Swaddling Linked to Higher Rates of SIDS

The age-old technique of swaddling a baby before putting the to bed is now being tied to a heightened risk of SIDS.

Swaddled Two-Week-Old Newborn Baby Girl Katrina Elena/Shutterstock
Swaddling a baby before laying them down to sleep is a technique that's been passed down for generations. Some believe it reduces crying and colic and helps a baby feel safe and secure, replicating the cozy feeling of being inside the womb. But new findings now show a link between swaddling and a higher rate of SIDs (sudden infant death syndrome).

Like a lot of parents, I was taught to swaddle my first baby before I left the hospital. So this research surprised me a bit. But the findings, which come from researchers at the University of Bristol, might now give new parents pause before wrapping their infants up in a swaddler or a receiving blanket. Though many pediatricians have long recommended it and many parents swear by it, claiming it's a surefire way to get babies to fall asleep and stay asleep for longer stretches of time, the research is pretty striking. "Babies who were swaddled were 50 to 60 percent more likely to die of SIDS," said lead researcher Rachel Moon, M.D., a professor of pediatrics at the University of Virginia School of Medicine.

A risk to older babies

The research analyzed data from four studies that involved 2,519 infants, including 760 whose deaths were attributed to SIDS. Of the total number of babies studied, 323 had been swaddled, of whom 133 died of the syndrome. The swaddled babies who were placed on their side or stomach were twice as likely to have died from the syndrome as babies in the same positions who had not been swaddled. Risk was also greater in babies that were six months or older, who researchers noted had a greater likelihood of rolling to a prone position. Even though the risk was less for all babies sleeping on their backs, it was still greater among swaddled babies, compared with babies who were not swaddled. So judging from this research alone, back is clearly best, but there might not be a way to swaddle that's 100% safe, except while under close watch.

Lead review author on the new research, Anna Pease said in a statement, "We found some evidence in this review that as babies get older, they may be more likely to move into unsafe positions while swaddled during sleep, suggesting an age is needed after which swaddling for sleep should be discouraged. Most babies start being able to roll over at about 4-6 months. On a practical level, what parents should take away from this is that if they choose to swaddle their babies for sleep, always place them on their back, and think about when to stop swaddling for sleep as their babies get older and more able to move."

Back is best

The back has been touted as the safest sleeping position for infants since the widespread promotion of the Back to Sleep campaign in the early 1990s, after which SIDS deaths dropped by about 50 percent. The findings of this study are further proof of the effectiveness of Back to Sleep, in that the swaddled babies who were not on their backs were especially at risk. Still, SIDS is the number one cause of death in babies ages 1 month to 1 year so more research about why it continues to take babies lives is a good thing. Other ways to reduce its occurrence include maintaining a smoke-free environment and putting Baby to sleep alone in a crib or bassinet. If parents choose to co-sleep, they should not use drugs or alcohol, not sleep with baby anywhere other than a bed (such as a couch or recliner) and avoid heavy covers. Parents who are nervous about co-sleeping but aren't comfortable putting a baby to sleep in their own bed can also invest in a co-sleeper, which attaches to the bed and makes extra room for baby.

To swaddle or not to swaddle

While some may want to avoid swaddling altogether in light of these new findings, others believe the risk of swaddling is quite low, especially for newborns. Calm birth C.B.E. (childbirth educator) and certified birth/postpartum doula, Adrienne Bergthold, who knows a thing or two about getting babies to sleep says she's still an advocate of swaddling. "As someone who's been swaddling and smiling at babies for over 20 years I have definitely seen that it makes a difference in calming them down," she told Fit Pregnancy. "I'm holding two babies that are swaddled at this very moment! Sweet twin baby girls! I definitely think it gives them a sense of womb-like security and keeps their flailing arms from disturbing them." But Bergthold does advise caution as baby grows. She says though she will likely still recommend swaddling to new parents it should be done "only until they begin to show signs of rolling over."

As a parent who often swaddled to get my kids to sleep, I will say that as soon as they were out of the newborn phase, it didn't feel as natural for me to wrap them up before putting them to bed anymore. I always worried about what would happen if they got to their side or belly and couldn't turn back over or lift their head. I no longer have babies in my own house, but I do think this study shows evidence that parents absolutely need to exercise caution when swaddling. It's important to remember that changes in infants often occur quickly—some develop the ability to roll earlier than others—so it's definitely best for parents to be aware of when those changes are coming and adjust their protocol for safe sleeping.

"Oh great, another thing to worry about!" Right? I know how you feel. As parents, sometimes these studies about everything we're doing wrong can feel like overload. And in the information-age, this is understandable. My gut reaction, too, upon reading was "my God, haven't I ever done anything right?" But I think it's important to remember, that while it can sometimes feel like too much, research such as this is put into place to help keep all of our babies safer and decrease the rates of infant death overall. So as far as I'm concerned, if it can save one baby's life, then it's research worth doing.