Is swaddling safe?

A meta-analysis published in the June 2016 issue of Pediatrics yesterday sounds pretty scary to parents of new babies: the risk of SIDS (Sudden Infant Death Syndrome) was found to be higher when infants are swaddled.

Wait, what? Swaddling is one of paediatrician Harvey Karp’s five magical “S” tips for soothing newborns. If you haven’t heard of Karp yet, he wrote The Happiest Baby on the Block and The Happiest Baby Guide to Great Sleep. He’s basically our generation’s Dr. Spock or Dr. Sears—the modern baby-bible-guru. While it’s important for everyone to know the risks when it comes to safe baby sleep, personally, I would hate for tired, overwhelmed new parents to miss out on the magical effects of swaddling just because of this analysis.

The researchers looked at four studies over 20 years, in different countries (including England, Australia, and the US), and found that the risk of SIDS doubled in infants who were swaddled AND found on their stomachs. “The studies suggest that the majority of those found on their stomachs moved into this position after being placed on their sides or backs,” wrote the researchers. “Although the numbers were small, the risk of SIDS from swaddling increased with age, with the highest risk associated with infants aged over 6 months.” (You can read the whole article here.)

But there are a few problems: first of all, the study didn’t specify how—or how well—these babies were swaddled. Some parents use light cotton or muslin swaddling blanks to bundle up their little baby burritos; some parents use the specially-designed swaddles that fasten with Velcro tabs or zippers. And the SIDS data they were analyzing was actually collected in the ‘80s and ‘90s. Meanwhile, SIDS rates have been falling, and swaddling has been rising in popularity.

So rather than throwing all your swaddles out with the bath water, the more measured, common-sense takeaway for parents awash in conflicting advice is this: always lay your baby down on his or her back to sleep (never on the tummy or side), don't keep loose bedding or stuffies in the crib, and stop swaddling once your infant has learned how to roll over. This is common around three or four months of age, and you’ll probably know because learning this new skill can cause sleep disruptions—often part of the delightful baby sleep phenomenon known as the four-month sleep regression. (Don’t say we didn’t warn you!)

Lots of babies learn how to roll from their backs to their tummies first, but haven’t mastered the all-important task of righting themselves in the other direction, from their tummy to their back. You don’t want your little one to end up stranded on her tummy, without any arms free to help re-position herself or move her face away from the mattress or any bedding.

You should never swaddle a baby older than six months. And if you know your infant is a stomach sleeper—some babies end up on their tummies no matter how many times you put them down on their backs, or flip them mid-nap—it's safer not to swaddle.

After my son Cal was born, we tried swaddling for the first two weeks. One big advantage of swaddling—in addition to a baby who cries less and feels cozy and secure—is that all those newborn poop blowouts were semi-contained (there’s another layer of fabric between the baby and the bassinet, so you usually don’t have to change the sheets). The main disadvantage was that our little guy really liked to self-soothe by sucking on his thumbs and hands, and when he was swaddled, they were inaccessible. Sometimes we did the “arms out” swaddle instead of the “arms-in” version. Mostly, I just nursed him to sleep.

But I clearly remember the magical night we randomly decided to try swaddling again. Cal was two months old, and he was more into his pacifier now than his thumb, so he didn’t really need his hands out anymore. We gave it a go, and it was the first time he’d ever slept seven hours in a row. I felt like a new woman the next day—like an invincible baby-whispering Jedi master.

We stuck to the same bedtime routine from that night onward: PJs, nursing, swaddle, white noise, pacifier. I don’t think we managed to replicate the elusive seven-hour stretch again the next night, but overall, Cal did seem happier and snug-as-a-bug when he was swaddled. Luckily, he was a devoted back sleeper, and he was right next to me in a bedside bassinet with mesh sides, so I didn’t feel too anxious about sleep safety.

By four months, however, he could roll over, and the swaddle was really starting to enrage him. He wanted OUT. And he was getting too long for his bassinet anyway. It was time to move him to the crib, and to graduate to sleep sacks. 

I do remember panicking a bit—if we couldn’t swaddle anymore, how would he sleep?—but we all adjusted. It wasn’t terrible. I learned that infants grow out of their newborn startle reflex, and as they get older, they don’t wake as often to feed (unless it’s a growth spurt!). That’s the thing with baby sleep habits: they evolve (and then devolve, and then evolve again). You’re often dealing with a new phase, a new skill, or a new setback. I hate to break it to you, but the technique that was a total sanity saver for the first few weeks probably won’t work forever… And the technique your friend/mother-in-law/neighbour swears by may not work for your kid, like, ever. See what works for you, and don’t feel as if you’re missing out on some top-secret sleep solution that other parents surely have figured out. The truth is, we don't.

Read more:
How to soothe your baby like a boss
How to swaddle
The right way to swaddle