We’ve always recommended swaddling as a good (and safe) way to help soothe fussy newborns and to promote better baby naps and longer nighttime sleep. But, do we need to rethink our position on swaddling babies?
At this point, many daycares have banned swaddling and the American Academy of Pediatrics has labeled swaddling an “unsafe” practice in childcare settings. In fact, since December 2012 it is now illegal for child care centers in Minnesota to swaddle at all!
Why Are Daycares Banning Swaddling, and How Is It Affecting Babies?
So, what’s prompted this recent ban on swaddling? In 2011, a study by the National Resource Center on Child and Health Safety (NRC) and the American Academy of Pediatrics (AAP) concluded that swaddling can increase the risks of “serious health outcomes” and concluded that “swaddling is not necessary or recommended” in any childcare setting.
The AAP named several specific swaddling-related concerns, including:
- Hip dysplasia or dislocation (tight swaddling increases the chances of hip problems.)
- Loose blankets in the crib (if a baby breaks free of the swaddle, the blanket can cover his face, increasing the risk of SIDS.)
- Stomach sleeping (if a swaddled baby is placed on her stomach to sleep, or if she rolls from her back to her stomach while swaddled, it increases the risk of SIDS.)
- Improper swaddling technique in general (the AAP has concerns that not all childcare workers know how to safely swaddle babies.)
As you can imagine, this recent push to stop swaddling newborns and young infants has made a major impact on childcare providers. Daycare providers report that infants who used to sleep an hour or more at a time are now sleeping for 15-20 minutes (or not at all). This, of course, means there’s far more crying and fussiness for daycare staffers to deal with and lack of sleep isn’t good for the babies, especially! This has parents and caregivers alike feeling very, very frustrated.
Who Doesn’t Support the Ban?
As you know, most newborns need more gentle approaches to help them fall asleep, so what’s a family to do when they have a fussy newborn? We do offer newborn-friendly sleep coaching strategies in our e-book, Essential Keys To Your Newborn’s Sleep, as well as newborn-focused Personalized Sleep Plans® to help your newborn develop healthy sleep habits. But, it’s not as if child care employees can hold and rock every single wailing infant at the same time, after all; swaddling is likely one of the few methods childcare centers have to soothe all their babies simultaneously. Unfortunately, a persistent lack of daytime naps isn’t healthy for young babies, and it likely means less sleep at night, too — since the over-tiredness brought about by poor naps directly affects nighttime sleep.
However, if not done properly, swaddling can create issues (some of them serious). Swaddle a baby too loosely, and she’s likely to kick off her blanket. And loose blankets in the crib? A big no-no. Swaddle a baby too tightly, though, and you risk causing hip dysplasia or dislocation.
And there’s another big risk: A baby who’s snugly swaddled may still be able to roll over, from his back to his stomach. And a baby who’s swaddled and lying on his stomach is at an increased risk for suffocation.
The American Academy of Pediatrics may support the ban on swaddling in childcare centers, but not every baby expert agrees with this approach. Dr. Harvey Karp, the creator of the Happiest Baby on the Block books and DVDs, and an avid proponent of swaddling, has spoken out against this recent trend. He emphasizes that swaddling is an ancient and universally-used technique, and he points out that, in his opinion, the NRC hasn’t met the “burden of proof” they need to in order to issue such a sweeping recommendation. In their 2011 report, the NRC listed only five studies as references, and ignored the huge body of literature that highlights the benefits of swaddling. There have been others who have spoken out against the ban such as here.
But, does this mean you should ignore the NRC and AAP recommendations?
Should You Still Swaddle Your Baby? Safe Swaddling Tips and Techniques
It appears there’s always a study coming out showing something unsafe that was once safe. It’s hard to keep up with it all! As with many “recommendations” each family needs to weigh the pros and cons, make an educated decision, and do what’s best for their own baby and situation. This is true of many decisions you will need to make with your baby. For now, we wanted to share safe swaddling tips should you choose to swaddle your baby:
- NEVER PUT/ALLOW A SWADDLED BABY TO SLEEP ON HIS STOMACH – Swaddled babies should be laid down on their backs, and should sleep that way. Putting or allowing a baby to sleep on his stomach while swaddled increases the risk of SIDS and is not safe.
