By: Laura A. Jana, MD, FAAP & Jennifer Shu, MD, FAAP
We'll be the first to admit that going belly up doesn't always seem to agree with all babies. While it seems to vary, we've found that quite a few babies are prone to startling themselves awake from peaceful slumber. That's because all babies are at the whim of their own reflexes—which, by definition, they cannot control—and are born with one particularly inconvenient reflex (the startle, or Moro, reflex).
The Moro reflex causes infants to jerk suddenly, flail their arms and legs, and even cry out in response to being startled—hence the name. And yes, even when you've gone to great lengths to create a startle-free environment for your sleeping baby, they may just take matters into their own hands (and feet), startle themself awake and then flail around until someone comes to their rescue. But don't give up on uninterrupted sleep just yet, because there is something quick and easy you can do: a handy little technique we call the "burrito wrap."
The burrito wrap
Most commonly referred to as swaddling, wrapping your baby up as snug as a bug in a baby blanket before putting them down to sleep can be helpful. While there is no shortage of readily available, commercially made swaddling blankets, it's also possible to bundle your baby at home simply using a regular baby blanket. Hands down, the most talented people we've ever seen at this sleep-saving technique are the nurses in the newborn nursery. These baby-bundling experts take uncomfortably free and exposed newborns and almost effortlessly have them bundled in blissful, no-flailing-allowed slumber in the blink of an eye. If you have an opportunity, we highly recommend watching these professionals in action.
For those of you who are already home and either missed out on the hospital demonstration or could use a little refresher course, we've laid out the details for you as best we can without actually being there to demonstrate in person.
Swaddling in 6 steps
Lay a thin baby blanket out like a diamond in front of you.
Fold the top corner of the blanket down a bit so that the folded corner almost reaches the middle of the blanket.
Place your infant on their back and center them on the blanket with their arms at their sides, their head just above the folded edge and their shoulders just below it.
Take one of the side corners of the blanket and fold it over your baby's shoulder and across his body, making sure to tuck the corner underneath him on the opposite side.
Then take the bottom corner of the blanket (below your baby's feet) and fold it up over your baby. If the blanket is large enough that the bottom corner reaches up to (or over) your baby's face, you can simply fold it back down until their face is no longer covered or bring it over one or the other shoulder and tuck it under them.
Finally, take the only remaining corner and pull it over your baby's other shoulder and across their body. Again, tuck this corner snugly under your baby's opposite side.
Once you have the general idea, remember that variations are perfectly acceptable. Feel free to play around with what works best for you and your baby. While the exact details and the order in which you do them may not matter too much in the end, we will point out that there is a good reason why we recommend folding the bottom of the blanket up before flipping the last corner across (i.e., step 5 always before step 6) and always tucking corners under your baby; doing so helps to keep your handiwork from coming undone quite as easily.
However, if you find your swaddling technique to be less than secure, you may want to opt out of the do-it-yourself approach and use a blanket designed specifically to stay in place. (Note: the American Academy of Pediatrics does not recommend using weighted swaddles, weighted blankets or other weighted objects like rice-filled bags inside a swaddling blanket.)
Of course, you'll need to always make sure the swaddle is not so snug as to potentially restrict your baby's breathing. As a rule of thumb, this means you should be able to fit two or three fingers between the swaddle and your baby's chest.
Some of our esteemed parenting colleagues suggest doing whatever it takes (with regard to bundling, that is) to ensure that your baby's arms and legs stay snugly secured in the blanket. Other equally convincing and respectable experts recommend never restricting your baby's arms—focusing your bundling attention on just your baby's legs while allowing their arms free rein. While there is admittedly no evidence to lend support to either approach, we personally have tried bundling both ways with good results. If you find that your baby seems unhappy having their arms "pinned down" by their sides instead of up next to their head, then just go ahead and burrito wrap them without placing their arms inside.
According to the American Academy of Pediatrics, swaddling can be an effective technique to help calm infants and promote sleep when done correctly and so long as babies are always on their backs when swaddled. Most child health experts agree that a baby's hips should not be bundled too tightly. Instead, they should be allowed to relax in their natural frog-leg positions to allow for proper growth and joint development. For safety reasons, you should always be sure that your swaddled baby is on their back—never on their side or tummy.
Swaddling also has the potential to cause babies to overheat, so be sure to check and make sure your baby isn't showing signs of overheating (sweating, damp hair, rash and rapid breathing). And finally, for safety and developmental reasons, it is a good idea to stop swaddling by about eight weeks of age, before babies typically start rolling. If your baby is trying to roll earlier than that time (whether swaddled or not), you should stop swaddling sooner.
About Dr. Jana
Laura A. Jana, MD, FAAP, is a pediatrician and mother of 3 with a faculty appointment at the Penn State University Edna Bennett Pierce Prevention Research Center. She is the author of more than 30 parenting and children's books and serves as an early childhood expert/contributor for organizations including the Maternal and Child Health Bureau, Primrose Schools, and US News & World Report. She lives in Omaha, NE.
About Dr. Shu
Jennifer Shu, MD, FAAP serves as the medical editor of HealthyChildren.org and provides oversight and direction for the site in conjunction with the staff editor. Dr. Shu is a practicing pediatrician at Children's Medical Group in Atlanta, Georgia, and she is also a mom. She earned her medical degree at the Medical College of Virginia in Richmond and specialized in pediatrics at the University of California, San Francisco. Her experience includes working in private practice, as well as working in an academic medical center. She served as director of the normal newborn nursery at Dartmouth-Hitchcock Medical Center in New Hampshire. Dr. Shu is also co-author of Food Fights and Heading Home with Your Newborn published by the American Academy of Pediatrics (AAP).