Swaddling, the art of snugly wrapping an infant in a garment for warmth and security, is a go-to for sleep-deprived parents the world over.
Baby expert upon sleep guru upon wise grandma will recommend it. It’s the first of the storied “5 S’s” in the “Happiest Baby” method, parenting guru Harvey Karp’s technique for calming newborns and coaxing them to sleep. In some circles, people pay dearly for big squares of muslin or flannel, or special swaddling devices.
In light of all this, parents were understandably alarmed by an analysis of sudden infant death syndrome risk for infants swaddled for sleep, published this week in the journal Pediatrics.
“Swaddling babies may increase risk of SIDS,” the headlines blared. Some readers latched on and panicked. But the analysis emphasizes a more nuanced conclusion that supports what many parents and pediatricians already know.
To quote the article: “Current advice to avoid front or side positions for sleep especially applies to infants who are swaddled. Consideration should be given to an age after which swaddling should be discouraged.”
Put another way: Stick to current advice not to place infants to sleep on their stomachs or sides, and stop swaddling as your baby grows — probably around the time he or she shows signs of rolling or begins to break out of this fabric cocoon.
The review of previous research looked at four studies spanning two decades from the United Kingdom, Australia and the United States.
Overall, the analysis showed an increased risk of SIDS when babies were swaddled for “all babies put together,” said co-author Dr. Rachel Y. Moon, division head of general pediatrics at the University of Virginia School of Medicine.
There was a slight increase in risk when infants were swaddled and placed on their backs, Moon said.
However, the risk was much greater when infants were swaddled and placed on their sides — nearly double — and even more when infants were swaddled and on their stomachs, according to the review.
The risk was also higher when the infants were at least 6 months old, Moon said.
Contrary to what some headlines suggested, the data and findings don’t prove relationships, Dr. Wendy Sue Swanson of Seattle Children’s wrote in a blog post titled “Swaddling on side and tummy may increase risk of SIDS.”
Instead, they evaluate risks for babies who are swaddled versus risks for babies who were not, she wrote.
In other words, the article confirmed what many pediatricians and parents already know: Infants should avoid sleeping on their sides and stomachs to reduce the risk of dying from SIDS.
Since 1994, a “back-to-sleep” campaign has encouraged parents to place their infants on their backs when they sleep to prevent SIDS, the leading cause of death among children age 1 month to 12 months. It helped: Ten years later, the death rates from SIDS were cut in half. Around 2000, those rates began to plateau; research published in 2012 in Pediatrics suggested that it may be due to an increase in other risk factors, including bed-sharing and babies sleeping on adult mattresses and bedding.
Moon was also involved in that study, which suggested that parents should be aware that newborns are at risk for multiple and simultaneous SIDS risk factors, not just one. This latest study seems to reveal another factor for parents to consider.
The review also underscored another widely held view in parenting circles and pediatrics: Swaddling is helpful but only until a certain point.
“There’s a time to swaddle and a way to swaddle safely and a time to stop,” said Dr. Ari Brown, an Austin, Texas-based pediatrician and author of the Baby 411 book series. “All good things must come to an end.”
Brown says the time to stop is two months in, but others’ advice ranges from three to six months. At that point, the benefits of swaddling diminish as the startle reflex in newborns goes away, and potential risks such as flat head and anencephaly increase, she said.
“Swaddling does have some risks associated with it, and parents need to be aware of safe swaddling techniques and what they can do to reduce the risk and reap the benefits,” Brown said.
The American Academy of Pediatrics has the following recommendations to help prevent SIDS:
Babies should always sleep on their backs. Always use a firm sleep surface. Keep soft objects or loose bedding out of the crib. No pillows, blankets or bumper pads. Do not let your baby get too hot. Place your baby to sleep in the same room where you sleep but not in the same bed. Keep your baby away from smokers and places where people smoke. Breastfeed as much and for as long as you can. Offer a pacifier at nap time and bedtime. Schedule and go to all well-child visits. Do not use products that claim to reduce the risk of SIDS, such as wedges, positioners or special mattresses. Do not use home cardiorespiratory monitors to help reduce the risk of SIDS.