- DO NOT SWADDLE TOO TIGHTLY – When you swaddle your baby, you may feel tempted to wrap him up as tightly as possible, so that he’ll be less likely to break free. Avoid that impulse, though. Babies who are wrapped too tightly may not be able to breathe well, and wrapping their legs too tightly can lead to hip dysplasia and dislocation. A baby’s legs should always be able to bend freely in the swaddle. Bottom line: babies should be wrapped snugly, but not tightly, in a light and breathable blanket. Note: Nicole used the Miracle Blanket with both her boys.
- CHOOSE ARM/HAND POSITION – Historically, parents have swaddled babies with their arms by their sides. Recently, however, there’s been a push to swaddle babies with their hands by their faces. Supporters of this technique point out that it allows babies to self-soothe, by sucking on their fingers. They also point out that it gives baby a bit more mobility, which means that if baby does accidentally roll over while swaddled, she can do something about it.
However, not everyone agrees. In a recent phone interview with Nicole, Dr. Karp explained that he still advocates for swaddling with arms by the sides. He shared that after the first few weeks of a baby’s life, his arms begin to relax and it’s more comfortable for most babies to have hands by the sides. He also pointed out that if babies’ hands are by their faces, they’re less likely to soothe themselves and more likely to hit/scratch themselves in the face (which is decidedly un-soothing!) He also pointed out that a baby who’s swaddled with hands by face is far more likely to break free of the swaddle, and that means loose blankets in the crib.
All babies are different, so listen to your baby’s cues about what is most comfortable for her. If you do swaddle with arms by sides, be sure to leave a little flexion in the elbows — your baby’s arms shouldn’t be rigidly straight. If you swaddle with hands by face, be aware that you may need to check on baby regularly, to be sure she hasn’t broken free of the swaddle and loosened her blanket.
- SUPERVISE YOUR BABY – To be completely safe, you should supervise your baby while he’s swaddled. That way, if the blankets come loose, or if he rolls over, you’re there to intervene. Many families of newborns tend to room share for closer monitoring.
If you’re practicing safe swaddling techniques (using light cotton blankets, swaddling snugly but not tightly, etc.), you greatly reduce the risk that anything dangerous can happen to your baby while he’s swaddled. However, to be extra cautious, if you want to swaddle your baby for prolonged periods of time at night, you could invest in a movement monitor. A movement monitor does just what the name says — it monitors your baby’s movements. If your baby is completely still for too long, an alarm sounds, letting you know about it. Movement monitors are designed to combat SIDS, and to alert parents (or daycare staffers) to situations in which a baby might not be breathing.
For a demonstration on safe swaddling techniques, check out this video:
I feel it’s preposturous to ban swaddling in childcare centers on the basis that a baby can break out and end up with loose blankets in the crib OR turn over and suffocate! Babies in such centers – whether they are swaddled or not – should be checked on frequently. It’s not like they are being put down for a nap and the caregivers all go to sleep for 2 hours! It takes almost no time to look over all the cribs with sleeping babies to make sure they are all ok. It would make much more sense to require that caregivers in a childcare center get trained on safe swaddling techniques and are instructed to not leave sleeping babies unattended for long periods of time.
We just weaned our 4 month old from swaddling. We didn’t start out swaddling him, but by 10 days old he constantly startled himself awake. He’s a large baby – and strong – so traditional swaddles never worked. After doing research, we chose the Woombie, which looks a bit like a cocoon. It’s a stretchy cotton fitted sack that zips up the front and hugs the baby. It allows arm movement inside close to the body, so our little guy was able to pull his arms anywhere along the side and front of his torso, including up by his face if he wanted. But controlled flailing arms when he startled. And it was loose enough that it gave room for his legs to spread some, addressing the hip dysplasia concerns. When he hit 3 months we switched to a version with arm holes that we could open or close, and that allowed us to wean him. Once a week we tried having him sleep at night with 1 arm out. First 3 weeks it didn’t work, but right at 4 months he slept through the night with 1 arm out. So we did that for a whole week, then 1 week later we popped the other arm out and – voila – he slept with arms unswaddled. A few days later we switched to a sleep sack to give him lots of room for movement for his legs, no more swaddling. Transition worked like a charm. I think there are a lot of different products on the market that take into account the various health and safety concerns and enable an easier transition away from swaddling, such that people don’t have to rely exclusively on traditional swaddling if they aren’t comfortable with it. But in the end, people have to do what works for them. I know our baby needed it, and once he didn’t need it anymore transitioning away was pretty easy.
