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Higher risk of SIDS for swaddled babies, finds research

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Swaddled babies sleeping on their stomachs or sides are at double the risk of sudden infant death syndrome than those not wrapped in a blanket or cloth, according to new analysis of research.

The study review by the University of Bristol also found a “small but significant risk” for swaddled babies placed for sleep on their backs.

“We found some evidence that as babies get older, they may be more likely to move into unsafe positions while swaddled during sleep”

Anna Pease

In addition, there was evidence to suggest the likelihood of SIDS increased for swaddled babies as they got older, with double the risk for those aged six months or more.

This was likely due to infants being more able to roll into less safe positions at an older age, said the researchers.

They recommended that healthcare professionals and guidelines should consider an appropriate age limit at which swaddling should be discouraged.

The analysis covered four SIDS studies – from the UK, Australia and the US – and included 2,159 infants, of which 760 died of SIDS.

The researchers found babies swaddled and placed prone – on their stomachs – when sleeping created the greatest risk of SIDS, although this practice was rare.

“What parents should take away from this is that if they choose to swaddle their babies for sleep, always place them on their back”

Anna Pease

For swaddled babies put to sleep in both prone and side positions, the risk of SIDS was doubled compared to those not wrapped in a blanket or cloth.

“Notably, there was still a small but significant risk associated with infants being swaddled and placed for sleep on their backs,” said the study authors in the paper, published in the journal Pediatrics and called Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis.

Lead author Dr Anna Pease said: “The focus of our review was not on studies about swaddling – a traditional practice of wrapping infants to promote calming and sleep – but on studies that looked at SIDS. We tried to gather evidence of whether there was an association between swaddling for sleep and SIDS.

“We only found four studies and they were quite different, and none gave a precise definition for swaddling making it difficult to pool the results,” she said. “We did find, however, that the risk of SIDS when placing infants on the side or front for sleep increased when infants were swaddled.”

Dr Pease added: “We found some evidence in this review that as babies get older, they may be more likely to move into unsafe positions while swaddled during sleep, suggesting an age is needed after which swaddling for sleep should be discouraged. Most babies start being able to roll over at about four to six months.”

“On a practical level, what parents should take away from this is that if they choose to swaddle their babies for sleep, always place them on their back, and think about when to stop swaddling for sleep as their babies get older and more able to move,” she said.

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Readers' comments (1)

  • Unfortunately parents will swaddle because babies generally settle and sleep better when swaddled. Trying to give advice that is research based AND acceptable is important, otherwise it is of little value. To minimise the risk of swaddling as much as possible we should advise using cotton or linen wraps and using only for the first few weeks while baby is unable to move much. Always placed supine with feet to bottom of cot, head uncovered and lower body wrapped loosely as hip dysplasia has been noted in some swaddled babies.

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