Recommendations for Safe Sleeping and Swaddling

By Howard J. Bennett, MD

Swaddling is a time-honored method to help babies calm down and sleep better. In theory, wrapping a baby snugly in a blanket “reminds her” of being in the womb. Swaddling also prevents babies from waking up because they accidentally hit themselves due to random arm movements. Swaddling works best if a baby’s arms are securely at her side. Because it can be difficult to keep babies in a swaddle, products like the Miracle Blanket have been invented to assist parents with the maneuver.

Swaddling has a potential downside, however, which has led to some recent precautions. First, it’s important for a baby to be able to flex her legs when swaddled. The reason for this is because it can interfere with normal hip development if a baby’s body is kept rigid when swaddled. The goal, therefore, is to swaddle the baby’s arms and upper body and to allow her legs to bend. Second, it’s important to de-swaddle babies by three months. At this age, it’s helpful for babies to be able to use their hands if they wake up in their cribs. More importantly, a small number of swaddled 4-month-olds have died after rolling over at the night. It’s not clear what happened in these situations. Either the swaddle made it easier for the babies to roll over and a SIDS event occurred or, once they had rolled over, they were unable to use their arms in a protective way to prevent suffocation while in the tummy-down position.

My current recommendation is to stop swaddling babies between two and three months. Many parents make this transition easier by putting their baby in a sleep sack. Others simply put the baby to bed in regular sleepwear. Regardless of the method used, the key is for the baby’s arms to be free while she sleeps. If your baby cries or wakes herself up after she’s been de-swaddled, you have a few options to consider.

  • Be patient and give her a week to get used to the new sleeping arrangement.
  • Use a white noise machine in the baby’s room. Like shushing, white noise helps calm babies and promotes sleep.
  • Try using a pacifier to help the baby sleep better. The main problem with pacifiers is they may fall out of the baby’s mouth, which can lead to repeated waking.
  • Use something that discourages rolling over without keeping the baby’s arms at her side. A product that many of the parents in my practice use is called Merlin’s Magic Sleepsuit. The suit is warm and cozy and prevents the baby from rolling over or inadvertently hitting herself in the face. Don’t use this product unless your baby is big enough to fit the company’s sizing chart.

The following additional tips promote safe sleep and reduce the risk of SIDS:

  • Use a firm mattress and always place your baby on her back to sleep. This is true both for sleeping at night and for napping during the day.
  • Keep the crib free of bumper pads, pillows, sheepskin and other soft bedding, toys, and positioners that are designed to prevent babies from rolling over.
  • The crib should be in an area that is smoke-free.
  • Do not put loose blankets in the crib. A loose blanket, including a swaddling blanket that comes unwrapped, could cover a baby’s face and result in suffocation.
  • Swaddling increases the risk that babies will become overheated. If you notice that your baby is sweating, has wet hair or flushed cheeks, remove some of her clothing, use a lighter blanket to swaddle her or lower the room temperature. (It’s normal for a baby’s hands and feet to be cooler than her body.)
  • Consider using a fan in your baby’s room for better circulation. Although unproven, this may reduce the risk of SIDS.
  • A baby is safest in her own crib, a bassinet or a co-sleeper that is next to your bed. Babies should never sleep in the parent’s bed.
  • Some babies begin rolling over at four months. If your baby cries when this happens at night, put her on her back. However, many babies turn over and do not cry. If this happens, parents wonder if they should put the baby on her back throughout the night. I don’t recommend returning a baby to her back more than once. If you continue to turn her over, she will repeatedly wake up and no one will get a good night’s sleep.

© 2015 Howard J. Bennett. All Rights Reserved.

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