Swaddling your baby - are you doing it right?

Prince George - Image from Getty

When the world met baby Prince George there began a spark of controversy about the safety of swaddling in the UK papers. There were some that suggested swaddling can cause SIDS (Sudden Infant Death Syndrome) and others that said it causes hip dysplasia (clickey hips). What can you do to minimise these risks? Are they really risks at all?

Choose your blankets wisely

Overheating is known to contribute to SIDS, babies have very poor temperature control and rely on us to monitor them closely. According to the World Health Organisation a room to sleep in should be between 18-20 degrees Celsius. If you need a heater in the baby's room to keep it at this temperature, choose a safe one with a thermostat and one that will not cause a fire if knocked down - I know it sounds simple, but you would be amazed what silly things we do in a sleep deprived state. If baby's room is heated by heat pump, either directly or indirectly, please have it set on 18-20 and leave it on this, the room will warm up, albeit slowly, there has been at least one tragic incident where a baby died from being left sleeping in a room with a heat pump set to 30 degrees. In a room that is 18-20 degrees you will find a baby probably doesn't really need much in way of blankets if they are swaddled and wearing clothing as well (probably you won't need much if you are sleeping in the same room either).

For baby bedding, clothing and swaddles choose natural, breathable fibres - cotton, bamboo, wool and merino are great choices. Merino and bamboo in particular are amazing at absorbing moisture and wicking it away from the baby while maintaining a good temperature. Natural fibres will be warm in the cooler temperatures but stay cool if baby gets hot.

What you should avoid

Synthetic materials like polar fleece make terrible swaddles, they do not breathe and baby is at real risk of overheating. Yes they are cheap, yes they are everywhere, just please don't use them for swaddles! Keep them for lying on on the lounge floor and as knee blankets in the pushchair.

If baby is swaddled please do not put them in under your bed blankets as well, keep them on top of the blankets and keep duvets well away from their face. In their own bed a swaddled baby often needs nothing else, or just a light additional blanket may be all that is required. Ensure any blankets are tucked in well at the bottom of the bed and that baby can't slip under them, or flick anything up on to their face.

It is a good idea to check baby's temperature while they sleep - pop two fingers down the back of baby's neck and check for warmth, if it is hot and clammy remove some blankets or clothing, if it is cool take measures to warm baby up. Baby hands, feet and noses are poor temperature gauges. For peace of mind I always used to do a sneaky check of their neck as I was heading to bed, and adjust blankets are required.

Sleep Baby on their Back

A swaddled baby cannot move themselves well enough to keep their airways clear if they are placed on their tummy. Although a swaddled baby will find it very difficult to roll from their back to their stomach, but it is possible. Because of this it is suggested that once a baby can roll, you should leave one or both arms out of the swaddle just in case they do roll then they can lift their heads. In my experience a baby with its arms out are actually more likely to roll, but nothing is fool proof, so go with what you think is best for your situation.

Many parents worry about baby choking if they are lying on their back rather than on their side or tummy. It is reassuring to know that when a baby (or adult for that matter) is lying on their back, their windpipe actually sits above the oesophagus (food pipe). This means that if baby vomits it will be more likely to go straight back down into their stomach and avoid the windpipe if they are on their backs. Babies also have very acute sensors on their larynx (back of throat), as soon as anything is detected on these sensors the baby epiglottis (flappy valve thing) closes the route to the lungs, leaving the dribble/spew/other moisture to flow back to the belly where it belongs.

Careful wrapping/swaddling technique

Babies hips are soft, and still forming at birth and beyond. To ensure they form properly the muscles of the pelvis naturally flex a baby's legs and rotate the knees outwards somewhat. This ensures the ball of the hip joint stay firmly in the socket of the pelvis as it continues to form.

Pulling baby's legs down straight and keeping them there, especially for long periods, can cause them to slip out of the socket and form poorly. It is crucial that when you wrap or swaddle a baby that you allow enough room in the swaddle for them to both straighten their legs in a stretch and have it loose enough that their legs can sit naturally in a bent and relaxed outward direction - see below:

Source

 In practicality it means that all the tucking in and wrapping firmly needs to be above the hips. Swaddling is most effective when it stops baby's arms from flicking when they startle and gives a firm pressure on their belly - both of which can be done while allowing baby to have a natural hip position.

Can swaddling be dangerous? When it is done poorly, with inappropriate blankets; in a hot and stuffy bedroom; with loose bedding or swaddles near a baby's face or when a swaddle is overly restrictive on leg movement; the answer is yes, it can be dangerous. However when it is done properly, swaddling is truly a wonderful skill for parents to have in their tool box and despite what some may say, I believe it to have saved my sleep many many times.