Is it OK to swaddle newborn with arms out?

Swaddling can seem like a miracle cure for a fussy baby. Many exhausted parents have found that wrapping their infants snugly in a blanket to resemble the feeling of a mother’s womb is an effective method to help babies calm down, fall asleep, and stay asleep. Based on their personal experiences, even our own doctors swear by it, recommending special swaddling blankets as gifts for new parents.

So it’s understandable if you were alarmed by recent headlines exclaiming, “Swaddling babies may increase risk of SIDS.” Sudden Infant Death Syndrome (SIDS) is the unexplained death of a seemingly healthy baby, usually during sleep. It is the leading cause of death in infants between 1 and 12 months old. In Texas, the infant mortality rate due to SIDS is about 37 per 100,000 live births. This is just below the national average of nearly 40 per 100,000 live births – about 1,500 infants die in the United States from SIDS each year.

However, if all you heard was the 60-second version of this story on the nightly news, you may not have gotten all the facts. Before you unwrap the blanket from around your newborn, take a moment to learn more about the study, safe swaddling tips, and how to reduce SIDS risk factors.

What the study says about swaddling and SIDS

The authors of the May 2016 study in the journal Pediatrics conducted a meta-analysis of four previous studies to determine if there was an association between swaddling and SIDS. These four studies were conducted at different periods over a 20-year timeframe in three geographic areas – the United States, the United Kingdom, and Australia. While looking at four studies allowed the researchers to analyze a much bigger dataset, the long timeframe and geographic differences bring many factors into play, such as changing best practices and trends among the different populations.

The analysis found that, overall, there was an increased risk of SIDS when babies were swaddled. However, the increase in risk was very small when the swaddled babies were placed on their backs. The risk was much higher when the swaddled babies were placed on their sides, and even more so when they were placed on their stomachs.

The study also showed that the age of the swaddled baby mattered. As the age of the swaddled baby went up, so did the risk of SIDS. There wasn’t any increase in risk of SIDS when swaddling was used in infants less than a month old. A couple of the studies had information about the sleep positions that the infants started in compared with the positions in which they were found. Many of the older babies who were placed on their backs were found on their stomachs. As babies get bigger and start moving around, they may be able to roll over once, but because they can’t move their arms, they may not be able to roll over again or have enough free space around their face to breathe while on their stomachs.

Basically, this study supports what we already know:

• Sleeping infants should be placed on their backs, not their sides or stomachs.
• Swaddling infants for sleeping should not be used once a baby begins trying to roll over.

Unfortunately, the headlines for the stories about this study caused some undue panic. Be reassured, swaddling your newborn is a reasonable option as long as you follow a few guidelines.

How to safely swaddle your baby

Swaddling can comfort babies when they are upset and help them fall and stay asleep. To keep your baby comfortable and safe while swaddled:

• Do not swaddle the legs: Studies have shown that babies whose legs were tightly swaddled may develop hip problems. Make sure your baby can move their legs up and down at the hips.
• Stop at the shoulder: This is especially important if you’re putting your baby to sleep for the night or for a nap. If you are holding and observing your baby, you can pull the blanket up around the head like a hood, but don’t do this if you are not watching them.
• Leave the arms free or the hands by the face: Some babies prefer to have their arms free, while others find it calming to have their hands near their faces.
• Make sure baby is not too warm: Swaddling should be done to help your infant feel secure, not to keep them warm. Use a thin, breathable blanket, and check periodically to make sure your baby is not overheating.
• Stop swaddling when baby begins trying to roll over: This can vary from baby to baby, but by three months, you should stop swaddling.

How to reduce SIDS risk factors

The stories surrounding the study remind us that not everyone is aware of current safe sleeping guidelines.

In 1992, the American Academy of Pediatrics released new recommendations that infants should be placed on their backs to sleep, not on their sides or stomachs. Since then, SIDS rates have plummeted, from around 130 deaths per 100,000 live births in 1990 to less than 39 deaths per 100,000 in 2014. However, some people may not realize that advice about infant sleep positions from well-meaning parents and grandparents may not be the best practice now.

Follow these safe sleeping guidelines to help reduce the risk of SIDS:

• Place baby on his or her back: Do not lay your baby down on his or her side or stomach.
• Keep the crib free of blankets, pillows, or toys: These items can cover your baby’s face, or your baby could become trapped up against them, causing suffocation or strangulation.
• Keep baby’s room cool: Contrary to popular belief, babies don’t need super warm rooms. Signs that your baby may be too warm include sweating, flushed cheeks, heat rash, or rapid breathing.
• Place baby on a firm surface with a single sheet: Cushy mattresses or couch cushions or fluffy carpets may look nice in photos, but they can block your baby’s face and impede their breathing.
• Give baby its own space: Your baby is safest in a crib or bassinet, not in bed with you. Try room-sharing instead of bed-sharing.

The next time you hear a news story about a medical study, don’t panic. Instead, take a few minutes to learn more about what it really means for you and your family. And if your infant is fussy or having trouble sleeping, don’t be afraid to try swaddling – just be sure to know and follow the expert guidelines around safe sleep practices.

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