Should You Swaddle Your Newborn?

Every new parent has likely heard the term “burrito” baby, referring to a newborn who is wrapped securely in a blanket or sleep sack from neck to toes. Swaddling is a very common practice for newborns and can be helpful for a variety of reasons, including:

• A snug swaddle helps babies maintain their body temperature when they are first born.
• Swaddling can make the very young newborn feel more secure and calm as it mimics the tight quarters of the womb.
• There is some evidence that swaddling may help a baby sleep longer by limiting the startle response, which can wake them up.

“Sometimes there is a medical indication for swaddling,” says Ganga Srinivas, MD, MBBS, FAAP, Medical Director of the UH MacDonald Women’s Hospital Newborn Nursery. “When an infant sustains a collarbone fracture during delivery, swaddling can be very useful to reduce pain from the injury. Collarbone fractures during birth are not uncommon, particularly with larger infants.”

What are the Potential Risks of Swaddling?

“It’s important to remember that once a baby starts being more active and moving, often within a few weeks of birth, swaddling is less helpful and can actually become a health hazard to the child,” says Dr. Srinivas.

Some of the biggest risks of swaddling include:

• Overheating. Swaddling may keep a baby snug and warm, but too warm is not a good thing when they are sleeping. In general, babies only need one layer more than the parent. A quick check with a hand on baby’s chest under the wrappings or clothes will tell if a baby is too warm. Overheating is one of the risks for Sudden Infant Death Syndrome, commonly known as SIDS.
• Suffocation/Choking. Babies are increasingly mobile by 2-4 weeks and some infants will fight free of a swaddle within a few days of birth. This can cause the sleep sack or blanket to come undone and become tangled around the baby’s neck, causing a choking hazard, or cover the baby’s face and mouth and block their airway.
• Hip Dysplasia. Swaddling a baby so tightly that the hips cannot move increases the incidence of hip dysplasia, a condition where the top of the thigh bone is not seated well in the socket of the hip. Whatever swaddle is used, it is very important that the hips are able move in all directions to promote healthy hip joint development.

A Useful Strategy…But Not For Long

Swaddling can be very helpful in the first days and weeks of life. However, it should be discontinued once the baby is actively trying to flip from back to front, which can happen as early as 6-8 weeks of age.

“Actually, the goal should be to swaddle as little as possible,” says Dr. Srinivas. “In particular, an awake baby should never be swaddled. Once fed, if they are awake and active, it is essential that they have free use of their arms, legs and voice (no pacifier) to promote development. As they begin falling asleep, parents can choose to swaddle, but should remain aware of their infant’s ability to wriggle free. If their infant is able to ‘escape’ the swaddle, it is preferable and safer to dress them in layers appropriate to the weather.”

“Parents should remember that sleep is just one of the things that newborns need. They also need to eat well, explore their world and connect with their family. Infants learn to self-regulate from the adults they are bonded with,” says Dr. Srinivas.

“A parent who is calm, and is calming to the baby, is essentially teaching them to self-soothe. Swaying, rocking and soothing, shushing noises can also be helpful. Self-soothing is a skill that takes time, and over time (weeks to months) babies can learn to self-soothe for sleep if a parent is consistent and present in the early weeks and months.”

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University Hospitals Rainbow Babies & Children’s has a wide network of highly skilled pediatricians at convenient locations across the region. Our specialists have the advanced training and experience to care for children of all ages and provide parents with the support and encouragement they need.