When you’re a parent to a young infant, it feels like you’re constantly bombarded with dire warnings and well-meaning instructions on what you should be doing to ensure the best outcome for your baby.
Any parent or caregiver that’s ever taken a baby care class knows that swaddling is considered the go-to solution for keeping newborns calm.
At the same time, fear of sudden infant death syndrome (SIDS) is real. We’re constantly concerned with the right way for a baby to sleep and how to minimize risk factors that could increase the chances of SIDS — especially in very young babies.
Not long ago, one study found a potential link between swaddling and SIDS — leading to a renewed concern over the potential dangers of swaddling.
The short answer is: probably not, but you should always lie a baby on their back to sleep, and stop swaddling once your child is starting to roll over.
In truth, the 2016 study led to many sensational headlines in consumer-focused publications that implied that swaddling, in general, was an inherently dangerous activity.
But when read in-depth, the study made very specific observations that are in line with current baby sleep guidance as outlined by the American Academy of Pediatrics (AAP).
In particular, the study noted that when swaddled, if a baby was placed on their stomach or side to sleep, the potential for SIDS was higher compared with babies who were placed on their backs.
That’s no different than current expert recommendations for infant sleep in general. The AAP advises against putting young babies to sleep on their stomachs or side regardless if they’re swaddled — especially if they have yet to reach the rolling-over milestone.
More importantly, the researchers explicitly stated that the concept of swaddling was loosely defined. So, the data couldn’t differentiate between factors such as picking a blanket that’s too warm or swaddling a child too tightly.
The researchers fully acknowledged specific limitations that couldn’t be reviewed given the limited data they were working with. According to a reply to the article, the study had three limitations:
- Their study didn’t reference a
report released by the U.S. Consumer Product Safety Commission reviewing infant deaths associated with swaddle wraps and blankets sold between 2004 and 2012. The report suggested most deaths were related to other sleep-related risks. - It would be useful to look at the number of swaddle-related SIDS deaths compared with infant deaths or injuries caused by infant crying coupled with parental exhaustion, postpartum depression, abuse, cigarette smoke exposure, and unsafe sleep practices.
- Older babies appear to be at an increased risk of SIDS-related swaddle deaths. This would imply that improper swaddling practices (continuing to swaddle long after a child has mastered rolling over) are more likely to encourage the risk of SIDS versus the general act of swaddling.
Once these factors are taken into account, it’s not possible to link the general act of swaddling to an increase in SIDS compared with known influential risk factors.
The short answer is, no.
Swaddling isn’t linked to a decreased risk of SIDS. But as with all other sleep-related concerns, practicing safe sleep behaviors is the best way to minimize the risk of your baby dying of SIDS.
This means:
- putting your baby to sleep on their back on a firm, flat surface
- not dressing them too warm
- ensuring that there are no other obstructions in the crib or bassinet, such as blankets, toys, or pillows
Specifically for swaddling, avoid using a blanket or wrap that’s too heavy. Similarly, don’t swaddle your baby too tightly, since this can interfere with their ability to breathe or move their hips. Additionally, avoid using weighted swaddles or adding weighted items when swaddling your baby.
To date, swaddles are still not a direct risk factor for SIDS. Instead, environmental and behavioral factors are more likely factors of an infant dying from SIDS.
The biggest risk factor for SIDS is putting babies to sleep on their sides or stomach instead of
Other behavioral and environmental factors that may increase a baby’s risk of SIDS — in order of prevalence — include:
- Bed sharing with a smoking parent
- Birth before 37 weeks
- Soft bedding
- Stomach sleeping
- Bed sharing with a nonsmoking parent
- Smoking during pregnancy
- Parental unemployment
- Infant exposure to cigarette smoke
- Side sleeping
It’s important to note that while bed sharing is still generally frowned upon in the United States by medical and scientific organizations, there’s a growing movement by organizations such as La Leche League and researchers to determine safer ways to co-sleep.
A 2019 study noted that while more guidance is needed — specifically in breastfed babies who are nursed — bed sharing didn’t pose an increased risk of SIDS as long as other known hazards as listed above weren’t present.
The biggest contributing factor to SIDS is placing babies in bed in what’s known as a nonsupine position — or not on their back. Whether they’re being put down for a nap or for the night, babies should always be put down on their backs on a firm surface free from obstructions.
Behavioral concerns as shown in the bulleted list above can also increase a child’s risk of SIDS. Experts recommend that keeping a baby up to date on
For soon-to-be parents, avoid substance abuse and nicotine use during pregnancy and be sure to attend all necessary prenatal care visits.
Again, phase out the swaddle once your child begins rolling over, since the swaddle can then pose a suffocation risk. And, avoid using inclined sleepers. These can also pose a suffocation risk.
While it might not be viable for all caregivers, opting for breastfeeding versus formula has been shown to be positively linked with lowering the potential for SIDS to occur.
While you should use caution — such as not swaddling when your baby begins to roll over, and not swaddling them too tightly or in a blanket that’s too warm — evidence suggests that your biggest risk factor for SIDS will be putting your baby to sleep on their stomach or side.
As long as you remember the ABCs of sleep (always alone, on their back, and in a crib — or flat surface), you can swaddle with confidence.