Baby swaddling is a
controversial subject. Read on to find out how to keep your baby safe. Peer
reviewed article published in the Journal of Health
Visiting (April 2015).
Archaeological records show that babies have been swaddled since
4000 BC. Swaddling involved wrapping pieces of cloth and a band tightly around
the baby’s body from the shoulders to the feet to in the belief that it helped
them to develop a strong, straight back before they were able to walk. The
swaddled baby was then placed horizontally in a cradle or cot, or strapped
firmly vertically to a cradleboard to support the spine.
Due to the effect of tight swaddling on limb restriction, the
practice fell out of favour in the mid-1960s, as new theories in baby
development took hold. However, following
the ‘Back to Sleep’ campaign in the 1990s, and popularisation in parenting
guides, swaddling has made a comeback.
Some healthcare professionals recommend
swaddling while others speak out against it. Advocates believe that swaddling
replicates the confined conditions of the womb, and helps the newborn adjust to life in the
outside world. Some studies (Gerard et al. 2002; Thach 2009) have shown that swaddled babies
startle less, have a lower heart rate, sleep more deeply, and wake less
spontaneously than when not swaddled. Swaddling also prevents babies from
rolling over on to their tummies, which is a risk factor for Sudden Infant
Death Syndrome (SIDS) (Gerard
et al. 2002).
Work by Blair et al. (2009) has linked
swaddling to respiratory complications, prolonged deep sleep, and overheating,
which are risk factors for SIDS. Other concerns include tight swaddling of the
legs, which can lead to
developmental dysplasia of the hip. There is also disagreement among
healthcare professionals about the benefits of restricting the protective startle
reflex in newborns. When the limbs are confined, babies are unable to startle
effects of swaddling on SIDS are controversial. Until there is
conclusive evidence that swaddling is unsafe, the practice is unlikely to
become less common.
History of swaddling
Egyptian tomb reliefs from 2500 BC show babies swaddled with
cloths and tied to the mother's back or hip. Sacred
statuettes of infants in swaddling clothes have also been found in Ancient
Greek and Roman tombs. History
shows that Alexander the Great and Julius Caesar were all swaddled as babies.
The practice of swaddling has been known for centuries over most of Europe,
Asia, Canada, South and North America.
famous record of swaddling is found in the New Testament concerning the birth
“And she brought forth her
firstborn son, and wrapped him in swaddling
clothes, and laid him in a manger; because there was no room for them in
the inn." (Luke 2:7).
birth, the newborn was washed, rubbed with salt and oil to thicken and firm the
skin. To prevent cold air from touching the skin and to
ensure that the limbs grew straight, the baby was wrapped in linen or
cotton and over-wrapped with six metre long bandage-like strips or bands. Swaddling
and salting became the model of infant care practice for some 1,500 years or
the Tudor period (1485 to
1603), newborns were ‘salted’ and wrapped in linen
bands from head to foot for up to nine months to ensure that they grew up
without physical deformity. The legs were placed closely together, the arms were placed at the
sides, and the swaddling cloth was then folded over the baby’s body, feet and
arms. A swaddle band was wrapped under the baby's chin and over the forehead to
secure the head, and then around the body all the way down to the ankles. The
weight and heat of the swaddle wrap and band restricted movement, cramped the
bowels, and increased body temperature.
In Medieval times, it was traditional practice to immobilise
babies for up to nine months without washing or regular human contact.
They were unable to reach out for objects or suck their fingers or toes for
comfort. Infants were also left in their own excrement for days on end.
Crawling, an important developmental milestone was often delayed or absent
In parts of Canada, North America, and
South America, babies were traditionally swaddled and attached to portable
cradleboards constructed of dogwood or willow sticks, which supported the spine
and constricted movement. However,
& Cary 2009) demonstrated a very high prevalence of hip dysplasia. The frequency of
hip dislocation decreased dramatically when cloth nappies, which slightly
flexed and abducted the hips, were introduced in the 1950s (American Academy of Pediatrics (AAP) 2011a).
In the 1800s, the medical profession recommended a less containing
form of swaddling, which kept the arms and legs free. Nevertheless,
most mothers continued to use traditional swaddling bands until the early
1930s. Swaddling eventually fell out of favour following concerns that it could
overheat the baby, restrict growth, and displace the hips.
years, swaddling has become increasingly popular as a
settling technique in the Netherlands, some parts of the United States, and the
United Kingdom (Frenken 2011). In the UK, about 19 percent of babies are
swaddled in the first
four weeks of life (Clarke 2013). However, modern swaddling allows ample room for hip and
Many parents say that swaddling provides comfort and security, limits
the startle reflex, and helps their babies get to sleep and stay asleep. Gerard et al.
(2002) found that babies were just as likely to
startle when swaddled as when unswaddled, but returned to sleep more quickly.
Longer sleep duration in swaddled infants is believed to be important for brain
to stay on their backs, which reduces the risk of SIDS.
Prevents the baby moving into dangerous situations.
Helps to settle
an overstimulated or distressed baby.
baby feel secure.
uncontrollable flailing of the baby’s arms and legs.
crying, fussiness, and distress.
sleep more deeply.
brain development by reducing stress.
