Swaddling Recommendations by Dr. Rachel Y. Moon
 
Physiologic studies show that swaddling decreases arousals, decreases awakenings and increases sleep duration.

Swaddling increases arousal threshold particularly in those who easily wake when swaddled and those who are not routinely swaddled. This can be good (baby sleeps longer) or bad (baby doesn't wake as easily).
Tight swaddling can make it more difficult for the baby to breathe, and some babies have increased respiratory rates when swaddled. Tight swaddling can make hip dysplasia worse if the legs are kept straight down.

Swaddling may increase overheating especially if the head is covered or the baby is sick, but Richardson et al found no increase in skin temperature if the baby was swaddled in a light cotton blankets from the shoulders down.

Some studies suggest a decrease in SIDS rate with swaddling if the infant is supine but there is increased risk of SIDS if the infant is swaddled and placed prone. We are in the process of surveying parents about swaddling behaviors. Some of the preliminary data suggest that parents who usually don't use supine positioning will place their babies supine if they are swaddled. So swaddling may encourage supine positioning and may help with the "retraining" process for usual prone or side sleepers.

Swaddling may be helpful as a strategy to calm the infant and encourage use of supine sleep position. A light receiving blanket should be used and the infant should not be overdressed to avoid overheating. Swaddle should not cover baby's head or face. Swaddle probably should not be used if the baby is sick (has a fever). The swaddle should be tight enough that it does not become loose, but not too tight as to restrict respirations and hip movements.

Swaddled infants should NEVER be placed in the side or prone position and swaddling should be discontinued after the infants is 3 months of age or after the infant begins to roll, whichever occurs earlier. If the swaddle becomes too loose, the blanket should be removed from the sleep area.

Rachel Y. Moon, MD Director, Academic Development Associate Chief, Division of General Pediatrics and Community Health Goldberg Center for Community Pediatric Health Children's National Medical Center Professor of Pediatrics George Washington University School of Medicine and Health Science.

How to "Swaddle" shown below: