Death From Swaddling

Can Swaddling Be Made Safer?

Laura A. Stokowski, RN, MS


March 14, 2014

In This Article

A Retrospective Study of Swaddling Deaths and Injuries

A recent study examined swaddling incidents reported to a voluntary reporting database, the Consumer Product Safety Commission (CPSC), from 2004 to 2011. McDonnell and Moon collected demographic information and data on infant position, type and mechanism of injury or potential injury, cause of death when applicable, and presence of known SIDS risk factors (such as smoke exposure, presence of soft bedding, or bed sharing) in swaddling incidents involving 36 infants ranging in age from 3 days to 15 months, including:

5 cases involving wearable blankets (1 death, 2 injuries, 2 potential injuries);

18 cases involving swaddle wraps (8 deaths and 10 potential injuries);

1 death involving an unspecified product (either swaddle wrap or wearable blanket); and

12 deaths involving swaddling in ordinary blankets.

In the cases of infant deaths involving wearable blankets or swaddle wraps, 7 out of 10 infants were placed to sleep supine, but the swaddled infants rolled to the prone position (1 reportedly at 5 weeks of age) and death was attributed to positional asphyxia. Among infants who were swaddled in standard blankets, 6 died in a similar fashion. In some cases involving swaddling blankets or standard blankets, parts of the blanket were found covering the dead infant's nose and mouth. Other risk factors were believed to contribute to infant deaths, including the use of soft bedding and hyperthermia from overbundling in an excessively warm environment. Of the total 22 deaths in the study, only 1 involved no sleep environment risks. The investigators documented many other safe-sleep infractions in the reported cases, such as the use of soft bedding (blankets, pillows), bumper pads, comforters, stuffed animals, bed sharing with adults, and secondhand smoke.

The 2 injuries that were reported involved older infants (9 and 15 months) whose teeth became snagged on the zippers of wearable blankets, resulting in accidental tooth extraction. Ten reports described potential injury associated with swaddle wraps when part of the swaddle wrap became wrapped around the infant's face and/or neck. The infant's arms and/or legs came out of the swaddle wrap, and the wrap was pushed up to the face and/or neck, posing the risk for asphyxiation, although the infant was not harmed.


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