[Updated 10th October 2024]

“Should I swaddle my baby?” is a question I often get asked in my Bub Savvy Workshops.

My starting point is always…however you choose to care for your baby is completely up to you. You are going to get a lot of conflicting advice,  so it can be helpful to get good at thinking about the pros and cons, or risks and benefits, of different suggestions then filter that through your own value system and then decide what’s right for you, your baby and your family.

So to help you with looking at the pros and cons of swaddling I’m writing a blog.

Remember that the next step after reading this blog is to filter this information through your value system, and then make your own decision as to whether you believe you should swaddle your baby or not.

Let’s look at the commonly suggested benefits and risks of swaddling.

 Benefits:

1. Calming effect: Swaddling can help calm babies and reduce crying by mimicking the feeling of being in the womb.
2. Improved sleep: Swaddled babies may sleep more soundly and for longer periods, which can be beneficial for both the baby and the parents.
3. Reduced risk of SIDS: Swaddling may help reduce the risk of sudden infant death syndrome (SIDS) by preventing babies from rolling onto their stomachs during sleep.
4. Easier for feeding: Swaddling can make it easier to feed newborns and may help them stay in a more comfortable position.

 

Risks:

1. Increases the risk of SIDS: Swaddling can cause a baby to overheat, which can increase the risk of SIDS. Swaddling can also alter babies’ sleep states and create conditions unfavourable to arousability which is protective against SIDS
2. Hip dysplasia: Swaddling too tightly can put pressure on a baby’s hips, which can lead to hip dysplasia.
3. Impaired breathing: Swaddling can impair a baby’s breathing if the blanket or cloth is wrapped too tightly around their chest.
4. Reduced mobility: Swaddling can limit a baby’s mobility and prevent them from developing proper motor skills.
5. Potentially impacts breastfeeding.

 

As you can see there is already one glaring conflict there.

Does swaddling reduce or increase the risk of SIDS?

I can understand the theory that swaddling a baby can stop them rolling onto their front, but I also haven’t seen too many newborns who, if placed on their back can roll on their front.

Perhaps it is more that the act of swaddling a baby is a cue to place babies on their backs than the actual swaddling itself.

I don’t know if you’ve ever swaddled a baby and then tried to put them on their sides. It just doesn’t work. And you certainly wouldn’t put a swaddled baby face down; that’s just wrong.

So could we use a different cue that doesn’t increase the risk of SIDS by other mechanisms? Overheating, breathing restriction, and altered sleep states.

A Systemic Review of Swaddling in 2022 concluded that …

This review supports the possibility that, by producing conditions unfavorable to arousability, swaddling may increase SIDS risk in infants that are naïve to the experience (3, 20). This argument is strengthened by the finding that swaddling significantly reduces the frequency of sleep state transitions and promotes quiet sleep. Given that swaddling is typically used during the critical period in which infants are most vulnerable to SIDS, namely <6 months of age (52, 57) further research into the effect of swaddling on infant sleep and arousal, particularly for swaddle-naïve infants, is strongly recommended. (Dixley, A. &  Ball, H. 2022)

The other conflict is does it make breastfeeding easier or does it potentially impact breastfeeding.

Again, I can see how, theoretically, swaddling makes breastfeeding easier as the baby is in a neat bundle but it also dulls babies’ innate breastfeeding reflexes, namely bobbing and using their hands. It also prevents skin-to-skin and chest-to-chest, which switch on these breastfeeding reflexes.

I think the bigger problem is that we have been showing women how to breastfeed wrong for decades now.

This is a whole other blog, but when you understand the incredible breastfeeding reflexes babies are hardwired with, and how to work with them and not against them, you won’t feel the need to swaddle your baby for breastfeeding.

And this 2023 Paper has shown that…

Infants swaddled immediately after birth show a delay in initial breastfeeding, less successful suckling at the breast, reduced intake of breastmilk and greater weight loss compared to un-swaddled babies. Swaddling visually obscures feeding cues and reduces crying, thereby eliminating two key feeding prompts typically used by parents/carers. (Dixley, A. &  Ball, H. 2023

If a swaddled baby is not being fed as much as they should be, because parents aren’t seeing feeding cues, this can impact a woman’s milk production, especially in the first days and weeks.

Milk production is really a use-it-or-lose-it process. It is also different for different women depending on their unique milk storage capacity. Unfortunately, we don’t know an individual woman’s storage capacity this early as it’s not related to breast size. So your best policy, to really get your milk supply to its optimal level, is free and frequent feeding which swaddling can impact.

