WRITTEN BY ROBYN HUNT
Certified Car Seat Technician &
Safe Sleep Consultant
A safe sleep space is one with no loose blankets, duvets, pillows, sheets, toys, or cot bumpers. Your baby’s cot should be completely clear with nothing but a properly fitted waterproof sheet over an approved and firm cot mattress.
For babies under 2 months old, swaddling is a great way to eliminate the need for blankets while still keeping your baby warm and content. But is swaddling safe?
Swaddling is safe if done correctly and safe sleep principles are adhered to. Approved swaddles are the recommended way of keeping your newborn baby warm, without the risk of loose blankets. It is suggested that you swaddle your baby for the first 2 months and stop immediately when they start showing signs of rolling. Once you stop swaddling your baby, you can use a sleep sack.
What is swaddling?
When a baby is born in a hospital; one of the first things that the nurse or doctor will do is wrap the baby up like a ‘burrito’. This is called swaddling.
A thin muslin blanket, receiving blanket, or a “ready-made” swaddle called a swaddle sack/bag is wrapped snuggly around a baby’s body which creates a similar feeling to being in their mother’s womb. This can help a new baby adjust to their new environment with the familiar comfort they have had for the past 9 months.
Why do we swaddle our babies?
Besides keeping your baby warm and comforted, newborn babies have reflexes that can cause a baby to wake up unintentionally. These reflexes can be toned down by swaddling your baby.
As per the American Academy of Pediatrics (AAP); swaddling can be an effective technique to help calm infants and promote sleep.
Below we expand on newborn reflexes:
1. The startle reflex or moro response
A newborn’s startle reflex, otherwise known as the Moro reflex, is present when your baby is born and lasts a few months, becoming less and less prominent as they get older. Testing your baby's startle reflex is part of the newborn assessment the paediatrician performs after your baby is born.
The reflex is caused by a sudden noise or movement which startles the baby. When this happens, your baby will suddenly straighten and extend their arms outward, away from their body. Their fingers will also extend outward from their normal newborn clenched fists. It can also be explained as your baby getting a slight fright.
This startle reflex can cause your baby to wake up unintentionally and suddenly. Therefore swaddling can tone down the startle reflex quite a bit to prevent your baby from waking up.
This video demonstrates the startle reflex:
2. Normal Involuntary newborn reflexes
Normal newborn reflexes can be described as unintentional, uncontrollable, and automatic movements from your baby’s arms and legs. these movements are normally quite jerky and spontaneous.
Newborn babies are unable to control movements in their limbs and therefore they may accidentally rub/scratch their faces, pull their hair, or smack themselves causing them to cry and/or wake up from a peaceful sleep (one of the reasons mittens were invented, but they should only be used when baby is awake). Swaddling can eliminate these accidents from happening by keeping their arms restricted within the swaddle.
What are the dangers of swaddling?
Although swaddling may give you an extra hour or two of sleep, swaddling is not risk-free.
While swaddling does reduce the startle reflex and baby’s arousal; decreased arousal can be potentially dangerous and may be one of the main reasons that babies die of SIDS (Sudden Infant Death Syndrome). This may be due to the baby not moving as much and therefore not waking up or coming out of deep sleep. Although, the research on this has not been very extensive, it is worth noting that it is important to check on your baby often while they are sleeping, especially when they are newborn as they already have a higher risk of SIDS.
Swaddling can also increase the chances of your baby overheating, so it is important to avoid letting your baby get too hot as this may also increase the risk of SIDS.
Important signs to look out for, that may tell you if your baby is too hot, include sweating, damp hair, flushed cheeks, heat rash, and rapid breathing. If you are using “ready-made” swaddle sacks, It is vital to use a swaddle sack that is appropriate for the current climate (this will usually be described as the TOG).
If you are using a blanket to swaddle your baby, avoid swaddling them in fleece or other thick materials that are not breathable. It is strongly advised to use either a thin receiving blanket or a muslin blanket. If the climate is cold, rather dress your baby in an extra layer of clothing than swaddling with a thick blanket.
It is also very important not to swaddle your baby once they can roll over as this can cause them to suffocate or trap themselves in a potentially dangerous position.
How do I swaddle my baby safely?
