When Melissa Romain had her first baby at a Toronto hospital in 2016, the nurses demonstrated how to swaddle him and encouraged her to continue doing it at home. But by the time she had her second baby four years later, things had changed. The nurses swaddled her baby the whole time they were on the maternity ward; then, as she was being discharged, they told her she shouldn’t swaddle at home because it was too dangerous. They said this was because the baby was under closer supervision in the hospital, but Romain says there was plenty of time that she and her baby were alone together in her room. “I was confused and a little frustrated,” says Romain. “Nobody explained why swaddling is no longer a best practice. They just said that this is how it is now.”
According to Wendy Hall, a sleep specialist and professor emerita at UBC’s School of Nursing, most hospitals now advise parents not to swaddle. They’re likely following the guidelines of the Registered Nurses Association of Ontario and Perinatal Services BC, who both recommend against it.
“We suggest families use sleep sacks instead, because babies move, the blankets [you use to swaddle] can come undone, and if that gets in their face, there is a risk for sure,” says Cynthia Joly, a nurse educator at CHEO in Ottawa. “Unless you’re able to really watch the baby, like during a nap in your arms, we don’t advise that parents swaddle.”
The other concerns are that swaddling might lead to overheating; chest infections (because an overly tight swaddle can restrict breathing); and hip dysplasia, a condition in which a baby’s hip joints are loose or partially or fully dislocated. Swaddling also may be linked to sudden infant death syndrome (SIDS), which is not necessarily when a baby rolls over and suffocates, but an unexplained death of a baby under one year old.
But this messaging can be confusing for parents who have researched swaddling on their own. Paediatrician Harvey Karp, author of the best-selling Happiest Baby on the Block books, includes swaddling as one of his five key ways to soothe a newborn. (He also markets his own line of swaddles to use.) And other trusted sources, like The American Academy of Pediatrics and the Canadian Paediatric Society, both say swaddling is low risk if practised correctly.
“The Canadian Paediatric Society certainly is not against swaddling as long as it’s done properly,” says Janice Heard, a community paediatrician in Calgary and member of the Canadian Paediatric Society’s public education and advisory committee.
Swaddling does seem to help newborns sleep longer stretches at night. That’s because it helps calm the Moro reflex, which makes the baby’s arms spring out. “Many babies like that cuddled-up feeling. It’s like being in the womb,” explains Heard.
Toronto paediatrician Dina Kulik says to avoid swaddling if you can, but that it’s much better than some other sleep “crutches” parents reach for, like holding a baby all night, using a swing or sleeping with them on the couch. “If they can go down without it, don’t do a swaddle,” she says. “But if the alternative is holding them all night, swaddling is certainly safer than that.”
Make sure the swaddle is worn low—around their shoulders, not bunched up at their neck—and fits snugly, because there is a risk that the swaddle will become loose and the fabric could cover the baby’s face and suffocate them. Babies should be dressed lightly underneath a thin swaddle to avoid overheating. If you’re using a Velcro or zip-up swaddle, make sure it’s the right size so your baby’s head doesn’t scooch down into the swaddle as they sleep. And the baby’s hip area should be left loose so there is room for them to bend up and kick out their legs, which helps prevent hip dysplasia.
Then, there’s positioning: Always put a swaddled baby to sleep on their back, never on their side or their front, which greatly increase the risk of SIDS. When babies show signs of learning how to roll over, it’s time to ditch the swaddle.
Babies who bed-share with a parent should also never be swaddled. “Swaddling and co-sleeping is really not a very good combination,” says Hall. “If a baby is swaddled and ends up face down, they are completely defenceless.”
Kulik adds that there are some infants who shouldn’t be swaddled under any circumstances, such as babies who are very jaundiced or underweight. If you’re unsure, ask your healthcare provider for personalized, up-to-date advice, she says. “Always talk to your doctor. Every kid is different.”