I think that we can’t keep banning things just because a few people are clueless how to use it. Swaddling is a great tool, and like any tool, needs to be done and used the proper way. My DD had horrible colic for four months and had all kind of sleep problems in her first year, and was swaddled and slept in a swing almost the whole first year because she could not control her arms to go to sleep and would or could not sleep anywhere else at night. We used a Woombie, and her legs were free to do as they pleased, and her hands and arms were free inside the suit to be in whatever position she felt comfortable. She couldn’t break out of it because it zipped up and I’m convinced it saved my life because even with these tools it was a most horrible year. Without swaddling she just simply would have never slept. I think that there are alternatives out there to using a blanket, and that if a parent is having difficulty mastering the art of the perfect blanket swaddle they can use something else. Banning swaddling altogether is just going to stress out already stressed out parents even more I think.
@ Stephanie — yes, I can see how poor swaddling technique can be dangerous. It seems to me, though, that making sweeping legislation that bans all swaddling in all childcare situations (like the state of Minnesota has done) is overkill. I feel like there must be more reasonable approaches, like asking parents to sign a waiver, or requiring parents to provide their own swaddling blankets, or requiring childcare workers to get training in safe sleeping and swaddling techniques.
Still, I know some people think it’s better to be safe than sorry. Thanks for weighing in, Stephanie!
@ Andrea K — So glad to hear that swaddling is such a powerful tool for you! I know, though, that it can be kind of a mixed blessing, because (as you mention) you can’t do it forever.
This article about weaning your baby from the swaddle may be helpful to you: https://www.babysleepsite.com/tag/weaning-from-swaddle/
Thanks for commenting, Andrea! 🙂
@ Jules — good point. 🙂 I do understand the push to ensure that daycare and childcare centers are operating as safely as possible, but it does seem unbalanced, doesn’t it?
Thanks for commenting, Jules.
@ Mary — thanks for mentioning the sleep sack! While those don’t work well for every baby, they make a great, safe alternative to swaddling with a regular blanket. And they can be great for weaning your baby from the swaddle, too.
Thanks for joining the conversation, Mary! 🙂
@ Jennifer M — it’s not for every baby, that’s for sure! 😉 All 3 of mine liked to be swaddled when they were newborns, but they were over it in the first 3 months.
Thanks for sharing a little bit about your experience, Jennifer!
I agree that swaddling can be unsafe, especially in a childcare setting. I have heard of childcare givers swaddling and then placing on stomach, or parents swaddling during sleep training. How horrible and sad for the helpless babies! Frankly many people are uneducated or lack common sense and compassion, and poor swaddling technique and usage is yet another example.
We’re not swaddling fans. My son HATED to be restrained in any way whatsoever. I’ve got three kids, 22 yo, 19 yo and now 9 months old – no swaddling. Two of them slept 7 hours a night at 8 weeks, the other woke up once a night until she was about 3.
We swaddled for calming purposes only. Our little man was a mover in his sleep from an early age and liked having his hands free. We found that when he moved from his rocker to the crib the sleep sacks were the best for him. We used the ones that had the wrap around the chest area but kept his arms free until he was 6 months. Then we moved to the regular sleep sacks until he could walk at 9 months. After that it was regular pjs. I can see where it could be unsafe but you have to do what is right for you and your child. I think the sleep sacks with the velcro around the middle mimic the swaddling which help and also keeps it from coming undone and creating the hazard.
If we weren’t able to swaddle our daughter, I doubt she would have slept at all when she was a newborn! It was a life saver for her and us. She was swaddled until she was almost six months old and she would fall asleep almost before we finished wrapping her. It was the best thing for her, and any siblings she may have will also be swaddled, no matter what these so called experts may say. What a nanny state we live in when soothing our children becomes a matter of public debate. Karp’s book is wonderful and I recommend it to anyone who is expecting.
We’ve tried unswaddling our daughter (she’s five and a half months old now), but she has what we call “crazy arms”. She won’t stop rubbing her eyes or knocking her pacifier out of her mouth – then she’s furious and screams for hours. Swaddle her arms, though, and she’s out like a light.
I know we can’t keep it up forever, but I don’t know what else to do.
We use a swaddle sleep sack with Velcro straps. She can’t get it around her face, and she’s a back sleeper, so I’m not worried about her rolling over on her face.