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Special Report: Swaddling Safety

How tight is too tight?

swaddle

Reading about the California daycare owners charged with endangering babies by swaddling them too tightly got us thinking about swaddling safety. We turned to our pediatric expert, Dr. JJ Levenstein, co-founder of MD Moms, for some honest answers about the safety of wrapping babies snugly—and tips on proper swaddling technique.

StrollerTraffic: Let's start with the basic question on lots of parents' minds right now: Is swaddling safe?
Dr. JJ Levenstein: Yes. Swaddling can be done to give baby a sense of containment. But a swaddle must give the baby's chest room to move, and must be loose enough from the waist down to allow baby's hips to flex (thus reducing the chance of developmental dislocation of the hip).

ST: How do you feel about swaddling? Is it something you encourage?
Dr. Levenstein: I'm in favor of it. It helps to settle rough nights, and leads to better sleep and fewer awakenings. And it does keep babies on their backs in the first few months more securely.

ST: A recent WSJ article cites that some hospital maternity wards are opting for sleep sacks rather than swaddles. Thoughts?
Dr. Levenstein: Sleep sacks designed to allow baby's hips to move freely are a great alternative to swaddling, however for most of America, they are cost-prohibitive. I think swaddling has stood the test of time; the key is education on how to swaddle properly. For parents, pre-natal classes need to start the ball rolling; at an institutional level, doctors and nurses need to be re-educated on how to swaddle in safe ways.

ST: What practical advice can you give parents who want to make sure they are swaddling safely and properly?
Dr. Levenstein: Swaddle just tightly enough so that arms and shoulders can wiggle, and never tightly swaddle the legs. Just twist the bottom of the swaddle and tuck it under the baby so that legs and hips can move. Never knot a swaddling cloth, and if using a purchased swaddled with velcro, attach it so that baby has room for some movement in the arms and shoulders.

ST: How do you know when it's time to stop swaddling?
Dr. Levenstein: As a baby begins to love her fingers and engage in self-soothing, or starts to roll over actively, it's time to stop. Definitely stop by 4 months; consider stopping by 3 months.

ST: If a baby keeps busting out of a reasonably tight swaddle, do you try to make it even tighter, or do you stop?
Dr. Levenstein: You stop, and use firm, confident cuddling to settle your baby. If she is constantly breaking out, the swaddle is disruptive to her. And to you!

ST: Are there risks to swaddling beyond a certain age, even if the baby can't roll yet?
Dr. Levenstein: By 3 to 4 months babies need to learn to acquire self-soothing skills. By restricting the use of their hands, you may be delaying that critical aspect of development.

ST: What about physical development? Can swaddling inhibit that?
Dr. Levenstein: Yes. Too-tight swaddling of the hips and legs puts the ball/socket joint of the hip into a position where adequate development of the hip socket doesn't occur, and the hips can dislocate.

ST: Yikes. Is there anything else we should know about swaddling?
Dr. Levenstein: Trust that you can offer comfort to your baby beyond the swaddle, and try to limit swaddling to 3 months or less.