How about this proposed benefit of the calming effect?

The theory is that swaddling can help calm babies and reduce crying by mimicking the feeling of being in the womb.

But does it?

Babies are certainly not restricted in their movement in the womb as any pregnant woman will tell you.

They have lots of freedom of movement, even at the end of pregnancy. Their movement mustn’t be restricted so that they can grow their beautiful bodies and explore a full range of motion without being tightly compressed.

This is born out by the fact that some of the risks of swaddling are…

1. Hip dysplasia: Swaddling too tightly can put pressure on a baby’s hips, which can lead to hip dysplasia.
2. Impaired breathing: Swaddling can impair a baby’s breathing if the blanket or cloth is wrapped too tightly around their chest.
3. Reduced mobility: Swaddling can limit a baby’s mobility and prevent them from developing proper motor skills.

Plus in the womb babies have the perfect temperature, constant noise and movement, and constant connection with their mum. Does swaddling a baby and putting them in a bassinet really mimic the womb environment?

In fact, the place that most mimics this environment is being placed skin-to-skin on their mum (or anyone), which also calms babies and reduces crying.

This is where Dr. Nils Bergman’s research is so important to consider.

Dr. Nils Bergman is a Swedish specialist in perinatal neuroscience and the researcher who gave us Kangaroo Mother Care, which ironically we are rubbish at in Australia.

His research has revealed that what we often see as ‘contently sleeping babies’ in cots away from their carers are actually babies in ‘survive mode.’ These babies are in their sympathetic nervous system, which is controlled by the survival part of the brain—the only part fully developed at birth. The baby’s brain determines that staying quiet is the safest option, but as a result, it doesn’t get the energy needed for rapid growth. To conserve energy, the survival brain makes the baby sleep instead of calling out.

On the other hand, when babies are close to their mums—especially during skin-to-skin contact—they enter a state of ‘thrive mode.’ Yes, they may wake and feed more often, but this is because they are in their parasympathetic nervous system, the part that helps them feel calm and safe. During this time, they’re soaking up all the nourishment and energy their growing brains need to thrive.

“The  swaddled  and  separated  baby  lies  still  with  its  eyes closed, and is believed to be sleeping. A study on autonomic activation (Morgan et al. 2011), showed that quiet sleep was reduced by 86%  in separated babies and  their sleep cycling was  almost abolished.  There were  also specific  autonomic patterns  in  separated  babies, which  match  perfectly  those described  as  ‘threat  responses’  found  in  abused  children (Perry et  al.  1995).  The first  sign  of perceived threat  results in  vigilance,  where  crying  has  survival  value  since  the perceived  threat  is  further  away  than  the  mother.  When the perceived  threat  is  closer  than  the  mother,  or  if  the mother is  not  responding,  a  cry response  would, however, increase  danger,  thus  a  state  of  freeze  follows  (Misslin 2003).  This  ‘freeze  state’  is  produced  by  intense and  total autonomic  activation,  with  profound  avoidance  activation on electroencephalogram (Jones, McFall & Diego 2004). Such babies lie absolutely  still, absolutely quiet, with  eyes  firmly closed. This is believed  to be  sleep! It is however a state  of high arousal, also called ‘fear-terror’ (Perry et al. 1995). When this state is prolonged, cortisol may initiate harmful changes that can affect the individual across its lifespan.” (Bergman 2014)

 

But I imagine the promise of improved sleep is still very alluring for you.

 

Swaddled babies may sleep more deeply and for longer periods but the claim that this can be beneficial for the baby is false. Yes, parents may find it beneficial but for the above reasons, it is not beneficial for babies.

This is where we need to have a conversation about cultural exceptions of infant sleep versus biologically normal infant sleep. This is really the crux of the debate as to whether to swaddle or not, IMHO.

Our culture places so much emphasis on babies sleeping deeply and for long periods and this seems to be the goal from day one for most parents.

This notion is further reinforced by people saying things such as “Is she a good baby, is she sleeping?”

This constant reinforcement that a good baby is a baby that sleeps is so dominant in our culture that parents think they are doing something wrong if their baby isn’t sleeping for long stretches of time, with the implication that they are bad parents.

But from a biological point of view, babies are not meant to sleep deeply and for long periods of time.

Biologically normal sleep for infants means that they should wake frequently through the night throughout the first year of life to support the energy needs of this rapidly growing brain.

Biologically normal infant sleep is very different from adult sleep with babies spending a large portion of their sleep in active (REM) sleep and much less time in quiet deep sleep.

