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Safe Swaddling

Safe Swaddling

by Wendy Wright

A year ago


Infant sleep is a big issue for new parents: co-sleeping versus cry-it-out, pacifier or no pacifier, nurse to sleep or set in the crib awake, sleeping through the night. Recent headlines have even made parents question the age-old practice of swaddling.

In their information for parents, the American Academy of Pediatrics suggests that swaddling will help a baby sleep – but at the same time, they caution fewer arousals is a SIDS risk factor. But a recent study published in the AAP’s journal, Pediatrics, caused a storm of media coverage with titles linking swaddling to increased Sudden Infant Death (SIDS) risk. The study was a meta-analysis – a compilation of previous studies to look for trends in the combined data. The meta-analysis was limited to a small set of studies with disparate data that was hard to compare, according to the authors. The differences in definitions, time periods and locations are limitations that could impact the generalizability of the meta-analysis results.

The authors' conclusions? Babies should be placed on their back to sleep even when swaddled, and more research is needed for the age at which swaddling should end. No conclusions about a connection with SIDS. Within the discussion of their analysis, the authors do say the risk of SIDS when swaddled reached “borderline significance” – a weak connection based on only 4 case-control studies (one of which they eliminated from the analysis due to the possibility that it was skewing the results). The authors add that the significant results are linked to babies being positioned on their sides or stomachs, or being swaddled past age 6 months – two practices that aren’t recommended anyway.

Pediatrician and author Dr. Harvey Karp emphasizes that when practiced safely, swaddling can become part of an effective parenting routine that will keep baby calmer and will help parents manage baby’s fussiness. His Five S’s (shushing, holding in a side or stomach position, sucking, swaying and swaddling) are baby’s “reset button” during the early weeks of life outside the womb. To make parents fear swaddling takes away this important piece of the fussy baby puzzle.

On the flipside, lactation consultant Nancy Mohrbacher believes swaddling could be detrimental to breastfeeding, especially in those early days when babies need to wake often to eat. If babies are sleeping through feedings due to swaddling, decreased milk supply and low weight gain could result. She suggests it’s better to keep baby close – in a sling or a wrap, which mimics swaddling but gives you a close-up view of baby’s hunger cues. Babies who are carried much of the time cry less and settle more easily.

Just like any other parenting tool, swaddling can be overused. Be sure you’re giving your baby plenty of un-swaddled time so he can kick his legs and move his body. Be sure you’re watching for hunger cues (which can sometimes be very subtle when baby is sleeping so much because he enjoys being swaddled). And most of all, be sure to swaddle safely.

If you choose to swaddle your baby, you can keep your baby safe …

  • by always placing your baby on his back to sleep.
  • by discontinuing swaddling when your baby can roll over on his own. Rolling typically happens between 4 and 6 months. The AAP has an even more conservative guideline of stopping sleep-time swaddling when your baby is 2 months old.
  • by paying close attention to your baby’s positioning in the swaddle blanket. Hip problems can occur with too-tight swaddling. So, position your baby’s legs slightly bent and out at the hips – or, even better, allow his legs to be loose so he can find a naturally comfortable position. Your baby may also prefer to have his hands near his face rather than wrapped with his body.
  • by being sure your baby doesn’t get overheated. Use a light swaddling blanket and dress your baby in light clothes underneath. Be sure the room isn’t too warm, and watch for signs of overheating (sweating, warm/hot skin, flushed cheeks, heat rashes, or rapid breathing). The blanket should be not too tight (you should be able to slide your hand between baby’s chest and the blanket) and not too loose (as it could pose a suffocation hazard).

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