By: Rachel Y. Moon, MD, FAAP & Danette Glassy, MD, FAAP
New parents often learn how to swaddle their infant from the nurses in the hospital. A thin blanket wrapped snuggly around your baby's body can resemble the womb and help soothe your newborn. When done correctly, swaddling can be an effective technique to help calm infants and promote
sleep.
But if you plan to swaddle your infant at home, you need to follow a few guidelines to make sure you are doing it safely.
Back to sleep
To reduce the risk of
Sudden Infant Death Syndrome, or SIDS, it's important to place your baby to sleep on their back–every time you put them to sleep. This may be even more important if your baby is swaddled. Some studies have shown an increased risk of SIDS and unintentional suffocation when babies are swaddled if they are placed on their stomach to sleep, or if they roll onto their stomach. If babies are swaddled, they should be placed only on their back and monitored so they don't roll over.
When to stop swaddling
Stop swaddling as soon as your baby shows any signs of trying to roll over. Some babies start working on rolling as early as 2 months of age, but every baby is different. There is no evidence with regard to SIDS risk related to the arms swaddled in or out.
What about wearable blankets or sleep sacks?
Infant sleep clothing, such as layers of clothing or a wearable blanket or sleep sack, is preferred over blankets and other coverings to keep a baby warm. A
safe sleep space for infants should stay free of any loose bedding or soft objects. However, as with regular blanket swaddling, the use of wearable blankets or sleep sacks that compress the arms, chest and body should stop once a baby shows signs of starting to roll over. Sleep sacks that do not swaddle and allow the baby to move freely can be used as long as you want.
Know the risks
Parents should know that there are some risks to swaddling. Swaddling may decrease a baby's arousal, so that it's harder for them to wake up. That is why swaddling can seem so attractive to new, sleep-deprived parents—the baby sleeps longer and doesn't wake up as easily. But we know that decreased arousal can be a problem and may be one of the main reasons that babies die of SIDS.
AAP safe sleep recommendations
The AAP recommends parents follow the safe sleep recommendations every time they place their baby to sleep for naps or at nighttime:
Place your baby on their back to sleep on a firm, flat surface and monitor them to be sure they don't roll over while swaddled.
Do not have any loose blankets in your baby's
crib. A loose blanket, including a swaddling blanket that comes unwrapped, could cover your baby's face and increase the risk of suffocation.
Do not use weighted swaddles or weighted blankets, which can place too much pressure on a baby's chest and lungs.
Use caution when buying products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS.
Your baby is safest in their own crib or bassinet, not in your bed.
Swaddling can increase the chance your baby will overheat, so avoid letting your baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash and rapid breathing.
Consider using a
pacifier for naps and bedtime.
Place the crib in an area that is always
smoke-free.
See
How to Keep Your Sleeping Baby Safe: AAP Policy Explained for more information and tips.
Keep hips loose
Babies who are swaddled too tightly may develop a problem with their hips. Studies have found that straightening and tightly wrapping a baby's legs can lead to hip dislocation or
hip dysplasia. This is an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.
The Pediatric Orthopaedic Society of North America, with the AAP Section on Orthopaedics, promotes "hip-healthy swaddling" that allows the baby's legs to bend up and out.
How to swaddle correctly
Use only a thin blanket for swaddling.
To swaddle, spread the blanket out flat, with one corner folded down.
Lay the baby face-up on the blanket, with their head above the folded corner.
Straighten their left arm and wrap the left corner of the blanket over your baby's body, tucking it between their right arm and the right side of their body.
Then tuck the right arm down, and fold the right corner of the blanket over her body and under their left side.
Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
Make sure their hips can move and that the blanket is not too tight. You want to be able to get at least two or three fingers between the baby's chest and the swaddle
Swaddling in child care
Some child care centers may have a policy against swaddling infants in their care. This is because of the increased
risks of SIDS or suffocation if the baby rolls over while swaddled, in addition to the other risks of overheating and hip dysplasia.
Compared to a private home, where one or two people are caring for an infant, a child care center usually has a number of caregivers who may have variations in their swaddling technique. This raises a concern because studies show babies who are not usually swaddled react differently when swaddled for the first time at this older age. They may have a harder time waking up, which increases their risk of SIDS.
The difference in the advice for swaddling at home or the hospital nursery, versus in a child care center, really comes down to the age of the child and the setting. A newborn can be swaddled correctly and placed on their back in his crib at home, and it can help comfort and soothe them to sleep. When the child is older, in a new environment, with a different caregiver, if they are learning to roll or perhaps haven't been swaddled before, swaddling becomes more challenging and risky.
More information
About Dr. Moon
 Rachel Y. Moon, MD, FAAP is a pediatrician and SIDS researcher at the University of Virginia. She is also a Professor of Pediatrics at the University of Virginia School of Medicine. Her research centers on SIDS and SIDS risk factors, particularly in high-risk populations, such as African Americans and infants attending childcare. Within the American Academy of Pediatrics (AAP), she is chair of the Task Force on SIDS and Associate Editor for the journal Pediatrics. Dr. Moon is also the editor of
Sleep: What Every Parent Needs to Know.
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About Dr. Glassy
 Danette Glassy, MD, FAAP, is a member of the American Academy of Pediatrics Councils on Community Pediatrics and Early Childhood, as well as the Washington Chapter of the AAP. She practices in Mercer Island, Washington
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