Skip to main content

Swaddling and Infant Sleeping Practices

Abstract

Swaddling promotes quiet sleep and may be a useful strategy to encourage infant safe sleep practices. We explored the effect of a swaddling education intervention on infant sleep practices in an urban minority community. We compared a cohort of postpartum mothers who were given education about swaddling to a historical group. Breastfeeding and pacifier use were similar in both groups. Compared to the historical group (n = 121), mothers in the swaddling group (n = 40) were more likely to swaddle infants to sleep (52.5 vs. 23.1 %, p = .001) and less likely to bedshare (15.4 vs. 33.1 %, p = .042). No significant effect was reported on infant supine sleep (81.6 vs. 69.4 %, p = .212). A postpartum swaddling education intervention had a limited impact on infant safe sleeping practices in an urban minority community. A recent metaanalysis demonstrated an increased risk of sudden infant death in infants swaddled for sleep and recommended the need to avoid the prone and side sleep position, especially for swaddled infants, and to set an age and developmentally appropriate limit for the use of swaddling. Ongoing studies are needed to monitor the safety and effectiveness of swaddling as a tool to promote safe sleeping in infants.

This is a preview of subscription content, access via your institution.

References

  1. Moon, R. Y. (2011). Task Force on Sudden Infant Death Syndrome. Technical report: SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 128(5), e1341–e1367.

    Article  PubMed  Google Scholar 

  2. Centers for Disease Control and Prevention (CDC). (2015). Data and statistics. http://www.cdc.gov/sids/data.htm. Accessed 2 September, 2015.

  3. Kemp, J. S., Unger, B., Wilkins, D., et al. (2000). Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: Results of a four-year, population-based, death-scene investigation study of sudden infant death syndrome and related deaths. Pediatrics, 106(3), E41.

    Article  CAS  PubMed  Google Scholar 

  4. Weber, M. A., Risdon, R. A., Ashworth, M. T., Malone, M., & Sebire, N. J. (2012). Autopsy findings of co-sleeping-associated sudden unexpected deaths in infancy: Relationship between pathological features and asphyxial mode of death. Journal of Paediatrics and Child Health, 48(4), 335–341.

    Article  PubMed  Google Scholar 

  5. Trachtenberg, F. L., Haas, E. A., Kinney, H. C., Stanley, C., Krous, H. F. (2012). Risk factor changes for sudden infant death syndrome after initiation of back-to-sleep campaign. Pediatrics 129(4), 630–638.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schnitzer, P. G., Covington, T. M., & Dykstra, H. K. (2012). Sudden unexpected infant deaths: Sleep environment and circumstances. American Journal of Public Health, 102(6), 1204–1212.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Unger, B., Kemp, J. S., Wilkins, D., et al. (2003). Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics, 111(2), E127–E131.

    Article  PubMed  Google Scholar 

  8. Pickett, K. E., Luo, Y., & Lauderdale, D. S. (2005). Widening social inequalities in risk for sudden infant death syndrome. American Journal of Public Health, 95(11), 1976–1981.

    Article  PubMed  PubMed Central  Google Scholar 

  9. U.S. Department of Health and Human Services Administration, Maternal and Child Health Bureau. Child Health USA 2013. Rockville, Maryland: U.S. Department of Health and Human Services, 2013. http://mchb.hrsa.gov/chusa13/perinatal-health-status-indicators/p/SIDS-SUID.html. Accessed 28 April, 2016.

  10. Colson, E. R., Willinger, M., Rybin, D., et al. (2013). Trends and factors associated with infant bed sharing, 1993–2010: The National Infant Sleep Position Study. JAMA Pediatrics, 167(11), 1032–1037.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Colson, E. R., Rybin, D., Smith, L. A., Colton, T., Lister, G., & Corwin, M. J. (2009). Trends and factors associated with infant sleeping position: The national infant sleep position study, 1993–2007. Archives of Pediatrics and Adolescent Medicine, 163(12), 1122–1128.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Philadelphia Child Death Review Teams. (2013). Child Death Review Report 2009–2010. Philadelphia, PA: City of Philadelphia; 2013. http://www.phila.gov/health/pdfs/PhiladelphiaChildDeathReviewReport2009_2010.pdf. Accessed 16 January, 2014.

