this study, “Studies note that swaddling is thus associated with a “significant reduction of maternal anxiety, and an increase in parental satisfaction”
Are swaddling blankets safe?
Let’s review safety information about swaddling!
A swaddled infant should only be placed on their back to sleep. Placing an infant on their side or stomach increases their risk of SIDS. For those put on their bellies, especially babies more than 6 months old, the risk doubled.
Research suggests that the increased risk is linked to unsafe swaddling techniques, such as placing babies to sleep on their front or using thick sheets or blankets, rather than the practice itself.
Experts also recommend that if you’re going to swaddle your baby, you should do it from birth. Don’t introduce swaddling at two to three months, when the risk of SIDS is at its highest.
By then, your baby will have learned to sleep without swaddling, so a change in her sleeping habits may make her more vulnerable.
Whatever you are using to swaddle should be snug and secure to ensure nothing comes loose and increases the risk of suffocation. This includes blankets– they should be secure enough that they won’t become a loose blanket in the crib.
While it should be snug around their arms, we want it loose around the hips to decrease the risk of hip dysplasia.
One last safety check is to make sure they are not overheating with the swaddle. Signs of overheating are:
Sweating
Damp hair
Heat rash
Red cheeks
Heavy breathing
For more safe sleep information, check out this blog!!
Can swaddling cause SIDS?
No, not necessarily because SIDS has no cause. If a baby is placed on their belly or a loose swaddle blanket becomes a risk, then it wouldn’t be classified as a SIDS death.
But does swaddling reduce the risk of SIDs? According to this study, “In 2002, researchers explained that “recent epidemiologic evidence . . . shows swaddling in supine sleeping infants is associated with reduced SIDS risk as compared with back sleeping alone.”
For infants placed to sleep on their backs, the investigators summarized: “swaddling seems to be protective. . . Up to a certain age, swaddling hinders turning prone, but on the other hand, when an infant is prone, his or her risk of SIDS significantly increases.”
And this study specifically states the risk is increased if the infant is unfamiliar with swaddling: “This study provides a scientific basis for assessing the safety of swaddling in infant care practice. The decreased cortical arousals observed in infants unfamiliar with swaddling may correspond to the increased risk of sudden infant death syndrome for inexperienced prone sleepers.
Experts agree: swaddling is only a risk when it’s done improperly.
Can swaddling restrict breathing?
It could if it isn’t done properly and is done too tight around their chest. That’s why it’s important to ensure it is roomy enough to fit 2 fingers between the swaddle and your baby’s chest as well as ensure it isn’t going to become loose and create a suffocation risk.
Can swaddling help colic or reflux?
Swaddling can be especially helpful for a baby with colic. Because the incessant crying can cause parents stress and anxiety, finding ways of not only calming the baby but from getting a break from the fussiness are paramount for a parent’s mental health!
For reflux though, swaddling may help as a temporary calming tool but it isn’t going to cure the root cause which is super important in solving reflux.
When swaddling doesn’t work
Swaddling isn’t a cure for fussiness- it’s simply a tool and we often have to combine tools in order to get the maximum calming benefit.
Oftentimes, babies will resist the act of swaddling and are a little fussy after swaddling them, especially for sleep if they’re really tired.
It isn’t uncommon to have to soothe them even further after swaddling with rocking, swaying, bouncing, a pacifier, feeding, white noise, etc.
It’s usually the combination of all the soothing that solidifies sleep for them!
Swaddling when rolling over
Swaddling cannot be done when rolling, whatsoever. This increases the risk of suffocation as your child can get stuck on their belly and unable to reposition themselves.
This is why the recommendation is to discontinue swaddling at the first SIGNS of rolling, not when you actually see them roll. They will often roll for the first time while sleeping, so you have to be on the lookout for potential signs that they’re going to start rolling and discontinue swaddling then.
Those signs could be:
lifting their head and shoulders more during tummy time.
rolling onto their shoulders or side.
kicking their legs and scooting in a circle when on their back.
increased leg and hip strength, such as rolling the hips from side to side and using the legs to lift the hips up.
Why stop swaddling at 8 weeks?
The head of the SIDS task force, Dr. Moon, put out a statement that she would recommend discontinuing the swaddle at 8 weeks because there are instances of incidental rolling happening at that age. It’s an extra precaution for suffocation prevention (and honestly, the sooner the better to focus on other sleep assocations).
Swaddling to what age?
