Swaddling 101

AllisonMS, RDN, CDN

Swaddling comforts the baby by recreating the feeling of the womb

Swaddling recreates the coziness and tight feeling of the womb – that snug and secure cradle so familiar to newborns. If your baby seems overwhelmed by her new surroundings, swaddling can be a great way to center her focus and shut out the outside world to allow her to relax. Just like skin to skin contact, swaddling can also help baby stay warm and toasty for the first few days of life until her internal thermostat kicks in.

Swaddling promotes sleep by combating the baby’s startle reflex

All babies are born with the startle reflex – an involuntary sudden movement of the arms as if reaching or grabbing for something – that disappears by 3-4 months of age. This reflex occurs when your baby experiences a sudden sensation of falling, which can be triggered if her head is suddenly lowered below the rest of her body, or when she’s transitioning between different sleep states. By swaddling your baby’s arms against her sides, you are decreasing the likelihood that as she moves through her natural lighter and deeper sleep cycles, her own movements and resulting reflex response will wake her.

Swaddling contains a baby’s involuntary movements that would otherwise keep her awake

Babies under the age of 3 months have no control over their arms or legs and don’t even realize their limbs are attached to their little body. When your baby is tired, you’ll notice that her arms and legs wave and jerk about, sometimes even hitting herself in the head and face. Through swaddling, you’ll help contain these involuntary movements that can prevent her from settling into sleep (and might wake her once she falls asleep).

Here’s one commonly-used method to swaddle your baby correctly:

  1. Spread the blanket out flat, with one corner folded down.
  2. Lay the baby face-up on the blanket, with her head above the folded corner.
  3. 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.
  4. Then tuck the right arm down, and fold the right corner of the blanket over her body and under her left side.
  5. Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
  6. Make sure her hips can move and that the blanket is not too tight.

What to Do

Always put your baby to sleep on her back, especially if swaddled

The American Academy of Pediatrics recommends that all babies be placed flat on their back to sleep, and this guideline is especially important if you swaddled your baby first. From a side sleeping position, it is easier for a baby to roll onto her stomach, and if a swaddled baby is on her stomach, her hands are not free to help her raise her head to breathe freely.

Use swaddling as part of your bed and naptime routines

Your baby will recognize the process of being wrapped into a swaddle as a predictable sign that sleep is coming. Try incorporating swaddling into your baby’s sleep routine, for nighttime sleep and daytime naps, to help your baby sleep longer and more soundly.

Consider room-sharing or a video monitor to keep an eye on a swaddled baby

You don’t want to make yourself crazy, but keeping a supervised eye on a baby wrapped in a swaddle may be a smart idea if your baby seems to be learning to—or trying to learn to—roll.

Keep your baby un-swaddled during waking hours

Keeping your baby swaddled all of the time can hinder motor development and mobility, as well as limit her opportunity to use and explore her hands when awake. After the first month of life, try swaddling your baby only during naps and nighttime sleeping.

Experiment with several kinds of blankets or commercially-made swaddle products to find what works best for you and your baby

Learning how to wrap a baby in a swaddle blanket is challenging for some families, but there’s likely a product on the market to help you. Some parents prefer a larger, muslin or cotton blanket, while others like the stretch of a thermal blanket that can really pull and stretch around your little one. Other products use pouches, pockets, zippers, snaps or Velcro to simulate the swaddle feeling without you actually having to learn the wrapping technique. These products are also great for larger babies or escape artist babies – those who can more easily squirm out of their swaddle blankets. And while the ease of Velcro and zippers is great for a tired mommy in the middle of the night, note that these products often don’t wrap quite as snugly as a blanket you can pull and tug yourself. As long as your baby is swaddled safely and securely, use whichever blanket or product works best for your family.

Do not swaddle your baby while breastfeeding

Babies need their arms and hands free to nurse because research shows that babies actively use their hands to locate the nipple area, promote milk letdown and latch properly. Having your baby’s hands free will also allow you to notice her hunger cues (when her hands go towards her mouth).

For some drowsy babies, the swaddle is just too cozy and they’ll doze off while nursing without getting enough to eat. Keeping your baby out of the swaddle while nursing will help keep her stimulated, awake and alert to feed.

Promote your baby’s healthy hip development with proper swaddling

If you swaddle with a blanket, swaddle tightly around the arms, but make sure the bottom tuck is loose enough that your baby can still move her legs and hips.

If you swaddle with a commercial pouch or sack product, make sure the pouch around your baby’s legs allows for plenty of hip movement.

An incorrect swaddle position is one where your baby’s legs are pressed together and pulled tight and straight, as if the baby was standing upright (like a papoose). This position can cause hip joint misalignment, which may lead to damage to the soft cartilage in the hips.

Swaddle your baby securely to reduce the likelihood of loose blankets in the crib, which are associated with SIDs

One of the biggest risk factors for sudden infant death syndrome (SIDS) is loose blankets in the crib, so make sure your baby is never put to bed with improperly swaddled blankets that may pose a strangulation hazard. Swaddling or wrapping babies in blankets loosely, or using a swaddle that your baby can easily break out of, increases the chances that a loose blanket may end up over your baby’s head or face. Big sisters and brothers love to help you wrap your new baby up in a nice, cuddly blanket, but make sure that an informed adult is swaddling your baby securely before placing her on her back to sleep.

If your baby is in childcare, check with your provider regarding their swaddle policy

Recent guidelines from the National Resource Center for Health and Safety in Child Care and Early Education, the American Academy of Pediatrics and the American Public Health Association provide that swaddling in childcare centers is “unnecessary,” and as a direct result, many states and centers have adopted “no swaddle” policies. The reason behind the policy is that, in your home, likely only 1-3 primary caregivers are swaddling and monitoring your baby’s safe sleeping, whereas in a childcare center, a multitude of teachers and staff using a variety of swaddling techniques can lead to a riskier sleeping environment for babies. If you still swaddle your baby for daytime naps when you start childcare, talk with your provider to find a solution that will work for all involved.

This may be a moot point, as most babies transition out of the swaddle at around 3 months old, often the same time they begin childcare. But it’s still always best to ask, just in case.

Start transitioning your baby out of the swaddle at around 3 months old, when she is beginning to roll over

Once your baby is rolling, the time for swaddling with both arms down is over! If you see the beginnings of rolling during the day, start transitioning out of the swaddle at night.

Some babies love being swaddled, and a cold turkey departure from their swaddle blankets can come as a shock. Try a slow transition out of the swaddle. Many commercial product blankets act as ‘one arm in one arm out’ swaddles, to help teach sleeping with arms free. Once comfortable, move to both arms free while still swaddling your baby’s midsection or using a wearable blanket that provides the same comfort and snugness of the original swaddle. You can also try a wearable suit that limits some arm motion, making it less likely she will startle herself awake, but still allows movement to bring her hands to her mouth or push up when she is on her belly.