By Ainslee Roughan - As published in OHBaby Magazine Autumn issue 2024

Swaddling can be a contentious topic, many people have strong feelings that all babies should be swaddled, or alternatively, that babies should not be swaddled. I don’t have any hard and fast rules or opinions  around swaddling for you, however,  what I do have is the information so you can make an informed decision about whether swaddling is right for your baby. Swaddling is indeed optional, and not something that you  must or mustn't do.

So let’s unpack the history of swaddling, why swaddling is used,  what the guidelines suggest about swaddling and SIDS, and options on how to navigate that information.

WHAT IS SWADDLING?

Swaddling is an age-old practise that runs centuries deep within human society and is a part of many cultures around the world. For generations,  swaddling has been commonly practised with newborns, and while the art and technique can vary between households and countries,  the principle of swaddling remains the same, to wrap a baby up firmly in  order to restrict arm movement and provide deep-pressure sensory input.  Both of these things can help a baby settle faster into sleep, and sleep for longer periods of time. But, times are changing – we have more knowledge of brain and body development now,  and there is a tide turning in the guidelines being given to parents about swaddling.

Once upon a time, all infant experts recommended swaddling.  There is now evolving advice from research and infant professionals that suggests parents should not swaddle. This is causing confusion for parents, especially those who were told to swaddle their firstborn, and now,  a few years later, are being told that swaddling isn’t recommended.

SO, WHY HAS SWADDLING ADVICE SHIFTED?

The idea of swaddling is to help a baby settle into sleep easier and help  them to stay asleep for longer. One  of the reasons swaddling sometimes  has this impact on babies is because  it creates deep-pressure sensory feedback for the baby which is thought  to simulate the womb. However, the  primary reason is that swaddling  inhibits the arms from being able to  move away from the body. When the arms move away from the body in a newborn it is called the  startle response, or Moro reflex and  this physical movement often wakes  a baby from their slumber. The startle  response is a physical reaction that involves the baby lifting their arms  up away from their body, tilting their  head back and often crying. Although  depending on the degree of the startle  response triggered the baby may not  cry. For example, a baby may throw  their hands and arms up, but not be  startled enough to cry. Swaddling  means their arms are kept by their  body (whether it be by their heart, side  or up by their head), which means this  reaction can’t happen and therefore  they are not startled awake.

For a long time the startle reflex  was considered an annoyance and  something that we wanted to dampen  down so it couldn’t happen, which in  theory, meant parents got more rest.

What we now know is that the startle response also illicits a physiological response that helps a baby take  a sharp breath in and there is a thought pattern that this is one of  the few inbuilt protective mechanisms  babies have against SIDS, alongside  many other influencing factors.  Another protective mechanism against  SIDS is waking regularly overnight  for feeding, especially in those early  months of life.

WHAT DO WE KNOW ABOUT  SIDS AND SWADDLING?

The American Academy of Paediatrics  states that there is no evidence to  support swaddling decreases the risk  of SIDS. This is relevant when the baby  is placed on its back, however, we know  that if a baby is swaddled and placed  on its stomach, side or is bed sharing,  then swaddling actually increases the  risk of SIDS.

BENEFITS OF NOT SWADDLING The startle response is a part of a  series of primitive reflexes that babies  are born with and it needs to be used  regularly in the early months in order  for it to integrate or 'disappear'. The  only way through the startle response  is by allowing it to happen. This means  that in some ways, allowing the startle  response to do its thing naturally in  those early months (even if it might  mean baby is more wakeful) will  allow for more settled sleep once it is integrated. This approach could also  prove beneficial timing-wise as a lot  of parents don't stop swaddling their babies until they're around four months  (around the time they start rolling)  and the combination of learning to  roll alongside finishing integrating  the startle response, developing their  circadian rhythm and changes to  sleep architecture can all be factors  that contribute to the four month sleep  regression/progression that babies  often experience. Removing the startle  response as a cause of waking at this  age by having it integrated earlier can  be helpful. With that said, all reflexes  integrate at their own pace, so some  babies who are not swaddled will still  have a significant startle response  around four months of age.

ALTERNATIVES TO SWADDLING It can be really handy to think of  swaddling as another tool in your  parenting toolbox to help with settling,  rather than thinking of swaddling as  something you do or don’t do. Some  parents find they don’t need it during the  day, but it is helpful during the evening  to help with getting the baby off to sleep.

I would encourage parents to explore  NOT swaddling from birth, or exploring  this about a week after the baby has  been born to see how it goes before they  explore swaddling for ALL sleep.

