What is the evidence for swaddling (swaddling) in newborns?

From the Guidelines

Swaddling newborns is not recommended as a strategy to reduce the risk of SIDS, and its use should be approached with caution due to potential risks such as hip dysplasia, head covering, and overheating. When considering swaddling, it's crucial to weigh the potential benefits against the risks. The most recent and highest quality study, 1, indicates that there is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. Key points to consider include:

• Swaddling can increase the risk of death if the infant is placed in or rolls to the prone position, as noted in 1 and 1.
• If swaddling is used, infants should always be placed on their back, and the swaddle should be snug around the chest but allow for ample room at the hips and knees to avoid exacerbating hip dysplasia, as recommended in 1.
• Swaddling should be discontinued once babies show signs of attempting to roll, typically around 2-3 months, to prevent increased SIDS risk, as advised in 1 and 1.
• Temperature regulation is important, as overheating is another SIDS risk factor, and swaddling may increase this risk, especially if the head is covered or the infant has an infection, as mentioned in 1.
• Parents should learn proper swaddling technique from healthcare providers to maximize benefits while minimizing risks, but the decision to swaddle should be made on an individual basis, considering the physiologic needs of the infant, as suggested in 1.

From the Research

Benefits of Newborn Baby Swaddling

• Swaddling calms infants and promotes sleep 2, 3
• It can be effective in managing pain, although it may be equally or less effective than other nonpharmacological methods 2
• Swaddling can soothe pain in infants and is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions 3
• Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled 3

Risks Associated with Newborn Baby Swaddling

• There may be a slight risk for sudden infant death syndrome (SIDS) associated with supine swaddling, although the impact of confounding variables is unclear 2, 4
• Swaddling tightly around the hips is strongly associated with developmental dysplasia of the hip 2, 3
• The combination of swaddling with prone position increases the risk of SIDS 3, 4
• There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling 3
• Swaddling can cause hyperthermia when misapplied 3

Safe Swaddling Practices

• Swaddling securely to minimize the risk of unwrapping 2
• Avoiding overheating 2, 3
• Placing infants to sleep supine 2, 5
• Discontinuing swaddling when infants first show signs of rolling over 2, 6
• Using swaddling without hats until they are attempting to roll over, after which appropriate clothing or wearable blankets can be worn 6