You’ve seen examples of it everywhere: at the OB/GYN office, on hospital pamphlets, and all over Instagram. Tiny newborns bundled in beautiful blankets, their arms and legs nestled cozily inside. Though popular (and adorable), is swaddling safe for infants?
As with anything baby-related, swaddling, the practice of tightly cocooning an infant in a blanket, comes with a set of pros and cons. SheKnows spoke to three professionals — Dr. Katherine Williamson, MD, FAAP; Dr. Brittany Odom, MD; Chloe Fries, certified pediatric sleep consultant — to learn all about swaddling’s benefits and potential dangers.
Parents can start swaddling their children as soon as they’re born, and nurses and pediatricians (as well as midwives and doulas) can teach you how, Odom says. If done correctly, swaddling can promote deeper sleep, reduce fussiness, and help babies regulate their body temperatures.
Ask any exhausted parent what they want most in the first few weeks of new-baby life, and you’ll likely hear something along the lines of, “For the love of God, I just want more sleep.” While newborns clock in around 16-18 hours of sleep per day, they rarely sleep for more than three hours at a time (to accommodate their needs for feedings and diaper changes), according to Stanford Children’s Health. If infants are only going down for short periods, you can bet parents want to make those naptimes count — and that’s where swaddling comes in to help.
If done correctly, swaddling is a safe way to ensure infants “feel safe and warm,” Williamson, who’s a pediatrician at Mission Hospital and the president of the American Academy of Pediatrics (AAP) Orange County chapter, tells SheKnows. “It feels like they’re still in mom’s womb, and it can help them sleep better because of that,” she adds.
Fries, who is the owner and found of La Lune Consulting, says swaddling can help ensure higher quality sleep for infants, who can sometimes experience a “startle reflex” (also known as the Moro reflex), that makes them “randomly feel like they’re falling.”
“What swaddling can do while they’re sleeping is keep them in that cozy, snuggled up position so that if they do have that reaction, they’re still snuggled in tight,” she says. “So, it kind of mutes the startle reflex so that they’re able to stay asleep longer [and] cozier.”
As cute as they are, sometimes babies can be devilishly fussy. For many babies, occasional outbursts are par for the course, yet some babies cry more often than others. Infants who cry excessively and demonstrate prolonged fussiness may have colic, a non-life-threatening condition that may be a sign of physical discomfort or stress, according to the Mayo Clinic. Odom says swaddling can help soothe fussy babies by creating a “contained, warm” environment in which they feel comforted, safe, and relaxed. So, even if it’s not the time for a nap, parents can swaddle and simply hold their awake child — to restore a bit of peace for everyone.
Newborns have a much harder time regulating and maintaining body heat than adults do, and they tend to lose heat quickly in chillier environments, the Children’s Hospital of Philadelphia reports. Swaddling can help keep babies comfortable, so long as parents use suitable materials and keep rooms “between 68 and 72 degrees,” Fries says.
“In the summer, you want a lighter cotton or a muslin material because they’re very breathable,” Fries adds. “In the winter, you can go a little bit thicker than that…with a thicker cotton, something that will keep them a little bit warmer.”
Fries also recommends parents choose appropriate sleepwear for underneath the swaddle. Opt for footed pajamas in the colder months and footless rompers, T-shirts, or onesies when the outside temperatures rise.
Between learning how to hold a newborn, finding a breastfeeding system, and figuring out the easiest (and cleanest) diaper-changing method, new parents have a lot to worry about in the first few weeks. As much as we’d love to tell you swaddling is an entirely worry-free practice, we’d be wrong not to include some of its potential dangers.
Swaddling too loosely, too tightly, or for too long can pose some risks. The good news is that all of the experts we consulted say these dangers are mostly preventable if parents are informed. Ahead are the most common hazards and how to avoid them.
