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Does swaddling increase SIDS risk?

An article published in the May 2016 edition of Pediatrics suggests that the incidence of SIDS may be higher in babies who are swaddled than in infants who are not swaddled for sleep. The study, despite being a meta-analysis, included a mere four trials, so its numbers are limited. Nevertheless, safe sleep is something parents and doctors alike take very seriously.

Swaddling, when you snuggly wrap babies for sleep, is very popular in the United States, especially in the first several weeks after birth. Swaddling is thought to improve the quality and duration of sleep and to help calm fussy babies. The swaddle industry is huge, with blankets and swaddle sleep suit choices numbering in the hundreds.

So what is a parent who swaddles to do when faced with the sensational headline that swaddling increases the risk of SIDS? First, take a look at the overall safety of your infant’s sleep space. We know that infants should sleep each and every time on a flat, firm mattress approved for babies — adult beds are not appropriate. Make sure the mattress is free of any other objects including other blankets, stuffed animals, and bumpers. The sleep space should be smoke-free and well ventilated.

Second, consider the swaddle you have chosen. Is it easy to use or do you find the baby unswaddled when you return to the bedside? If so, the swaddle blanket is loose and needs to be removed from the bed. There are many swaddle sleep blankets in stores that securely wrap around the baby using Velcro so the baby remains safely wrapped. The swaddle should end well below the head and neck of the baby and should cover but not bind legs to reduce the risk of developmental hip dysplasia. The swaddle should be lightweight to decrease the risk of hyperthermia or overheating of the baby.

Third, and perhaps most important, is that swaddled babies should only sleep on their backs and never on their sides or tummies. The meta-analysis was very clear in that the incidence of SIDS was significantly higher with a swaddled baby placed on his or her side or tummy. Tummy sleeping is not recommended — whether swaddled or not.

Finally, once babies begin rolling, the swaddle is no longer appropriate. For most babies, this happens between three and four months of age, although some do it earlier.

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About Dr. Sara Connolly, Bundoo Medical Director

Sara Connolly, MD, FAAP, is a Board Certified Pediatrician who practices in Palm Beach County, Florida. She has a passion for child advocacy and has worked on the local, state, and national level to increase access to care for children. Her interests include nutrition, breastfeeding, and parenting skills.

Comments

  1. Thank you for this breakdown, Dr. Sara! This headline popped up in one of my social media feeds the other day, and it caught my attention immediately. Although neither of my babies liked being swaddled initially, it helped them sleep better and longer for those first few months, and I’d hate to lose that for #3!

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