The American Academy of Pediatrics recommends a safe sleep environment for babies. In the first year of life, most deaths occur from SIDS. A loose blanket, including a swaddling blanket that comes unwrapped, could cover your baby’s face and increase the risk of suffocation.
Because so many parents ask, we want to share the AAP recommendation on swaddles. While the AAP does not have explicit guidelines on swaddling that covers infants face, they do recommend against it.
In following AAP recommendations, Halo Innovations cautions against the use of blankets, including swaddling blankets, in a baby’s sleep environment.
You might find products that claim to reduce the risk of sudden infant death syndrome (SIDS), but AAP warnings advise against using them.
The American Academy of Pediatrics strongly discourages the use of a blanket until your child is older than one year. Our swaddle blankets are designed to be tight and snug so that it does not become loose and could be dangerous for your baby. You can also choose our safe sleep wearable blankets which are designed to go directly to your baby.
According to the American Academy of Pediatrics, the safest way for your baby to sleep is on his back without any loose blankets. The old fashioned swaddle with a rectangular blanket can be difficult to get just right, and once unwrapped from a squirming baby it can become a dangerous hazard. The Happiest Baby SNOO Smart Sleeper’s ultra-soft medical grade cotton “wings” hold baby securely without rewrapping. It’s designed to keep arms in or out (just like you do). Night after night…even if your baby is super fussy or very active!
New parents often learn how to swaddle their infant from the nurses in the hospital. A blanket wrapped snuggly around your baby’s body can resemble the mother’s womb and help soothe your newborn baby. The American Academy of Pediatrics (AAP) says that when done correctly, swaddling can be an effective technique to help calm infants and promote sleep.
But if you plan to swaddle your infant at home, you need to follow a few guidelines to make sure you are doing it safely.
Swaddling a baby pros and cons
When considering swaddling your baby and assessing safety concerns, it’s important to weigh the benefits and risks. It’s also reasonable to ask questions like: Is it good to swaddle a baby? How long should babies be swaddled? When and why is swaddling not recommended? Do babies sleep longer when swaddled? Are there swaddling techniques that make it safer?
Today, many American infants, ages 0-3 months, are swaddled. Here’s how swaddling can benefit your baby:
- Helps infants feel more secure as they transition to life outside the womb. In a way, swaddling is like wearing a hug.
- Soothes and keeps the baby calm at naptime and at night.
- Keeps infants from being startled by their own Moro (or startle) reflex. Those little flailing arms can disrupt a baby’s sleep.
- Promotes longer periods of sleep. “Swaddling is not created to provide uninterrupted sleep,” Carolynne Harvey, a baby sleep consultant for 4moms and founder of Dream Baby Sleep, told TODAY Parents. “It does not have that power. Babies naturally awaken for safety measures — if they get too hot or hungry, they will wake up.”
- Keeps babies warm until the body can regulate temperature well.
Swaddling can also indirectly benefit new moms, since cozy, secure babies sleep better and cry less, which can lead to more — and better quality — sleep and less stress for moms. In many ways, swaddling creates a win-win situation, but there are some risks, too.
“One of the problems with swaddling is that it’s hard to do it absolutely right,” Michael Goodstein, MD, a neonatology physician at WellSpan Health in York, Pennsylvania, and director of the York County chapter of Cribs for Kids, told TODAY Parents. “It’s like baby origami.”
Because getting the baby wrapped correctly in a swaddle can be difficult, parents and caregivers may end up swaddling their babies in ways that do more harm than good. Incorrect swaddling can lead to:
- Hip dysplasia: If babies are swaddled too tightly around the hips, they could develop hip joint issues, including dysplasia, according to experts. In the first six months, a baby’s legs need to be flexed and separated; they shouldn’t be restricted and forced to extend straight.
- Trouble breathing: Babies swaddled too tightly around the chest may not be able to breathe deeply enough. Leave about two or three fingers-width between the baby’s chest and the swaddle.
- Suffocation hazards: If swaddled too loosely, a baby could kick out of the swaddle, leaving a loose blanket in the crib — and that increases the risk of suffocation and choking.
It’s also important to make sure swaddled babies do not get overheated, since this raises the risk of SIDS. Signs of overheating include:
- Damp hair
- Rapid breathing
- Flushed cheeks
A good rule is to dress your baby in one layer more than you’re comfortable wearing.
Babies need to be monitored while they sleep to make sure they don’t accidentally roll over. When swaddled babies are put to sleep on their stomachs — or if they roll onto their stomachs while they sleep — their risk of SIDS is 20 times greater than for non-swaddled babies. That’s because they can’t use their arms or legs to get out of danger. When babies show signs of starting to roll over (usually around two months old), it’s time to stop swaddling.