The CDC reports that 3,500 healthy children under one year of age die unexpectedly every year (otherwise known as sudden unexpected infant deaths), with many deaths occurring during sleep. In 2017, nearly 900 babies died as a result of strangulation or suffocation. Those are the facts, and, yes, they are scary. In some cases, swaddling can increase these risks if done too loosely or if babies “are placed on their sides or stomachs,” Odom says. (All infants should sleep flat on their backs on a firm surface, such as a crib mattress, without pillows, blankets, or toys, per the AAP’s guidelines.)
“Babies should be swaddled nice and snug,” Odom adds. “Avoid loose blankets as these can move and cover the babies’ faces, leading to suffocation and sudden infant death syndrome.”
Swaddling is also dangerous for babies who are moving more freely. “You should really stop swaddling [babies] when they’re going to start independently rolling,” Williamson says, adding that most babies begin to roll between two and four months of age.
“One potential risk of swaddling is that, because it puts them into a sleep mode, should they roll over when they’re swaddled, it’s going to be harder for them to lift their heads up and roll back over,” she adds. As a result, some babies may experience difficulty breathing or, in severe cases, suffocate.
Again, suffocation is preventable. Williamson recommends parents monitor their babies and look for signs that they’re ready to roll. As soon as they are, she says parents can “either stop swaddling or do a partial swaddle, which is where you have them loosely wrapped up on the legs.” Similarly, Fries encourages her clients to quit swaddling “cold turkey” once babies start to roll; but, instead of using a traditional swaddling blanket, she recommends parents consider transferring their kids into an armless sleep sack for increased mobility. As always, Fries says parents should consult with their pediatricians to ensure the best methods and transitions for their children.
People often compare swaddling to wrapping a burrito (albeit a much cuter, cuddlier version). But, unlike your favorite order from Chipotle, you don’t want anyone to wrap your baby too firmly.
“Swaddling too tightly with the legs in a straight-down position can lead to hip dysplasia, or instability of the hip joint,” Odom says. In some cases, developmental dysplasia of the hips (DDH) can cause a baby’s bones to disconnect from the sockets or cause future issues with stability, according to the AAP. “Babies in utero are able to flex the hips with their legs up and out, and it’s important for them to be able to have this motion of the hip joints while swaddled too,” Odom adds.
The solution here is to ensure babies have some wiggle room around their hips and legs. Some parents might find pre-made swaddles that fasten with Velcro or a zipper easier to use. In many cases, these models help eliminate the guesswork by providing built-in space around the hips.
Additionally, Fries says parents should “get swaddle-free time as much as you can during the day because you don’t want to keep them in that tight-knit position all of the time.”
“You want to allow for their joints to move for that growth and development to happen on all aspects on their bodies,” she adds.
Just as you don’t want your baby to be too cold, you also want to monitor her to ensure she doesn’t get too toasty.
“A good way to check is to put the baby in a swaddle, place her there for 20 minutes or so and, then, check her face to make sure she doesn’t look flushed and she’s not sweating,” Williamson says. “Then, undo the swaddle and put your hand on her chest and see if she feels overly heated.”
Make sure to use weather-appropriate swaddles and to keep a fan or air-conditioning unit running during hotter months for added protection.
Some babies simply don’t like being swaddled and, more often than not, they’ll let you know loud and clear, Fries says.
“If they’re not settling into it in a minute or two, that’s when you can try other calming techniques like shushing or swaying, using a pacifier, those different things,” she says. “If they’re not calming on top of those things, and you’ve checked everything off, that’s when you know there’s something more going on.”
Additionally, some babies have different preferences when it comes to how parents position their arms. Some prefer arms up, some like them crossed over their chests, and some like them down along their sides. Again, Fries says babies will provide plenty of cues to help guide new parents in the process.
Overall, swaddling is a safe way to calm and comfort infants who are not yet rolling. So, go ahead and pick out some cute prints, wrap your baby like a sweet little present, and enjoy some well-deserved rest.