Swaddling Your Baby

Swaddling is something that is recommended to parents to calm their infant and encourage uninterrupted sleep. This is because babies are born with a reflex called the Moro Reflex (also called Startle Reflex). 

The Moro reflex is brought on when an infant hears a loud sound or has a sudden change in position. It is noticeable as the baby will extend his arms and legs out straight, then bend them back in, finally it is usually accompanied by crying. This reflex can cause your munchkin to wake himself up while sleeping if his arms are free to move.  

Swaddling helps to minimize the amount of movement of the arms when the startle reflex is activated while your munchkin is sleeping. The limited arm movement allows for your baby to continue to sleep soundly. Swaddling imitates life inside the womb so it is very comfortable and calming to a baby who is getting used to the world outside the womb. 

Of course swaddling is not necessary, and some parents chose not to swaddle, and that is perfectly fine! If your munchkin sleeps and calms easily without being swaddled, that is what works best for you and your child.

According to the American Academy of Pediatrics (AAP), swaddling has been shown to cause improved neuromuscular development and motor coordination in infants. Babies who were swaddled also showed better ability to self-regulate. Conversely, a slight increased risk for respiratory (breathing) infections was found in babies who were swaddled tightly. This is why it is important to make sure you can fit one of your hands between the baby’s chest and the swaddle to ensure it is not too tight. 

Here are some things to consider when swaddling your newborn (a pediatric physical therapist perspective): 

1. Free the legs!

This one is crucial for your baby's hip joint health. When swaddling, make sure you do not extend the babies legs straight and together. Your baby’s legs should be free to move as needed, specifically with the ability to have knees separated and tucked up to his tummy. This position is to avoid any structural damage to the hip that can cause hip dysplasia. 

Hip dysplasia is when the bones are not providing enough stability in the hip joint. This can happen during development in utero or shortly after birth when the baby’s bones are still soft and malleable. When a munchkin is swaddled incorrectly (ie with his legs down and straight), it can cause the hip joint to develop in a way that can cause hip dysplasia. 

2. Swaddling position on the shoulder joint

To make sure you are not causing any harm to the shoulders, place your munchkin’s elbows on top of his chest or tummy and bent. This is to allow the shoulder to not be too far extended backwards. 

One concern I hear about swaddling is that it does not allow for much movement of the arms for an extended period of time. To be safe, make sure you can place your hand between the swaddle and your munchkin’s chest. This will allow for just enough wiggle room without houdini breaking free from the swaddle. 

***If your munchkin has enough free playtime while awake during the day then swaddling should not cause any muscle strength or movement issues. 

3. When to discontinue swaddling

The AAP has not taken a hard stance on the practice of swaddling. Some physicians within the AAP say to continue until the baby is rolling, some say to discontinue all by 8 weeks because babies can begin to roll by that age. It is up to the parent to decide. 

At the latest, swaddling should be discontinued when your baby begins to roll. This is to make sure that when he does roll from his back to his tummy that his arms are free to push down and lift his head to clear his airway and breathe. 

Now, some parents will notice that their baby first rolled at 4 weeks and will discontinue swaddling. It is likely that if a baby is rolling before 3 months, it was an accident and not intentional movement (and likely because there’s tightness and extra tension in the baby’s body).  Babies usually do not become intentional and consistent with rolling until 4-5 months old but it can happen earlier. Furthermore, babies usually have a much harder time rolling while swaddled due to not being able to use the arms and rotation of the ribcage to be successful at rolling. 

The Moro Reflex will typically integrate or disappear between 4-6 months old. This is also when babies become skilled at rolling. You know your munchkin best, there is no one better to make the decision to discontinue swaddling than you!

My personal journey with swaddling my daughter

I recommend the Ollie Swaddle. This swaddle is approved by the International Hip Dysplasia Institute. It grows with your baby so you only need one swaddle from birth-whenever you discontinue swaddling! Genuis!

I personally swaddled by little one till she was 4 months old. She was experimenting with rolling at 3 months, but was not intentional or capable of rolling while swaddled until 4 months. At that time, I used a transition sleep suit called Baby Merlin’s Magic Sleepsuit for an additional 2 weeks, knowing that it was a stepping stone to ditching any type of swaddle entirely.

Many physical therapists argue against using the Merlin’s sleep suit because it does restrict head/neck movement and can cause head shape abnormalities. Since my daughter had her moro reflex until 6 months, she was not able to sleep longer than 45 minutes without startling herself awake. I chose to use the Merlin’s suit knowing that it would be temporary to help her transition fully out of swaddles, and maintaining symmetrical, healthy motor movement during the day to prevent any head shape abnormalities. This is why all factors must be considered when making swaddle recommendations.

When working with families it is imperative to take an individualized approach to such a complex topic. Blanket statements to get rid of the swaddle at XX months is not always what is best for the child and parents. It certainly was not for me.

This is by no means a complete guide to safe sleeping for your munchkin. This post contains information and things to consider from a pediatric physical therapist’s perspective. Please see the sleep guidelines by the American Academy of Pediatrics. 

https://pediatrics.aappublications.org/content/138/5/e20162938

Keep your munchkin Moving!