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Baby Medical Q&A, Issue #086 Safe Swaddling
December 01, 2013
Hi

Welcome to another edition of Baby Medical Q&A News.

Safe Swaddling

This month I am going to talk about swaddling and how to make it safe, particularly for baby's hips.

You may be aware of recent press reports saying that swaddling caused hip dislocation in babies. This report needs some clarification.

Swaddling has been around for a long time - as we near the festive season, you will remember that the baby Jesus was swaddled. So why all the fuss now. There is good research evidence about the benefits and possible risks of swaddling and I will outline those below. I will also give advice regarding SAFE SWADDLING.

Swaddling is beneficial in many ways, including settling crying babies and increasing sleep time - it does this by holding the arms tight so the startle response that is normal in babies doesn't wake them. By that I mean that babies don't wake themselves when they have sudden jerking movements of their arms, which by the way are normal.

If swaddling is not done correctly, then there is a risk of hip problems, including dislocation and subluxation. This occurs when the legs are swaddled tightly and are held extended with hips adducted - this means legs straight out with knees held together. In cultures that use this type of swaddling, such as those who use a cradle board, there is an increase in the incidence of hip problems. On the other hand, in cultures where babies are carried on the back with the baby's legs wrapped around the parent (ie. hips abducted), there is a low incidence of hip problems.

For that reason, there is clear guidance now on how to swaddle safely so the hips are protected. I have a whole chapter on it in my "Essential Baby Sleep" book.I also cover different ways of swaddling and show step by step photos.

Safe swaddling means the legs are not straight out but rather in the frog position, so with knees bent and the hip abducted (turned out) and the swaddling of the lower body is loose.

So, despite what you may have heard in the press, swaddling is still a safe and useful technique for settling babies.

A systematic review of the evidence, published in 2007 found:

  • The benefits of swaddling included:
    • improved sleep because of less startle
    • reduced crying in babies with colic (or what I like to call 'excessive crying of infancy'

  • The possible risks included:
    • hip problems if swaddling is not performed correctly
    • overheating if too many layers of clothes are under the swaddling blanket and it is too thick a material. My advice to avoid overheating is to use a muslin cloth, because it is light and breathable, and limit the layers under the swaddling blanket (appropriate for weather). You also need to follow other advice like not putting a hat on your baby indoors, for example.


It is not a problem to swaddle your baby if you do so safely. The International Hip Dysplasia Institute even has information on safe swaddling - click here

So, have a happy festive season, and if you have a baby you swaddle, please do so safely

References:

  • van Sleuwen, Engleberts et al. Swaddling: A Systematic Review. Pediatrics Vol. 120 No. 4 October 1, 2007 pp. e1097 -e1106 (doi: 10.1542/peds.2006-2083)
  • Clark NMP. Swaddling and hip dysplasia. An orthopaedic perspective. Arch Dis Child October 2013 (doi10:1136/archdischild-2013-304143



Please feel free to share this ezine with family and friends.

Till next time,

Dr Maud

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