How to swaddle a baby — step by step
There are different ways to swaddle a baby. In fact, it’s not even necessary to swaddle the entire body. You can swaddle only the baby’s arms and leave the legs free to move. Additionally, instead of using a blanket, you can try products like the Ollie Swaddle or swaddles with Velcro fasteners or snaps that make it simple to swaddle correctly. Another option is a sleep sack, which provides the snug feeling of a swaddle without all the hassle. Sleep sacks can be helpful if your baby has trouble transitioning to sleeping without a swaddle.
What about tummy time for babies?
All babies need some tummy time every day. Being on the tummy helps babies develop head and neck control as well as core muscles, explained Harvey. “Do tummy time from day one, one minute three times a day, fully supported,” she said. “That is, place baby on your chest. Then, when baby is able to arch his back and lift his head and neck, transition to tummy time on the floor. Your pediatrician can advise you on the right time to do this, but it’s usually when baby’s around two to three weeks old.”
Harvey recommended adding a minute to each session for every week of age based on your baby’s due date. That means that by the time your baby is 15 weeks old — or is 15 weeks post due date — he should be having 15 minutes of tummy time, three times a day. Tummy time helps prevent SIDS by strengthening muscles that allow babies to move their head if they get caught against a stuffed toy, bumper, mattress or something else.
Should infants in child care centers be swaddled?
The AAP recommends that infants not be placed in child care centers until they are about three months old. By then, infants are no longer being swaddled, so the risks associated with swaddling aren’t a concern.
Swaddling is not recommended for infants younger than two months who are placed in childcare. Variations in swaddling techniques by the different caregivers and the inability of caregivers to monitor the infant adequately if it accidentally rolls over while swaddled are among the main reasons.
Swaddling and SIDS
According to the AAP, swaddling may help calm fussy infants, but there is no evidence that swaddling reduces the risk of SIDS. There are, however, other things you can do. Here are four ways to lower your baby’s risk of SIDS.
- Follow the AAP’s safe sleep guidelines. The AAP recommends placing babies on their backs in a crib near your bed without any bedding (other than a fitted sheet) or soft objects.
- Consider using a pacifier. The AAP endorses giving babies a pacifier when it’s time for sleep. (One-piece pacifiers are recommended.) Not only can a pacifier soothe your baby, said Dr. Goodstein, “there’s a very strong correlation in the use of a pacifier and a decreased incidence of SIDS.” If the pacifier falls out of your baby’s mouth during sleep, it’s not necessary to put it back in.
- Breastfeed. Breastfeeding may reduce the risk of SIDS, according to a meta-analysis of studies published in November 2017 in the AAP journal Pediatrics. Researchers found that breastfeeding for at least two months can lower the risk of SIDS by nearly 50%. Goodstein also pointed out that breastfeeding for six months may reduce SIDS risk by up to 65%.
- Maintain a smoke-free environment. Always keep your baby — whether sleeping or awake — in smoke-free areas. Exposure to secondhand smoke in the household can double a baby’s risk of SIDS, according to the National Institute of Child Health and Human Development. The risk of SIDS also more than doubles for babies with mothers who smoked during pregnancy compared to those with mothers who didn’t smoke while they were pregnant, according to a study published in April 2019 in Pediatrics.
Are Swaddles Safe for Sleep
As a new parent, it might have seemed strange when your newborn was brought to you swaddled — wrapped more like a burrito than a tiny baby. This centuries-old practice of wrapping a baby snugly to restrict movement of its arms and legs can be beneficial in a number of ways, but many wonder, is it safe to swaddle a baby? Here’s what you need to know about the pros and cons of swaddling, how to swaddle a baby correctly, and how to reduce your baby’s risk of sudden infant death syndrome (SIDS).
Back to Sleep
To reduce the risk of Sudden Infant Death Syndrome, or SIDS, it’s important to place your baby to sleep on his back, every time you put him to sleep. This may be even more important if your baby is swaddled. Some studies have shown an increased risk of SIDS and accidental suffocation when babies are swaddled if they are placed on their stomach to sleep, or if they roll onto their stomach, says Rachel Moon, MD, FAAP, chair of the task force that authored the AAP’s safe sleep recommendations.
“If babies are swaddled, they should be placed only on their back and monitored so they don’t accidentally roll over,” Dr. Moon says.