  13. Pennsylvania Department of Health. (2016). Pennsylvania Child Death Review Annual Report. http://www.health.pa.gov/My%20Health/Infant%20and%20Childrens%20Health/Newborns%20and%20Infants/Documents/PA_CDR_Annual_Reprt_2015_Final.pdf. Accessed 3 February, 2016.

  14. Willinger, M., Ko, C. W., Hoffman, H. J., Kessler, R. C., & Corwin, M. J. (2000). Factors associated with caregivers’ choice of infant sleep position, 1994–1998: The National Infant Sleep Position Study. JAMA, 283(16), 2135–2142.

    Article  CAS  PubMed  Google Scholar 

  15. Hauck, F. R., Signore, C., Fein, S. B., & Raju, T. N. (2008). Infant sleeping arrangements and practices during the first year of life. Pediatrics, 122(Suppl 2), S113–S120.

    Article  PubMed  Google Scholar 

  16. van Sleuwen, B. E., Engelberts, A. C., Boere-Boonekamp, M. M., Kuis, W., Schulpen, T. W., & L’Hoir, M. P. (2007). Swaddling: A systematic review. Pediatrics, 120(4), e1097–e1106.

    Article  PubMed  Google Scholar 

  17. Franco, P., Seret, N., Van Hees, J. N., Scaillet, S., Groswasser, J., & Kahn, A. (2005). Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics, 115(5), 1307–1311.

    Article  PubMed  Google Scholar 

  18. Gerard, C. M., Harris, K. A., & Thach, B. T. (2002). Physiologic studies on swaddling: An ancient child care practice, which may promote the supine position for infant sleep. Journal of Pediatrics, 141(3), 398–403.

    Article  PubMed  Google Scholar 

  19. Ponsonby, A. L., Dwyer, T., Gibbons, L. E., Cochrane, J. A., & Wang, Y. G. (1993). Factors potentiating the risk of sudden infant death syndrome associated with the prone position. New England Journal of Medicine, 329(6), 377–382.

    Article  CAS  PubMed  Google Scholar 

  20. Oden, R. P., Powell, C., Sims, A., Weisman, J., Joyner, B. L., & Moon, R. Y. (2012). Swaddling: Will it get babies onto their backs for sleep? Clinical Pediatrics (Philadelphia), 51(3), 254–259.

    Article  Google Scholar 

  21. Centers for Disease Control and Prevention. Infant Feeding Practices Study II. www.cdc.gov/ifps/2008.

  22. Advocate Health Care. (2008). Baby advocate connection: Sleep questionnaire. http://www.advocatehealth.com/system/services/babies/sleepquest,html. Accessed 9 December, 2008.

  23. Pease, A. S., Fleming, P. J., Hauck, F. R., Moon, R. Y., Horne, R. S. C., L’Hoir, M. P., et al. (2016). Swaddling and the risk of sudden infant death syndrome: A meta-analysis. Pediatrics, 137(6), e20153275.

    Article  PubMed  Google Scholar 

  24. McDonnell, E., & Moon, R. Y. (2014). Infant deaths and injuries associated with wearable blankets, swaddle wraps, and swaddling. Journal of Pediatrics, 164(5), 1152–1156.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This study was funded with a grant from the Albert Einstein Society. The funders made no contribution to the study design, data analysis, interpretation or manuscript writing.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matilde M. Irigoyen.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Human and Animal Rights Statement

The research involved Human Participants. The study was approved by the Einstein Healthcare Network IRB. All study participants signed informed consent.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kelly, B.A., Irigoyen, M.M., Pomerantz, S.C. et al. Swaddling and Infant Sleeping Practices. J Community Health 42, 10–14 (2017). https://doi.org/10.1007/s10900-016-0219-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-016-0219-1

Keywords