For brand-new moms, swaddling can feel a little like a magic trick: One moment your thrashing, squalling baby is giving the lead singer from Gwar a serious run for his money, and the next, they're all tucked up like a cute little burrito, happily snoozing away.
That's why so many parents rely on the technique to get babies all snugged up and ready for a warm, secure nap. But the technique isn't without controversy. There's been noise in the past about swaddling increasing a baby's risk of succumbing to SIDS, and a new study in Pediatrics seems to support that — to a point.
The study examined 760 past cases of SIDS in infants against 1,759 control subjects, where the commonality was, of course, swaddling. The researchers found that within this small sample, swaddling did in fact increase a child's risk of dying from SIDS by about one-third overall.
The cases where that risk was highest probably won't surprise you. Babies placed on their stomachs and sides to sleep, for instance, and babies who were swaddled past the age 6 months had the highest SIDS risk.
That might not sound like particularly gripping, groundbreaking information, and it would be great if there was a way that doctors and scientists could say, "OK, swaddling is terrible. You absolutely should not do it," or "False alarm, guys — swaddling is awesome. Carry on." But of course, science doesn't work that way. And in fact, the most useful information gleaned from the study is that when it comes to swaddling, there needs to be a whole lot more clarity on what constitutes good or dangerous practices.
Even that isn't new. The study screened 283 articles for potential inclusion, and only four made the cut. One of the reasons, the researchers noted, is that there's an "imprecise definition of swaddling."
That's a huge part of the problem right there, and it's one that the American Academy of Pediatrics attempted to address all the way back in 2013, when controversy over swaddling was ramping up again. You can ask a question like, "Is swaddling safe?" but without a universal technique, there's no real good answer.
Child care centers had begun to ban the practice, and studies on first nations' populations showed a connection between tight swaddling and later problems with hip dysplasia. Back then, pediatricians were saying exactly what the most recent study is saying now: Essentially, parents need a clear understanding of how to safely swaddle and, more important, when to stop.
Safe swaddling is still sometimes recommended, especially for babies who need a little extra help soothing themselves. But the emphasis there has to be on safety. A safe swaddle is one that is not too tight and is in fact open or loose around the hips. You should be able to fit three fingers between your baby's chest and the blanket you've used to swaddled them in. Your pediatrician should be able to show you how to do this.
A safe technique is just one part of the puzzle. Another huge piece is knowing when to stop, and the AAP recommends discontinuing the practice at just 2 months. This is the vital piece of information. In the study, babies over 6 months of age were being swaddled, and that's far too long. There is some amount of weaning that has to take place, and that can be unpleasant, but it has to happen. This isn't something that can be a gradual, yearlong process, like bidding adieu to a beloved pacifier. Transitioning a baby out of sleeping in a swaddle can mean keeping them healthy and alive.
The rest is an emphasis on the universal set of safe-sleep guidelines. Keep babies on their backs to sleep; keep cribs free of bumpers or loose blankets; do not smoke in the home... If you're a mom, chances are high that you can repeat the entire spiel by rote at this point.
The bottom line? Swaddling on its own isn't a danger to your baby if you've done it safely and correctly. But we need to do more about teaching parents what safely and correctly is. That, of course, includes keeping swaddled babies on their backs and making the switch from baby burrito to baby tostada when the time is right.
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