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  • Letter to the Editor
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Swaddling is not contraindicated in the newborn period

Journal of Perinatology volume 36, page 160 (2016)Cite this article

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Congratulations to Dr Varghese et al.1 on their contribution to the literature on the persistent issue of knowledge and behavior deficiencies amongst new parents regarding safe sleep recommendations at hospital discharge, as described in their manuscript, ‘An analysis of attitude toward infant sleep safety and SIDS risk-reduction behavior among caregivers of newborns and infants.’ However, as members of the American Academy of Pediatrics (AAP) Task Force on SIDS, we must express our concern regarding the discussion about swaddling. The article states that there is an ‘AAP recommendation to avoid swaddling infants at sleep time.’ This statement misinterprets the current recommendations. The 2011 AAP SIDS Task Force Technical Report states: ‘Although swaddling may be used as a strategy to calm the infant and encourage use of supine position, there is not enough evidence to recommend it as a strategy for reducing the risk of SIDS.’2 Parents often swaddle infants to promote sleep and minimize the number of awakenings. However, there is some concern, because decreased arousability (that is, the infant does not awaken as easily) may increase SIDS risk. Physiologic data about the effects on arousability to an external stimulus when infants are swaddled are conflicting, and there may be minimal effects of routine swaddling on arousal.3, 4, 5 Epidemiological data directly linking swaddling with SIDS or problems with arousability are lacking. Additional potential disadvantages to swaddling include increased respiratory rate and reduced functional residual lung capacity, exacerbation of hip dysplasia if the hips are kept in extension and adduction, ‘loose’ swaddling becoming loose bedding, and overheating, especially if the head is covered or the infant has an infection. The Technical Report concludes: ‘Swaddling must be correctly applied to avoid the possible hazards. Swaddling does not reduce the necessity to follow recommended safe sleep practices.’2

The authors also misinterpret the study by McDonnell and Moon6 that reviewed CPSC-reported injuries and deaths involving swaddling devices. Varghese states: ‘It is crucial that caregivers of infants are educated on the dangers of swaddling and the products designed to encourage it.’1 However this statement is not consistent with McDonnell’s and Moon’s conclusions: ‘Reports of sudden unexpected death in swaddled infants are rare. Risks can be reduced by placing infants supine, and discontinuing swaddling as soon as an infant’s earliest attempts to roll are observed. Risks can be further reduced by removing soft bedding and bumper pads from the sleep environment.’6 In McDonnell and Moon’s study, the vast majority of the cases were attributed to positional asphyxia, with prone positioning and other risk factors, most commonly soft bedding, often present.

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References

  1. Varghese S, Gasalberti D, Ahern K, Chang JC . An analysis of attitude toward infant sleep safety and SIDS risk reduction behavior among caregivers of newborns and infants. J Perinatol 2015; 35: 970–973.

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  2. Moon RY . Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011; 129 (5): e1341–e1367.

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  3. Franco P, Scaillet S, Groswasser J, Kahn A . Increased cardiac autonomic responses to auditory challenges in swaddled infants. Sleep 2004; 27 (8): 1527–1532.

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  4. Franco P, Seret N, Van Hees JN, Scaillet S, Groswasser J, Kahn A . Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 2005; 115 (5): 1307–1311.

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  5. Richardson HL, Walker AM, Horne RS . Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants. J Pediatr 2010; 157 (1): 85–91.

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  6. McDonnell E, Moon RY . Infant deaths and injuries associated with wearable blankets, swaddle wraps, and swaddling. J Pediatr 2014; 164 (5): 1152–1156.

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Authors and Affiliations

  1. Department of Pediatrics, York Hospital, WellSpan Health, York, PA, USA

    M H Goodstein

  2. Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA

    F R Hauck

  3. Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    R A Darnall

  4. Department of Pediatrics, Cooper University, Camden, NJ, USA

    L Feldman-Winter

  5. Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA

    R Y Moon

Authors
  1. M H Goodstein
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  2. F R Hauck
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  3. R A Darnall
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  4. L Feldman-Winter
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  5. R Y Moon
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Corresponding author

Correspondence to M H Goodstein.

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The authors declare no conflict of interest.

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Goodstein, M., Hauck, F., Darnall, R. et al. Swaddling is not contraindicated in the newborn period. J Perinatol 36, 160 (2016). https://doi.org/10.1038/jp.2015.182

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