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 have a 9 month old who is still swaddled and absolutely loves it. Her arms are down at her sides and now that she is older she can turn over, by herself, to find a comfortable position. I don’t plan on weaning her from it until she is ready, I feel like her being swaddled is a key part of her sleep routine and am not about to change anything that is still working! It really is a shame that something like swaddling could be banned and even illegal when it can truly help so many young babies. Like other comments have said there is no way child care providers can hold every crying baby at the same time. I feel like this is not good for baby or care provider and will only create more stress for everyone involved. I probably would not leave my baby with someone who said they wouldn’t swaddle her because of how much she needs it and enjoys it. Sleep is like gold and nothing should ever come between a baby and their sleep!
I will say with both of my babies swaddling did work for this first month or so, but soon after it became clear that they were no longer fans of it, and it was no longer safe for them with blankets being kicked off, and rolling over, and the velco-tupe swaddlers were even worse for them. That said, the transition from swaddling to sleep sack at the 1-2 month mark wasn’t exactly easy unfortunately. The first few nights were bad and it was a few weeks before they really seemed to settle into it, bit it is something that has to happen at one poiint or another. So in my experience it does help babies with the immediate transition from the womb to the outside world,but was definitely not a long term sleep tool. I can see the potential dangers of it, but as many people also pointed out a severely sleep deprived parent isn’t a great option either. I remember wondering a few times when my first especially was a newborn if I should be driving with such a lack of sleep. I think pediatricians and the AAP should recognize that not all babies are exactly the same so a “one size fits all” approach may be dangerous as well. It woulld be better if they made sleep style a topic to cover at all well-baby visits and worked more closely with the parents to make sure they are doing what is best for each individual baby. I know it wasn’t something I used for very long with my babies,but to say everyone else’s children are just like mine would seem a little silly!
My son would never sleep unless swaddled, some babies just need it to feel comfortable. When he got older I actually had to train him to sleep unswaddled – the legs were easier but he hated having his arms loose! My sister introduced me early on to a product called Woombie, I highly recommend it instead of wraps. Its basically a very stretchy bag you zip onto your baby, when they are not wiggling it gives them the feeling of closeness, but they can very easily stretch their arms and legs all around inside of it. It saved me from worrying that he would get trapped on his belly, because it still allowed him to push his arms out in front of him if needed. they have their own website, and ive also seen them on amazon if its of interest to anyone.
@ Jenn — you bring a helpful insight to this conversation, since you have childcare experience, so thanks for chiming in! I agree; I can’t imagine how chaotic a daycare that’s banned swaddling must be during the day. Can’t be a good environment for young infants. 🙁
@ Ellen — wow — thanks for sharing your experience with using the Miracle Blanket. Scary! But a good reminder that even the most “infallible” baby products are plenty fallible.
@ Emily — another vote for the Woombie! I think that makes 3 now. Glad to hear this has been such a great product for you! And interesting point about daycares requiring special swaddling blankets. That seems like it would be a more reasonable option than banning swaddling entirely.
Thanks for commenting, Emily! And great name, by the way. 😉
@ Catriona — thanks for recommending this! I haven’t heard of it, but it’s always nice to know about all the options available.
@ Lil — good point! I like your last sentence: “Banning swaddling altogether is just going to stress out already stressed out parents even more I think.” That’s a good point. Not to mention, it’s going to stress out already stressed-out childcare workers!
Thanks for commenting, Lil!
@ Melissa — thanks for sharing these specific details! They’re really helpful, especially for parents who may be in a situation similar to yours. 🙂
@ Anna — agreed. It seems like mandating more oversight for swaddling would make more sense than banning the practice altogether. Thanks for making this point.
@ Emily Slade — ha! I love that — a cost-benefit analysis for swaddling. I guarantee you’re not the only mom who feels this way. Thanks for sharing this observation, Emily! (Also — beautiful name. One of my favorites. 😉 )
The love to dream swaddle up saved our sanity! It’s a zip up swaddle sack in which baby’s arms are swaddled in wings by face for self soothing. It’s made of light cotton so not too hot and is snug but stretchy so no hip concerns. I recommend it to everyone – our daughter self weaned herself of it at 7 months but until then it was only way she would nap in crib!
We use theWoombie swaddle sack. It is not too tight, allows baby to have hands up on chest, and completely negates any worry about loose blankets. The two way zipper makes it extremely easy to use and Di diaper changes. I’ve tried various methods and this works best for us. I know that the military daycare here allows swaddling only with Halo sleep sacks and swasdlers.
I completely agree with what Lil said.
We had mixed results with swaddling. I have to say that the Miracle Blanket is NOT infallible! We stopped swaddling our first when I came in and found her out of it… with the long part wrapped around her neck!!! She was an extremely active sleeper and even when swaddled got all around her crib and apparently kicked her feet high enough to loosen her arms and escape from even the “Miracle”. This was at about 3 months of age, so we decided to ditch it altogether. She never seemed to love it, but had a strong startle reflex & it seemed to help her sleep a bit better, which is why we did it to begin with. After that experience, I decided to try NOT swaddling our second, which worked well! That said, the ease may have been due to her temperament and being a sleepier baby in general.
It would be a shame to ban swaddling altogether, especially when something like the Woombie is available, which seems to be an excellent compromise. That said, I think even Dr. Karp would agree that after 3 months (the ‘4th trimester’), it is time to start letting babies figure out how to sleep without it. Waiting doesn’t make it easier, and it’s at those older ages the side effects can start to worsen.
I worked in a classroom with eight 4 month old babies with only one other teacher besides myself. It is hard enough to care for that many and keep them happy. Swaddling was a lifesaver! If I was told I could not swaddle the babies then honestly I probably would have quit. I would also have recommended for parents to take their babies out of daycare all together because the babies and care givers would just be miserable all day long with lack of sleeping babies. It is a very hard job already especially when you are trying to keep the babies happy and trying to spend a little one on one with each baby throughout the day when others are sleeping…I couldn’t even imagine!!!
My child would have been at much greater risk for me losing my cool in the night if it weren’t for the swaddle, so I’d say the cost benefit analysis goes in favor of the swaddle! He was already a terrible sleeper. If you’d taken our swaddle away. . .I can’t even imagine how we would have survived!