Biologically babies are born without circadian rhythms. These take several months to develop because, again, from a biological perspective normal sleep involves frequent night waking for feeding and interaction with a mother who sleeps in close proximity to them so that their energy, warmth, and safety needs are met.

So although swaddling has been shown to make babies sleep for longer periods of time and more deeply, should they be sleeping deeply for long periods of time?

The answer biologically is no (and physiological no from an establishing milk production point of view).

In fact, from a biological/physiological point of view, it could be argued that if swaddled babies sleep more soundly and for longer periods this is actually a risk of swaddling not a benefit.

Swaddling does seem to stop the startle reflex, but again is this a good thing? Is the startle reflex actually a protective arousal mechanism for babies?

The startle reflex is a normal, protective response that babies have when they’re surprised, like by a loud noise or sudden movement. Over time, as your baby experiences more of these little startles, their body gets used to it, and the reflex happens less often and becomes less intense. While it can be tempting to swaddle tightly to prevent these startles, allowing the reflex to naturally play out actually helps your baby’s body adjust. Suppressing it through swaddling can be counterproductive for sleep, as it delays the process of your baby learning not to startle to loud noises, sudden movement etc.

Of course, all this brings up another question… “Should I buy a SNOO Smart Bassinet?”

To answer this you need to ask yourself do you believe your goal should be getting your baby to sleep for long periods of time, or do you think your goal should be to follow your baby’s biological drive for free and frequent feeding and connection, which will grow their brains optimally, and support optimal milk production, and therefore a better breastfeeding journey?

 

Finally, what about parental mental health?

This is often used as a rationale for getting babies to sleep more. And of course, parental mental health is important for babies as well as parents.

However, most “sleep training” strategies focus on separating parents and baby, teaching baby to self-soothe, etc, etc. Basically “fixing the baby” to get them to conform to (unrealistic) cultural infant sleep expectations. Ironically, a lot of parents report these strategies really increase their stress levels.

This approach sets up such a battle between parents’ belief they need to get a “good night’s sleep” in order to cope with early parenting and their baby’s needs for contact, comfort, and regular night-time feeds. This can impact parental mental health really negatively

A pilot study in the UK of a biological approach to infant sleep that supports parents to adapt and cope with the ultimate disruption to sleep that a new baby brings; helps their expectations and reality meet each other; educates them on the biological drivers of infant sleep and how to work with them and not against them; and gives parents some strategies when things get tough, found that…

Helping parents to better understand, and find ways of coping with, their infants’ unique sleep needs has the potential to improve parental mental well-being and infant safety while avoiding inappropriate medicalisation and treatment of infants. (Ball et al. 2020)

What we really need is a culture that normalises biological infant behaviour. That would go a long way to promoting positive parental mental health.

 

Now remember the above information is all from my value system.

The next step for you, after reading this blog, is to filter the information through your value system, and then make your own decision as to whether you believe you should swaddle your baby or not.

 

 

*The biological approach to sleep in the study was Sleep Baby & You, which is known as  Possum’s Sleep in Australia. If you want to know more about this approach I run workshops in Perth Western Australia. You can find out more HERE

 

References

Ball, H. L., Taylor, C. E., Thomas, V., Douglas, P. S., & the SBY working group. (2020). Development and evaluation of ‘Sleep, Baby & You’—An approach to supporting parental well-being and responsive infant caregiving. PLOS ONE, 15(8), e0237240. doi: 10.1371/journal.pone.0237240.

Bergman, Nils. (2014). The neuroscience of birth – and the case for Zero Separation.  37. 1. 10.4102/curationis. v37i2.1440.

Dixley, A., & Ball, H. L. (2022). The effect of swaddling on infant sleep and arousal: A systematic review and narrative synthesis. Frontiers in Pediatrics, 10, 180. doi: 10.3389/fped.2022.1000180

Dixley, A., & Ball, H. L. (2023). The impact of swaddling upon breastfeeding: A critical review. American Journal of Human Biology, e23878. doi: 10.1002/ajhb.23878.

Rudzik, A. E. F., & Ball, H. L. (2021). Biologically normal sleep in the mother-infant dyad. American Journal of Human Biology, e23589. doi: 10.1002/ajhb.23589.

Zhang J, Wang M, Wei B, Shi J, Yu T. Research Progress in the Study of Startle Reflex to Disease States. Neuropsychiatr Dis Treat. 2022 Feb 24;18:427-435. doi: 10.2147/NDT.S351667. PMID: 35237036; PMCID: PMC8884703.