The practice of swaddling or wrapping babies has been known for centuries over most of Europe, Asia and the Americas. Archaeologists have found sacred statuettes of babies in swaddling clothes in ancient Greek and Roman tombs. One of the most famous records of swaddling can be found in the New Testament concerning the birth of Jesus where it is said Mary ‘wrapped him in swaddling clothes, and laid him in a manger’.
There are many benefits to swaddling during the first months of life; it provides security and comfort, aids in settling and helps to keep babies on their back, which has been shown to reduce the risk of SIDS. It prevents babies moving into a dangerous position where their heads are covered by bedding which can cause overheating or asphyxia. When babies sleep better on their backs parents and other carers are also less likely to position them on their tummies for sleep.
While the benefits of swaddling are widely accepted, if it is done incorrectly it can cause harm. Some studies have linked tight chest wrapping with an increased risk for pneumonia and other studies have indicated that babies may overheat if heavy blankets are used or the head is covered.
In Australia recently there has been a disturbing increase in the incidence of late diagnosed developmental dysplasia of the hip (DDH). DDH is a common childhood condition where the hip joint does not fit in the ‘normal’ position due to abnormal development of the joint’s ball and socket. Early detection and treatment in babies is important because late diagnosis, after 3 months of age, is associated with poorer outcomes including an increased likelihood of surgery and early osteoarthritis of the hip. Approximately 20% of babies are born with some degree of hip dysplasia. In most cases this resolves without the need for any intervention however, these babies may be at risk of continuing DDH if they are being tightly wrapped with their legs straight.
To wrap a baby safely and to help natural hip development during swaddling, it is recommended that:
- The baby is positioned on their back with their feet at the bottom of the cot.
- The baby is not over dressed under the wrap and the head is uncovered.
- A lightweight wrap such as muslin or cotton is used to prevent overheating.
- The wrap is loose enough to allow for chest expansion so the baby can breathe easily.
- There is 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. Some commercially available cocoons or swaddle wraps are too tight around the thighs.
- Swaddling is stopped once the baby is showing signs of rolling from their tummy to their back (usually between 4 to 6 months).
- A safe sleeping environment is provided with a safe cot, safe mattress and safe bedding.
- Babies must not be wrapped if co-sleeping.
When these recommendations are followed both babies and their parents (or other care providers) can enjoy the benefits that wrapping can bring safe in the knowledge that no harm will be done. For more information on this topic go to https://rednose.com.au/