Sleep Sacks Are Safe for Rolling Infants
Sleep sacks (wearable blankets) should continue to be used when infants show signs of rolling—this is actually when they become most important as a safe alternative to loose blankets. The concern about discontinuation applies specifically to swaddling, not sleep sacks, and this distinction is critical for safe sleep practices.
Key Distinction: Swaddling vs. Sleep Sacks
The American Academy of Pediatrics explicitly recommends discontinuing swaddling when infants show signs of attempting to roll because swaddled infants have a high risk of death if they roll to the prone position 1. However, this recommendation does not apply to sleep sacks 1.
Why Sleep Sacks Remain Safe During Rolling
Sleep sacks are specifically recommended as preferable to blankets because they keep infants warm while reducing the chance of head covering or entrapment that could result from loose blanket use 1.
Sleep sacks allow normal leg movement and positioning, unlike swaddling which restricts movement and prevents infants from using their arms to reposition if they roll 2.
When infants can roll from supine to prone and back again, they can be allowed to remain in whatever sleep position they assume, and sleep sacks provide safe coverage throughout this developmental transition 1, 3.
Critical Safety Requirements for Sleep Sacks
Proper sizing is essential—the sleep sack must fit correctly so the infant's head cannot slip through the neck opening, which could cause entrapment 2.
Avoid overheating by selecting appropriate tog ratings for room temperature and ensuring the infant wears no more than one layer more than an adult would wear to be comfortable 1, 2.
Remove all loose bedding from the sleep environment when using sleep sacks, as soft or loose bedding poses suffocation and entrapment risks if the infant rolls 1, 3.
Common Pitfall to Avoid
The most frequent error is conflating swaddling recommendations with sleep sack recommendations. Swaddling must stop when rolling begins; sleep sacks should continue 1, 2. Sleep sacks eliminate the actual suffocation hazard (loose blankets) while allowing the mobility infants need as they develop rolling skills 2.
Supporting Evidence
Research demonstrates that sleep sacks are as safe as, if not safer than, other bedding when examining SIDS as an outcome, provided they are well-made, appropriately sized, and used with correct tog ratings for the environment 4. Sleep sacks are widely used (48-95% of infants in the UK) and advocated by safety organizations specifically because they maintain warmth without the risks associated with loose blankets 4.