When the baby sleeps better in the supine position, parents are
less likely to use the prone position for sleep. Improved sleep means that mother
is less likely to suffer from exhaustion, postpartum depression or stress.
practice in many neonatal intensive care units for
premature and/or low birth weight infants. However, swaddling takes place very loosely. The arms and legs are held
weakly against the baby’s body so that movement is possible. This form of
swaddling is very different to traditional tight swaddling in the stretched
The American Academy of Pediatrics (AAP 2011b) recommends
swaddling, when done correctly, to be an effective technique to help calm
infants, promote sleep, and reduce SIDS. Mothers who swaddle are twice as
likely to put their babies in the supine position, which reduces the likelihood
of SIDS. Safe swaddling also prevents the baby rolling into the prone
position or moving into a dangerous situation (Gerard et al. 2002). Additionally,
swaddling reduces the chances of bedding
covering the baby’s face and head, which can cause overheating or asphyxia. The baby’s hands can also be left
free to self-comfort by sucking on the fingers or hand.
Most modern swaddle wraps are produced in a triangular, ‘T’ or ‘Y’
shape, which may include ‘wings’ that fold around the baby's body and arms, and
a pouch that allows the baby’s hips to move and the legs to spread apart
naturally. Swaddle wraps are made from cotton, muslin, silk or
a lightweight breathable fabric to prevent overheating. Some swaddle wraps are
made from cotton spandex to reduce the risk of chest wall compression.
Swaddling should be stopped at three months-old (the peak age of
SIDS risk) or when the baby shows signs of rolling over. Older babies may use a
baby sleeping bag, which is less restrictive than a swaddle wrap. The sleeping
bag keeps the baby warm, and it offers plenty of room for the legs and feet to
move freely during the night. It is also sleeveless and without a hood to
prevent overheating or asphyxiation.
Potential risks of swaddling:
Placing the swaddled baby in the prone
Reduced ability to arouse from deep sleep.
Overheating, if a heavy blanket is used.
if the swaddle wrap covers the baby’s face.
breathing if the wrap is too tight across the chest.
dysplasia of the hip if movement of the hips or knees is restricted.
Increased risk of SIDS if continued over
the age of 3 months-old.
Blair et al. (2009)
found that one in 4 SIDS babies had been swaddled. However, the sample used for
the study was small and the risk was branded 'unreliable' by the National
Health Service. Other studies (e.g. Thach 2009) have shown that
swaddling increased the risk of SIDS when babies slept in the prone position,
but not when they slept on their backs.
studies (Thach 2009; Clarke 2013) found that swaddling babies slept more soundly. However this may not
be a desirable outcome, as the pathogenesis of SIDS is thought to involve an
impaired ability to arouse from sleep in response to a life threatening
respiratory or cardiovascular challenge. Although newborns have an inborn survival mechanism, which
enables them to wake up if the airway is obstructed; in deep sleep their
well-being could be threatened.
College of Midwives (Clark 2013) advised against tight swaddling and heavy
blankets in fear of overheating the newborn. Other concerns included
restriction of the chest wall resulting in breathing difficulties or secondary
complications such as pneumonia.
If the baby is swaddled too tightly, developmental dysplasia of
the hip (DDH) may occur (Mahan & Kasser 2008; Chisholm & Cary 2009; AAP 2011a). The risk is elevated in babies with:
history of DDH.
(asymmetrical head or neck position).
DDH occurs in about 1 in 1,000 babies. About 80 percent of cases are female. This is due to oestrogen produced
by the female foetus, which increases elasticity of ligaments and causes the
femoral head to move out of position. Treatment, which involves fitting a harness to keep the legs in a
flexed, widespread position day and night for six weeks, is successful in about
85 percent of cases.
About 17 percent of newborns have some
degree of hip dysplasia. Although the condition resolves untreated by 2 to 3
months-old, traditional tight swaddling may lead to late onset hip dysplasia
and early arthritis (Clark 2013).
There is a significant difference between traditional tight
wrapping and safe swaddling. If babies are placed on their backs to sleep, and
they are loosely wrapped without hip or limb constriction, swaddling may be
safe. However, swaddling could become a safety issue if blankets are used or
when the baby becomes mobile. Care should be taken to ensure that the
swaddle wrap does not restrict blood flow or breathing, or cover the baby’s
face or head.
The association between swaddling and SIDS has been mainly limited
to babies lying in the prone position. The risk of SIDS in supine swaddled babies
needs more in-depth research.
covering all aspects of baby care, health and safety can be found in our Baby
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Lin Day (www.babysensory.com)
This article appeared in the Journal of Health
Visiting › April 2015 › Volume 3 Issue 4 › and has been subject
to peer review.
American Academy of Pediatrics (2011a) Improper
swaddling a risk factor for developmental dysplasia of hip. Available from http://aapnews.aappublications.org/content/32/9/11.1
Academy of Pediatrics (2011b) Practice safe swaddling to protect baby’s
hips. Available from http://aapnews.aappublications.org/content/32/9/11.2 [Accessed 11 October 2014]
Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EM
and Fleming P (2009) Hazardous cosleeping environments and risk factors
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JS and Cary MC (2009) Navajo Infancy: An Ethological Study of Child
Development. New Jersey: Transaction Publishers. p.187
(2013) Swaddling and hip dysplasia: an orthopaedic perspective. Archives of Disease in
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Frenken R (2011) Psychology and history of
swaddling: Part two - The abolishment of swaddling from the 16th century until
today. The Journal of Psychohistory
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