Swaddling for Sleep
Benefits of swaddling
Some research studies (see: Swaddling: A Systematic Review. Van Sleuwen et al., 2007), and a vast body of parental anecdote suggest that swaddling can help calm and soothe babies (Oden et al., 2012), and help them sleep. As with dummy use, swaddling appears to help soothe infants following a pain stimulus (Campos 1989). In addition to emphasising the low levels of SIDS in some populations that have traditionally used swaddling (Horne et al., 2010), researchers have also suggested that swaddling can help babies settle on their backs, and prevent them turning on to their front or getting their heads covered by bedding, and that it may therefore be a useful SIDS reduction tool. Parents in Western countries are increasingly turning to swaddling to help calm their babies for sleep.
Recently, however, some research has begun to suggest that swaddling might not be protective against SIDS; additionally there are other potential risks that parents and health professionals need to be aware of.
Risks associated with swaddling
While some studies have found that swaddling increased SIDS risk for infants sleeping prone, and decreased it for babies sleeping supine (Van Sleuwen et al., 2007), the most recent UK case-control study (Blair et al., 2009) identified an increased risk of SIDS for all swaddled infants – including those sleeping supine. Infants that are swaddled may sleep more deeply, possibly in the same way as infants sleeping prone seem to sleep ‘better’ via reduced arousals and restricted potential for physical movement (Van Sleuwen et al., 2007). While this may at first appear to be a good thing (and naturally proves appealing to parents whose babies are wakeful) it may increase their vulnerability to the possibility of SIDS – most other factors associated with a protective effect against SIDS (including breastfeeding and, perhaps, dummy use) increase arousals during sleep rather than decreasing them (Horne et al., 2010). The ability to arouse from sleep is key to an infant’s ability to cope with environmental challenges that might otherwise put them at risk. Recent research (Richardson et al., 2010) shows that swaddling reduces this ability much more among infants who are naive to swaddling i.e. have not been swaddled since birth.
Swaddling too tightly, with heavy materials and/or with the infant poorly positioned also increases the risk of developmental hip dysplasia, respiratory infections and overheating (Van Sleuwen et al., 2007). Swaddling a bed-sharing infant is also inadvisable; infants need to be able to use their arms and legs to alert adults who get too close, and to move covers from their faces. Swaddling prevents a bed-sharing infant from doing this. Therefore when swaddling an infant soft bedding or additional blankets should be removed from the sleep environment (McDonnell et al., 2014).