Does Swaddling Increase a Baby's Risk of SIDS?

If you are a new parent, you may have wondered, does swaddling increase a baby's risk of Sudden Infant Death Syndrome (SIDS)

A 2016 study in Pediatrics, the official journal of The Academy of American Pediatrics, warned parents that swaddling a baby during sleep increases the likelihood of SIDS.

What does this new information mean to sleep-deprived new parents and tiny newborns looking to find security and comfort in their new world?

What Is Swaddling?

Swaddling is an ancient practice. In its most basic form, it involves using a blanket to wrap your baby up like a burrito. Swaddling gained popularity during the Back to Sleep (now Safe to Sleep) campaign of the 1990s.

The Back to Sleep campaign urged parents to put their babies on their backs to sleep to reduce the likelihood of SIDS-related deaths. Since babies are used to sleeping in closed, secure environments, swaddling helps mimic the womb and makes infants feel safe. 

Many new parents rely on swaddling as a way to soothe their babies and, in turn, get some much-needed rest for themselves. Swaddling is a practice used in most hospitals and encouraged by doctors. There are many ways to swaddle and many companies have created products guaranteeing the perfect swaddle.

Swaddling and SIDS

For the 2016 study, researchers looked at four case-control studies that examined the association between swaddling and SIDS. The studies spanned two decades and three areas: regions of England in the United Kingdom, Tasmania in Australia and Chicago, Illinois, in the United States.

The Findings

Overall, the analysis showed an increased risk of SIDS when babies were swaddled for "all babies put together," said co-author Dr. Rachel Y. Moon, division head of general pediatrics at the University of Virginia School of Medicine. There was a slight increase in risk when infants were swaddled and placed on their backs, Moon said.

However, the risk was much greater when infants were swaddled and placed on their sides—nearly double—and, even more, when infants were swaddled and on their stomachs, according to the review. The risk was higher for older babies who were at least 6 months old, Moon said.

American Academy of Pediatrics Recommendations

The American Academy of Pediatrics has the following recommendations to help prevent SIDS:

• Babies should always sleep on their backs.
• Always use a firm sleep surface.
• Keep soft objects or loose bedding out of the crib. No pillows, blankets or bumper pads.
• Do not let your baby get too hot.
• Place your baby to sleep in the same room where you sleep but not in the same bed.
• Keep your baby away from smokers and places where people smoke.
• Breastfeed as much and for as long as you can.
• Offer a pacifier at nap time and bedtime.
• Schedule and go to all well-child visits.
• Do not use products that claim to reduce the risk of SIDS, such as wedges, positioners, or special mattresses.
• Do not use home cardiorespiratory monitors to help reduce the risk of SIDS.

What Parents Need to Know

Parents should follow the safe sleep guidelines that infants should be placed on their backs to go to sleep, never on their sides or stomachs—whether they’re swaddled or not. Swaddling is helpful for newborns, but once a child hits 3 or 4 months, swaddling may be more for the parents' benefit than that of the baby.

Once a baby is big enough where they can roll back and forth, the swaddle will no longer help them. Learning to calm oneself is a milestone that all babies need to accomplish.

The good news is—there is no need for tired new parents to panic. There are risks and benefits to swaddling. If you are concerned, talk to your health care provider about any questions you have about swaddling, including how to do it safely.