COMMENTARY

Death From Swaddling

Can Swaddling Be Made Safer?

Laura A. Stokowski, RN, MS

Disclosures

March 14, 2014

In This Article

Viewpoint

As acknowledged by McDonnell and Moon, considering that millions of babies have probably been swaddled at some point during the years studied, 36 is not a lot of incidents. However, given that CPSC is a voluntary database and without a firm denominator, we have no way of knowing the true rate of injury or death associated with the use of swaddling practices or products. Our aim, of course, is zero.

Even without denominators, it is clear from this report that swaddling in ordinary blankets is not a safe practice beyond the immediate newborn period. An ordinary blanket has nothing to keep it securely in place, and with very little movement at all, it ends up becoming a loose piece of bedding in the infant's sleeping environment -- the very thing we advise against when we teach parents about safe sleep.

Swaddling is almost universally practiced in birth hospitals, primarily as a thermoregulatory measure. Parents are taught to never place loose blankets on top of their infants, and because hospitals aren't able to supply warm, fleecy infant sleepers (baby pajamas) for newborn infants, babies are dressed in cotton T-shirts and wrapped in standard, hospital-issued blankets to keep them warm while they sleep in their bassinets. Many new parents simply model this behavior when they take their newborns home from the hospital, substituting a better-quality blanket or a product purchased for the purpose of swaddling.

Strictly speaking, a newborn infant doesn't need to be swaddled to be put down to sleep. Swaddling is a parenting choice, like breastfeeding or using a pacifier. The infant can be dressed in a sleeper of an appropriate fabric weight for the season and the temperature of the home, and placed supine in a crib with no other wrapping at all. However, some studies have shown that swaddling prevents the supine infant from waking spontaneously by minimizing arousals during rapid eye movement (REM) sleep.[3,4] In other words, the swaddled infant doesn't wake him or herself with jerking "startle" movements of the arms or legs that often happen during REM sleep. This, along with less overall crying, is why many people swaddle a healthy supine sleeping infant during sleep.

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