COMMENTARY

Death From Swaddling

Can Swaddling Be Made Safer?

Laura A. Stokowski, RN, MS

Disclosures

March 14, 2014

In This Article

Not All They Are Wrapped Up to Be?

Still, there is no denying the appeal of swaddling in contemporary society. Last year, a huge debate arose about swaddling when, for safety reasons, 3 states instituted a ban on swaddling in daycare centers.[5] Many people became very upset because they did not believe that such a step was warranted, and thought that their parenting rights were being infringed upon.

The problem is that, although not believed to be common, there are potential harms and dangers associated with swaddling, and people should be aware of them. Swaddling too tightly or with the legs extended and adducted can cause developmental dysplasia of the hips.[6] Swaddling can also result in hyperthermia when the wearable blanket or swaddling blanket is added to the clothing and hat that the infant is already wearing. Tight swaddling can compromise the lungs and has been shown to increase the respiratory rate, presumably to compensate for a reduction in functional residual capacity.[7] Although this is unlikely to affect a healthy term infant, it could be detrimental to an infant with a chronic respiratory condition or respiratory infection.

Although some have argued that swaddling lowers the risk for accidental death by immobilizing infants in the supine position,[8] swaddling is also associated with a significantly increased risk for accidental death if, as in many of the cases reported to CPSC, the infant is placed to sleep in the prone position while swaddled, or rolls into the prone position from either a supine or side-lying position. Swaddled, prone-lying infants are unable to use their arms or upper bodies to push themselves off of the mattress or to change their head and body position if they find themselves in an asphyxiating situation. The infant essentially suffocates, trapped face-down in the mattress. Many of the infants in this study were older than 4 months of age and were still being swaddled when they were put down to sleep. Because it can't be predicted with certainty when the gross motor skill of rolling from supine to prone will begin to emerge, many of these infants were too old to be swaddled in this manner.

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