Critiques of these physiological studies have suggested that there is insufficient evidence that infants who are swaddled on their back are at any increased risk of SUDI 3, The advantages of swaddling back sleeping infants outweigh the risks 23 and swaddling is an important and appropriate tool in the care of the newborn 3. Tummy sleeping increases the risk of SUDI and must be avoided 1,5,36, Wrapping a baby and placing them in the tummy position is even more dangerous as it prevents babies from moving to a position of safety 1,2,5,6, If babies are wrapped, they should always be placed on their back 1,5.
Several early studies provided evidence that infant wrapping may reduce SUDI risk when infants sleep on their back Critiques of physiological studies have also suggested that there is insufficient evidence that infants who are swaddled on their back are at any increased risk of SUDI 3, Limited evidence suggested swaddling risk increased with infant age, and was associated with a twofold risk for infants over 6 months. This may be related to a greater likelihood of rolling to tummy position at an older age.
This meta-analysis concluded that current advice to avoid placing babies on their tummies or sides especially applies to babies who are swaddled. In addition, the increased risk of swaddling with age regardless of sleep position suggests that discussion needs to be encouraged relating to appropriate age limits for discontinuing swaddling.
Because of the likelihood of rolling onto the tummy, current advice for excessive crying in infants, suggests babies should not start wrapping after the fourth month, to un-swaddle as soon as the child signals they are trying to turn over, and always to stop swaddling before the sixth month, because after this age infants will be able to roll over There is a greatly increased risk of death if a swaddled infant is placed in, or rolls onto their tummy 1,,39, Current evidence strongly suggests that as soon as baby shows signs of beginning to roll, wrapping should be ceased for sleep periods 1,5,6.
Babies who are born preterm and wrapped during the period of hospitalisation have been shown to have improved neuromuscular development 2,41 , less physiologic distress 16,18 , better motor organisation and more self-regulatory ability Swaddling has been shown to reduce behavioural distress after heel lancing in preterm infants older than 31 weeks but not in more immature babies More recently a study conducted by Shu and colleagues 22 showed that both swaddling and heel warming reduced pain responses to the heelstick procedure in neonates born at weeks gestation Using a randomised controlled trial design, babies were randomised to be positioned in an alternative positioning device a stretchable cotton swaddle designed to provide containment while allowing the infant to move extremities into extension and recoil back into flexion or to traditional positioning methods wrapped in blanket and supported by nest for their length of stay.
Infants in the alternative positioning arm of the study demonstrated less asymmetry of reflex and motor responses than those positioned using traditional positioning methods In the early weeks of life however infant wrapping should not interfere with skin to skin contact of the low birth weight infant with a caregiver.
Kangaroo mother care, or skin to skin, has been shown to reduce risk of mortality and morbidity and improve growth, breastfeeding and maternal-infant attachment outcomes for low birth weight babies Current evidence would suggest that sick or very prematurely born babies who were physiologically too fragile to be wrapped in the early weeks of life due to their extreme prematurity, medical condition or fragility are still able to be wrapped for settling and sleep as they grow.
It is advisable to introduce wrapping for settling and sleep as soon as the infant is medically well and sleeping on their back, prior to discharge from the neonatal care unit, to provide an opportunity for baby to be monitored and for staff to assist parents in practising safe wrapping strategies. If a baby is diagnosed with congenital dysplasia of the hips, and parents wish to use infant wrapping as a settling and sleep strategy, specific advice from a health professional should be sought to ensure a safe technique is used that meets the individual needs of the baby.
There is no evidence with regard to SUDI risk related to the baby having arms inside or outside of the wrap. These decisions should be made on the individual basis, depending on the needs of the infant 1,5. It is important to leave enough room in the wrap for the legs to move freely.
The legs should be able to bend at the hips with the knees apart to help the hips develop normally. Parents should know that there are some risks to swaddling, Dr. The AAP recommends parents follow the safe sleep recommendations every time they place their baby to sleep for naps or at nighttime:.
Use caution when buying products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the AAP. Swaddling can increase the chance your baby will overheat, so avoid letting your baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and rapid breathing.
Consider using a pacifier for naps and bedtime. Place the crib in an area that is always smoke-free. Babies who are swaddled too tightly may develop a problem with their hips. Straighten her left arm, and wrap the left corner of the blanket over her body and tuck it between her right arm and the right side of her body.
Then tuck the right arm down, and fold the right corner of the blanket over her body and under her left side. Make sure her hips can move and that the blanket is not too tight. Moon explains. Some child care centers may have a policy against swaddling infants in their care. This is because of the increased risks of SIDS or suffocation if the baby rolls over while swaddled, in addition to the other risks of overheating and hip dysplasia. As a result, some child care centers, and the states where they are located, are implementing more forceful recommendations against swaddling in child care settings.
Glassy says. You may be trying to access this site from a secured browser on the server. Swaddling can help calm a baby — it is thought that swaddling helps recreate the restricted space in the womb. Some studies have shown that swaddled babies wake less frequently and sleep longer than non-swaddled babies.
Swaddling may also help reduce the risk of sudden infant death by keeping babies on their back during sleep. Swaddling is for very young babies — from birth to when they begin to show signs they can roll over usually 4 to 6 months old but sometimes younger. Stop swaddling once your baby can roll onto their tummy or if your baby does not seem to like it.
An alternative to swaddling is to use a safe infant sleeping bag. Do not swaddle your baby if they share a sleep surface with another person. Babies should not be wrapped while sleeping in a baby sleeping bag. Video provided by Raising Children Network. Read more about safe sleep for babies and for support or advice, call Pregnancy, Birth and Baby on Learn more here about the development and quality assurance of healthdirect content.
Read more on Red Nose website. See how to wrap a baby in this video. It can also soothe babies. Read more on raisingchildren. Read more on Karitane website. See how to wrap a baby in our illustrated, step-by-step guide. Wrapping can soothe some babies. View, print or download.
Sleep and settling is the number one topic we are asked about at Karitane. Often it can be the reflexes of newborn babies that startle them to wake. As a hel Read more on Sydney Children's Hospitals Network website. Dummy independence is when babies can put their dummies in by themselves.
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