Another alternative is swaddling with  the baby’s arms out, but creating pressure  around the torso, to give that snug feeling while leaving plenty of space around the  hips to allow for hip safety.

If you choose to not swaddle your baby then using a newborn sized sleep sack made of natural fibres, where the arms are out and free, is a brilliant way to keep baby’s temperature regulated overnight.

WHAT IF YOUR BABY WON’T SLEEP WITHOUT SWADDLING?

That is okay, every baby is different, and some babies really need to be swaddled, especially in those early days to help calm their nervous system and help them sleep. This often comes down to the temperament and vagal tone of the baby. Roll with whatever works for you and your little one when it comes to swaddling.

Just make sure, if they are swaddled, that they are always slept on their back and not in a bed sharing situation (more on this in the safe swaddling section below). We can also do gentle movements during their wake time to help them integrate the startle response while awake, such as holding them horizontally and gently lowering their head lower than their bottom to illicit a small startle response a few times throughout the day.

WHEN TO STOP SWADDLING, IF YOU DO SWADDLE?

There is a large bracket of suggested ages to stop swaddling. From the earlier, more conservative view that babies should not be swaddled after eight weeks of age (or at the earliest signs of rolling, whichever comes first), to stopping swaddling once your baby is rolling confidently which is  often around four months. The key here is education for parents, so they can make a call  about what suits them and their baby.  We know that some babies practise  motor skills in the REM stage of sleep.  This means some babies may roll in  their sleep before they are doing it  while awake. It is worth taking note of the points above that suggest unswaddling at an earlier age might make life easier around that 4 month age bracket, and if you see any signs of rolling (see below), then it is recommended to unswaddle for safety.

MINISTONES

Keeping this in mind, it is important  for parents to understand the smaller  motor ‘ministones’ that indicate rolling  is just around the corner. Awareness  around what these smaller movements  are allows parents to see that rolling  is being worked on and remove the  swaddle at an appropriate time, which  is often well before they are rolling  during the day confidently. These are:

Tummy to back ministones: + Pressing up on elbows and hands  when on belly

+ Accidentally rolling off tummy when  head throws them off balance

+ Attempting to grab toys with  one hand

+ Lifting head high and looking around  when head is up off the ground

Back to tummy ministones: + Rolling onto their side from being on  their back

+ Grabbing their own feet

+ Grabbing feet and rocking over to  one side or back and forth

+ Bringing hands to midline when  they are on their side

+ Tucking chin to chest to look at feet + When lying on their side one leg  straightens independently

WHAT FABRICS ARE BEST? Natural fibers are best, where possible,  to help regulate a baby’s body  temperature. We know that synthetic  fibers don’t breathe as well as natural  ones and can be an overheating risk  for babies while they sleep.

SWADDLE TYPES

There are so many different sorts of  swaddles, it can be overwhelming for new parents. Different styles work for  different babies. Options are: stretchy  fabric wrap swaddles, muslin wrap  swaddles, zip up swaddles, Velcro  swaddles, and everything in between.

SWADDLING AND FEEDING Babies need to utilise their feeding  reflexes to be able to latch and feed  well, so where possible, unswaddling  for feeds is a good idea.

SAFE SWADDLING GUIDELINES + Always place a swaddled baby  on their back, never on their side  or stomach

+ Baby must be in their own sleep  space and not bed sharing

+ Dress appropriately so they don’t  overheat, weighted blankets

and weighted swaddles are not  recommended

+ Allow plenty of room around the  hips so the hips can relax into  a safe position

+ Swaddle in natural fibers to help  regulate body temperature

+ Ensure the swaddle fits well and  doesn’t cover airways, this is  especially important if a baby  wriggles free of a swaddle and ends  up with fabric over their face, or  they are in a zip up/Velcro swaddle  that is too big and it moves up over  their face while they sleep

In summary, swaddling is a practice  that has been utilised for many  generations and as always, when it  comes to almost all things baby, there’s  no clear cut do or don’t. Instead, I hope  this article gives you as parents the  understanding that swaddling can  be used as a settling tool, rather than  something you “just have to do” and will  arm you with the information to decide  if swaddling is something you want or  need to use in your household and if so,  to be able to do it in a safe way. •

Dr Ainslee is a responsive infant sleep  expert and chiropractor who focuses  on holistic support and education for  families. Follow her on Instagram

@babysleepwithainslee or check out her  website www.babysleepwithainslee.com