When to Stop Swaddling
Parents should stop swaddling as soon as their baby shows any signs of trying to roll over. Many babies start working on rolling at around 2 months of age. There is no evidence with regard to SIDS risk related to the arms swaddled in or out.
|What about wearable blankets or sleep sacks?Infant sleep clothing, such as a wearable blanket or sleep sack, is preferred over blankets and other coverings to keep a baby warm. A safe sleep space for infants should stay free of any loose bedding or soft objects. However, as with regular blanket swaddling, the use of wearable blankets or sleep sacks that compress the arms, chest and body should stop once a baby shows signs of starting to roll over. Sleep sacks that do not swaddle and allow the baby to move freely can be used indefinitely.
Know the Risks
Parents should know that there are some risks to swaddling, Dr. Moon says. Swaddling may decrease a baby’s arousal, so that it’s harder for the baby to wake up. “That is why parents like swaddling – the baby sleeps longer and doesn’t wake up as easily,” she said. “But we know that decreased arousal can be a problem and may be one of the main reasons that babies die of SIDS.”
AAP Safe Sleep Recommendations
The AAP recommends parents follow the safe sleep recommendations every time they place their baby to sleep for naps or at nighttime:
- Place your baby on her back to sleep, and monitor her to be sure she doesn’t roll over while swaddled.
- Do not have any loose blankets in your baby’s crib. A loose blanket, including a swaddling blanket that comes unwrapped, could cover your baby’s face and increase the risk of suffocation.
- Use caution when buying products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the AAP.
- Your baby is safest in her own crib or bassinet, not in your bed.
- Swaddling can increase the chance your baby will overheat, so avoid letting your baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and rapid breathing.
- Consider using a pacifier for naps and bedtime.
- Place the crib in an area that is always smoke-free.
See How to Keep Your Sleeping Baby Safe: AAP Policy Explained for more information and tips.
Keep Hips Loose
Babies who are swaddled too tightly may develop a problem with their hips. Studies have found that straightening and tightly wrapping a baby’s legs can lead to hip dislocation or hip dysplasia, an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.
The Pediatric Orthopaedic Society of North America, with the AAP Section on Orthopaedics, promotes “hip-healthy swaddling” that allows the baby’s legs to bend up and out.
How to Swaddle Correctly
- To swaddle, spread the blanket out flat, with one corner folded down.
- Lay the baby face-up on the blanket, with her head above the folded corner.
- Straighten her left arm, and wrap the left corner of the blanket over her body and tuck it between her right arm and the right side of her body.
- Then tuck the right arm down, and fold the right corner of the blanket over her body and under her left side.
- Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
- Make sure her hips can move and that the blanket is not too tight. “You want to be able to get at least two or three fingers between the baby’s chest and the swaddle,” Dr. Moon explains.
Swaddling in Child Care
Some child care centers may have a policy against swaddling infants in their care. This is because of the increased risks of SIDS or suffocation if the baby rolls over while swaddled, in addition to the other risks of overheating and hip dysplasia.
“We recommend infants wait to enter a child care center until they are about three months old, and by then swaddling should have been phased out because the babies are more active and rolling,” said Danette Glassy, MD, FAAP, chair of the AAP Section on Early Education and Child Care and the AAP representative on a panel that wrote guidelines for child care providers.
The guidelines, Caring for Our Children, National Health and Safety Performance Standards, which are jointly published by the National Resource Center for Health and Safety in Child Care and Early Education, the AAP and the American Public Health Association, do not ban swaddling in child care centers, but they say swaddling is not necessary or recommended. As a result, some child care centers, and the states where they are located, are implementing more forceful recommendations against swaddling in child care settings.
“Compared to a private home, where one or two people are caring for an infant, a child care center usually has a number of caregivers, who may have variations in their swaddling technique,” Dr. Glassy says. “This raises a concern because studies show babies who are not usually swaddled react differently when swaddled for the first time at this older age.” They may have a harder time waking up, which increases their risk of SIDS.
“The difference in the advice for swaddling at home or the hospital nursery, versus in a child care center, really comes down to the age of the child and the setting,” Dr. Glassy says. “A newborn can be swaddled correctly and placed on his back in his crib at home, and it can help comfort and soothe him to sleep. When the child is older, in a new environment, with a different caregiver, he is learning to roll, and perhaps he hasn’t been swaddled before, swaddling becomes more challenging and risky.”
- Hip-Healthy Swaddling (International Hip Dypslasia Institute) – Learn more about the effect of tight swaddling on the soft hips of babies and view short videos to learn hip-healthy methods to swaddle your baby.