Current Swaddling Guidance

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In a report for CTV News, Megan DeLaire reviews the current guidance on whether or not to swaddle a newborn child.

Swaddling, which involves wrapping an infant securely in a light, breathable blanket to restrict their movement, is an age-old practice that has fallen in and out of style several times over the past decades.

Current expert advice, as Megan DeLaire reports, is that swaddling can offer benefits when done correctly. The Public Health Agency of Canada (PHAC) and the Canadian Pediatric Society (CPS) say the practice can calm infants and help them sleep. DeLaire interviewed Dr. Jessica Duby, neonatologist at the Montreal Children’s Hospital, who says, “It sort of mimics how they were in the mother’s belly. They feel a bit more contained, a bit more secure when their arms and legs are swaddled.”

The risks occur if swaddling is done improperly and the blanket used becomes unwrapped. It can then pose a face-covering risk and potentially raise the risk of Sudden Infant Death Syndrome (SIDS), especially if done in a warm room, where it may lead to overheating, depending on the type of blanket used. It has also been cited as increasing the risk of hip dislocation in children with hip dysplasia. Dr. Duby notes that swaddling was once promoted as a preventive for SIDS, however “there’s no evidence it helps” for this.

Susan Georgoussis, a registerted nurse and prenatal education co-ordinator at Toronto’s Mount Sinai Hospital, also interviewed, commented that the simplest answer can be the safest. “If you’re in public health and you want to give directions to parents, you have to think about how many different kinds of parents and backgrounds and literacy levels you’re dealing with. You want simple messages, so in some ways it’s easier to say, ‘Don’t swaddle.’”

DeLaire notes in the article that “the benefits of proper swaddling are still recognized by PHAC, CPS and the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, and all three agencies offer guidelines for doing it safely”. Dr. Duby comments that it is still a common practice in many hospitals, and that the most important guideline for reducing SIDS is putting the baby to sleep on their back.

The article cites the PHAC and CPS guidelines that swaddled infants should always be placed on their backs to sleep, on bedding that isn’t too soft, with their nose and mouth uncovered. As soon as a baby begins trying to roll over, around three to four months, parents should stop swaddling.

Dr Duby issued a note of warning about a new product fashionable at the moment, a weighted swaddler, which “have been shown to also not be safe” and stresses that a swaddle should just be done with a regular blanket.

PHAC advice on safe sleeping practices for babies, including swaddling, can be found at: https://www.canada.ca/en/public-health/services/health-promotion/childhood-adolescence/stages-childhood/infancy-birth-two-years/safe-sleep/safe-sleep-your-baby-brochure.html noting:

Swaddling is sometimes used to calm babies, but can also be a risk. Babies can get tangled or covered in the blanket if it comes loose, or can roll onto their tummy while still swaddled. These are risks for suffocation. If you swaddle your baby, be sure to do it safely:

·      Use a lightweight blanket. Make sure it stays well away from the baby’s nose and mouth.

·      Wrap your baby so they can still move their hips and legs.

·      Leave your baby’s hands free so they can show you when they are hungry.

·      It is very important to stop swaddling before your baby can roll. Swaddling is not safe for babies when they are on their tummies.