Before putting your little one down to sleep, ensure that there is a dedicated sleep space for your baby. It is highly recommended to follow the ABC’s of Safe sleep created by the American Academy of Paediatrics (AAP). Babies should be ALONE on their BACK and in an appropriate COT. Babies should sleep in a cot, camp cot, or bassinet with nothing but a tightly fitted sheet.
Placing your baby on their back to sleep is vitally important if your baby is swaddled. Studies have shown that babies who are swaddled and placed on their sides or stomach have a much higher risk of SIDS, accidental suffocation, and entrapment. Additionally, if you are swaddling your baby with a blanket; it must be done correctly because if the blanket comes loose or unwraps, it could cover your baby’s face and further increase the risk of suffocation and even strangulation.
It is also important to swaddle your baby correctly to ensure it does not interfere with their development. You can swaddle a baby with a thin muslin or receiving blanket but an approved age-appropriate swaddle sack is ideal as there is no chance of the swaddle coming loose and covering baby’s face. To learn how to swaddle your baby correctly with a blanket; have a look at this video below.
When purchasing a swaddle sack, it is highly recommended that you select a size based on your baby’s current weight and length. It is important not to purchase a swaddle that is too large for your baby as the baby’s head may move down through the neck hole causing suffocation. It is equally important not to purchase a swaddle that is too small as the neck hole may restrict their airway when sleeping.
Additionally, you should always check the climate that the swaddle sack is made for to ensure your baby does not overheat or get too cold. This will usually be referred to as the TOG. See the table below for guidance:
Can swaddling my baby cause hip dysplasia?
Hip dysplasia 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. Babies that are swaddled too tightly or incorrectly are at risk of developing hip dysplasia
image used with kind permission from healthy hips Australia
The incorrect way to swaddle:
If the swaddle straightens and tightens your baby’s legs together; it is too tight and can lead to hip dislocation or hip dysplasia.
The correct way to swaddle:
The Paediatric Orthopaedic Society of North America promotes swaddling that allows the baby’s legs to bend up and out in an “M” shape. This means that the swaddle will be loose around the baby’s hips and legs which will allow them to rest them in a hip friendly position.
When should I stop swaddling my baby?
The updated recommendation from The American Academy of Paediatrics (AAP) recommends that you should stop swaddling your baby when they show signs of wanting to roll. Developmentally, babies will start rolling over on average at 10-12 weeks old. This could happen sooner, or it could happen later, every baby is different.
Continuing to swaddle your baby once they are rolling is dangerous and increases the risk of suffocation, strangulation, entrapment, and injury. A baby who has mastered rolling needs their arms and hands free to ensure they can adjust their position if they were to roll over into a potentially unsafe sleeping situation.
My baby will not sleep without being swaddled. How do I transition from a swaddle to a sleep sack?
Transitioning your baby out of a swaddle or swaddle sack around 2 months old can be a daunting process as babies will usually regress in terms of sleep as they adjust to the change. There are a few sleep sacks that are designed to help with this transition but transitioning your baby to a sleep sack can be done easily without one of those as well.
The following can be helpful when transitioning your baby from a swaddle into a sleep sack:
- A week or two before your baby turns 2 months old; you can start swaddling only one arm in by positioning your baby’s dominant arm out of the swaddle. In this position, your little one will get a gradual introduction to the feeling of being able to move their arm freely. By putting your baby to sleep wrapped with one arm out for a few nights; they will slowly become comfortable and accustomed to it.
- After your baby has mastered one arm in and one arm out, wrap your baby with both arms out of the swaddle. In this position your baby will have the freedom to move their limbs, while at the same time feeling the snug and familiar comfort of the swaddle wrapped around their torso.
- When your baby has become accustomed to both arms out of the swaddle, you can eliminate the swaddle entirely.
- Once your baby is out of the swaddle, The AAP (American Academy of Paediatrics) recommends that babies are dressed in a certified sleep sack for safe sleep. Sleep sacks can be used from birth as well if your baby does not like being swaddled but it is important to ensure that the sleep sack is approved for use from birth for it to be considered a safe option.
Read our blog article on sleep sacks here
If you practice safe sleep guidelines, purchase certified and approved swaddles and sleep wear, and make sure your baby is in a safe environment when sleeping, you can rest easy knowing you have done everything you can to ensure your new baby is safe, warm, and comforted, just as they were in the womb.