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How to Safely Swaddle Your Baby

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swaddledSwaddling has long been used in many cultures as a way to soothe fussy babies and promote sleep. Although swaddling is a great tool to help calm babies, it is important that swaddling is done correctly to avoid complications such as hip dysplasia, overheating and respiratory problems.

 

  • The International Hip Dysplasia Institute states that hip dysplasia occurs when the “bones of the hip joint are not aligned properly." Hips can develop abnormally when an infant is swaddled tightly with the legs extended. Watch this animation to see what happens to the hips when an infant is swaddled with legs extended.
  • Overheating can occur when a baby is swaddled with heavy blankets, is overdressed or is swaddled in a warm environment.
  • Respiratory issues including infection have been found when an infant is swaddled too tightly. Researchers relate this to the inability of the chest to completely expand which then in turn leads to respiratory difficulty.

Safe swaddling can be easily mastered and can be accomplished by a variety of techniques. The main principles to keep in mind are:

  • Swaddle your baby so that the hips and legs are free to move. The legs should be able to bend up and out at the hips (flexed and abducted).
  • Swaddle and place your baby on his back to sleep. Do not put a swaddled baby to sleep on his tummy (the risk of SIDS increases 12-fold).
  • Do not overheat your baby when swaddling. Avoid using heavy blankets to swaddle and dress your infant in light clothing (a general rule of thumb is to dress your baby in one additional layer than you have on). Keep your baby’s environment at a cool, comfortable temperature (a temperature that is comfortable for a lightly clothed adult). Watch your infant for signs of overheating such as warm/hot skin, flushed cheeks, sweating, heat rashes or rapid breathing.
  • To avoid head covering from loose blankets, be sure to tuck each side of the blanket when swaddling. Using sleep sacks help to avoid the risk of suffocation from loose bedding.
  • Make sure not to swaddle your baby too tightly. One way to check tightness is by sliding your hand between your baby’s chest and the blanket. The blanket should feel snug, not tight.
  • The blanket should not come higher than your baby’s shoulder to prevent accidental covering of baby’s mouth and nose. When you and your baby are sleeping, it is best not to use a blanket.
  • However, if you feel your baby needs a blanket to sleep, swaddle your baby with his arms outside of the blanket (with the sides securely tucked) assuring that the blanket comes no higher than the chest. This will help prevent the blanket from covering your baby's mouth and nose if he moves around during sleep.
  • Remember to unswaddle your baby and give him time throughout the day to stretch and move his arms and legs without restriction.

Swaddling Using a Diamond-Shaped Blanket:

  1. Turn your baby’s blanket into a diamond shape.
         Sleep Sacks and
      Swaddling Blankets

    Sleep Sack
  2. Fold the top triangle of the blanket down.
  3. Place your baby in the center of the blanket, with his/her shoulders at the top edge of the blanket.
  4. Position your baby’s right arm either a) flexed on the chest and close to the face or b) down next to baby’s side. Take the right side of the blanket and pull it across the arm and chest to the opposite side. Tuck the excess blanket under your baby. Be sure to smooth the blanket out so your baby is not lying on bunched blankets.
  5. Take the bottom of the blanket and fold it up towards the chest. Be sure that there is ample room for the legs to move (legs should be bent up and out) and that the blanket does not come higher than the chest (fold blanket at chest level if necessary).
  6. Take the left arm and position it as mentioned in step 4. Take the left side of the blanket and pull it across the arm and chest to the opposite side. Tuck the excess blanket under your baby. Again, make sure to smooth out the blanket.

Swaddling Using a Square-Shaped Blanket:

  1. Place your baby in the center of the blanket, with his/her shoulders at the top edge of the blanket.
  2. Position your baby’s right arm either a) flexed on the chest and close to the face or b) down next to baby’s side. Take the right side of the blanket and pull it across the arm and chest to the opposite side. Tuck the excess blanket under your baby. Be sure to smooth the blanket out so your baby is not lying on bunched blankets.
  3. Take the left arm and position it as mentioned in step 4. Take the left side of the blanket and pull it across the arm and chest to the opposite side. Tuck the excess blanket under your baby. Again, make sure to smooth out the blanket.
  4. Take the bottom of the blanket and fold it up towards the chest. Be sure that there is ample room for the legs to move (legs should be bent up and out) and that the blanket does not come higher than the chest (fold blanket at chest level if necessary).

Swaddling can be beneficial in the first three months of age. Many babies are ready to be weaned from swaddling around 3-4 months of age, however some require longer periods of swaddling. Some experts suggest swaddling be stopped once a baby begins to roll over since prone positioning (sleeping on the tummy) can increase a baby’s risk for Sudden Infant Death Syndrome (SIDS). A guide found in Contemporary Pediatrics (2004) suggests the following to see if your baby is ready to wean from swaddling:

“To decide if your infant no longer needs to be wrapped, try this: After she reaches 2 to 3 months of age, swaddle her with one arm out. If she gets fussier, continue wrapping (with both arms in) for a few more weeks. However, if she still sleeps well with one arm out, she probably doesn’t need swaddling any more.”

Keep these recommendations in mind when swaddling your baby and be sure that anyone caring for your baby does the same.

How to Swaddle Your Baby

 

   

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Sources:

Contemporary Pediatrics (February 2004). Guide for Parents: Swaddling 101
First Candle: Model Behavior: Sample Policy and Procedures- Safe Sleep Practices for NICU
Franco, P., et al. Influence of Swaddling on Sleep and Arousal Characteristics of Healthy Infants. Pediatrics; Vol. 115 No. 5 May 1, 2005. pp. 1307 -1311 (doi: 10.1542/peds.2004-1460)
International Hip Dysplasia Institute: Hip-Healthy Swaddling
Korioth, T. Practice safe swaddling to protect baby’s hips. AAP News; Vol. 32 No. 9 September 1, 2011. pp. 11. (doi: 10.1542/aapnews.2011329-11a)
Price, C. & Schwend, R. Improper swaddling a risk factor for developmental dysplasia of hip. AAP News; Vol. 32 No. 9 September 1, 2011. pp. 11 (doi:10.1542/aapnews.2011329-11)
Van Sleuwen, B., et al (2007). Swaddling: A Systematic Review. Pediatrics; Vol. 120 No. 4 October 1, 2007. pp. e1097 -e1106 (doi: 10.1542/peds.2006-2083) 

 

 

 

 
 
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