by Anne Eglash MD, IBCLC, FABM
Swaddling is often recommended as a means to help infants sleep on their own, but is swaddling safe? Many cultures around the world have been swaddling their infants for centuries. In the USA, hospitals often wrap newborns in one or two blankets to keep them warm during their hospital stay. Such modeling of infant swaddling may contribute to the current trend of swaddling infants at bedtime for several months postpartum.
A 2017 review of the literature investigated the risks and benefits of swaddling term, near-term and older infants.
What do you think the researchers found regarding the benefits and risks of swaddling infants? (choose 1 or more)
- Excessive blanket use during swaddling can cause overheating and increase the risk of sudden infant death syndrome.
- Swaddling reduces pain equal to breastfeeding during a painful heel stick.
- Swaddled infants sleeping on their stomachs (prone) have an increased risk of sudden infant death syndrome.
- Swaddling tightly around the hips increases the risk of hip dysplasia.
- Swaddling should be discontinued when infants show signs of rolling over.
See the Answer
The correct answers are A,C,D,E
Risks and Benefits of Swaddling Healthy Infants: An Integrative Review
Nelson AM
BACKGROUND:
Swaddling has been practiced since antiquity; however, there is controversy about its safety.
OBJECTIVES:
The purpose of this review is to update and build upon previous reviews and synthesize evidence on risks and benefits of swaddling in healthy term, near-term, or older infants.
DATA SOURCES:
MEDLINE (1960-May 13, 2016) and CINAHL (1963-May 13, 2016) searches were conducted, relevant articles retrieved, and citation lists reviewed for other references. Synthesis Methods: A table summarizes study details. Selected older references and supporting literature are integrated into the synthesis to provide context.
RESULTS:
Swaddling calms infants and promotes sleep, but it is equally or less effective than other non-pharmacological methods in managing pain. There may be a slight risk for sudden infant death syndrome associated with supine swaddling, although the impact of confounding variables is unclear. Early skin-to-skin contact supports early breastfeeding, but swaddling does not have a negative impact on breastfeeding long term. Swaddling tightly around the hips is strongly associated with developmental dysplasia of the hip. More research is needed on the impact of swaddling on pain in term infants, infant vital signs, arousal thresholds, and a possible association between swaddling, vitamin D deficiency, and acute lower respiratory tract infection.
LIMITATIONS:
The number of studies was small, with few randomized control trials, and researchers used different definitions of swaddling.
CONCLUSIONS:
If a few precautions are taken, such as swaddling securely to minimize risk of unwrapping, avoiding overheating, placing infants to sleep supine, and discontinuing swaddling when infants first show signs of rolling over, swaddling presents minimal risk.
CLINICAL IMPLICATIONS:
Maternity and neonatal nurses should model swaddling practices based on the evidence and promote informed decision-making among infant caregivers.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
My patients frequently ask me if swaddling is safe, and until what age can they continue to swaddle. Many parents report that their infants sleep longer when swaddled. In this review, the authors evaluated the evidence on sleep arousal. They report that some studies found swaddled infants have less spontaneous awakening and improved sleep. This may be why placing swaddled infants prone to sleep is a significant risk factor for sudden infant death syndrome.
Swaddling is not as effective as breastfeeding or kangaroo mother care in reducing pain during a procedure.
The American Academy of Pediatrics, in its Updated 2016 Recommendations for a Safe Infant Sleeping Environment recommends that swaddled infants should only be placed on their backs to sleep. The swaddling should be snug around the chest and loose around the hips to prevent hip dysplasia. As soon as the infant shows signs of rolling at night, swaddling should be discontinued. Having the arms in or out of the swaddle does not seem to have an effect on sudden infant death syndrome.