Since there’s no definite age on when a child may show signs of rolling, it’s best to intentionally watch your child for signs to ensure you catch it before they physically roll over while swaddled!
Will swaddling help baby sleep?
It certainly can contribute to better sleep as it prevents the Moro reflex or startle reflex from being so strong and waking them up during light sleep or moments it is activated. However, these would be signs that it isn’t helpful or to discontinue using it for sleep:
Their moro reflex is integrated and they do not “startle” any longer
If they have outgrown their swaddle
If they are breaking out of their swaddle
Showing signs of rolling
You are about to do some form of sleep training
Your baby is getting more frustrated with the swaddle than without
They are becoming mobile/scooting around while swaddled (if they are asking for freedom, let them have it!)
Suddenly waking up more often while swaddled
Will swaddling overheat my baby?
It’s a possibility if your child isn’t dressed appropriately for the room temperature. Swaddles can have different TOG ratings (this is simply how much heat a garment holds- the higher the TOG, the more heat it holds so it’s more appropriate for colder temperatures) and using multiple layers of clothing + a swaddle can lead to overheating.
Check out this blog for dressing a baby during sleep.
Does swaddling help babies sleep through the night?
That’s usually the hope, but isn’t always the case. If it helps your little one sleep longer stretches, then keep doing it! But it isn’t a fail if your child doesn’t sleep longer with it (if they sleep better without it, by all means don’t use it!)
Here’s a blog about night wakings with research on what’s normal!
Can swaddling cause hip dysplasia?
From Hospital of Special Surgery, “If not done properly, swaddling could affect an infant’s tiny hips.
Wrapping a baby too tightly puts a newborn at risk of developing a condition known as hip dysplasia, according to Dr. Emily Dodwell, a pediatric orthopedic surgeon at HSS. Basically, it means the infant’s hip does not grow properly.
To understand what happens, think of the hip as a "ball-and-socket" joint. In a normal hip, the ball at the top part of the thigh bone fits firmly into the socket, which is part of the pelvis. When a baby has hip dysplasia, it can range from mild to severe. The ball may be loose in the socket or it may partially come out of the socket. Sometimes it dislocates out of the socket completely. The condition is often referred to as “developmental dysplasia of the hip” or DDH.”
Can swaddling cause sensory processing disorder?
This is a big myth we see floating around and it simply isn’t true or founded in ANY research. We’ve read every available article about swaddling and cannot find a link to this anywhere. There is no current date that proves or connects swaddling as a cause of SPD just from the temporary inhibition of the Moro reflex.
There is also no magic quantity of times the Moro has to be activated to integrate. In fact, science shows this will naturally integrate within 2-4 months and is fully integrated by 6 months unless there is an underlying issue.
It really comes down to BALANCE. Don’t swaddle your baby 24/7. Don’t babywear 24/7 (because, same thing when we refer to restriction).
And to be honest, swaddling provides deep pressure proprioceptive feedback to your baby (which is what they received in the womb). which is extremely beneficial in calming little ones and regulating them. Infant massage also provides this feedback to them.
And while we are here… swaddling cannot alter your child’s biological sleep pattern or rhythm unless you medicate them (a concern people have is that it will cause TOO deep of sleep).
Swaddling and feeding
It’s usually. helpful to encourage full feedings by not swaddling while feeding. For middle of the night feedings, I recommend unswaddling, changing diaper, feeding one side (or half of a bottle), reswaddling and finishing the feeding so you don’t wake them too much after they’ve fallen back to sleep after feeding!
When to stop swaddling and use sleep sack?
When your child shows signs of rolling (listed above) you can switch to a sleep sack (any they fit in is fine!). A sleep sack is a great sleep association as well but you can expect some bumps in their sleep while they adjust! It’s not usually a seamless transition.
How to transition out of the swaddle?
The biggest question! It’s time to transition out— how do we do this?!
You have some options:
my favorite: cold turkey. If you’re seeing signs of rolling OR you child has already rolled over, it’s gotta go. No weaning options for that. At bedtime, use a sleep sack and then naps the next day.
One arm out, then the other. If you’re not seeing signs of rolling, you can use this to gently transition from the swaddle to the sleep sack; alternate which arm is out for about a week then transition to the sack.
Using a transitional suit like the Merlin. It should really only be used temporarily as we don’t want any developmental delays from the restrictions those suits provide either!
If you’re really struggling with the swaddle transition or know that you’ll want support with that, fill out this form to work with me this month!
