Should you swaddle your baby?

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When I was in medical school, the nurses in the newborn nursery taught me how to swaddle babies. They taught me how to lay the blanket down and how to tuck the edges around the baby so that he became a little "papoose." Sometimes it worked like absolute magic to calm a cranky newborn. Over the years, I’ve taught parents to swaddle and have swaddled my own babies.

But not only does it not always calm a baby, it’s not always a good idea. And as with everything we do in life, it’s important to use common sense when you swaddle.

Swaddling has been part of caring for babies for centuries — millennia, really. It makes a baby feel like he’s back inside the womb — or like he is being snuggled close. It has been shown to help many babies sleep better. It can be particularly helpful for babies with neurologic problems or colic, or for babies born addicted to drugs.

It also can really help some parents get their babies to fall and stay asleep on their backs, which is what we recommend to help prevent sudden infant death syndrome, or SIDS. Some babies have trouble with sleeping on their backs because they startle themselves awake; when they are swaddled, that’s less likely to happen.

But there are downsides to swaddling. Because it keeps the legs together and straight, it can increase the risk of hip problems. And if the fabric used to swaddle a baby comes loose, it can increase the risk of suffocation.

Another warning about swaddling comes from a study published in the journal Pediatrics, which found that when swaddled babies were put on their sides or bellies, their risk of SIDS went up a lot. For those put on their bellies, especially babies more than 6 months old, the risk doubled.

Although the study can’t tell us exactly why the risk doubled, one can imagine that a tightly swaddled baby might not be able to get her head up if she started having trouble breathing — and if that swaddling blanket came loose and she was face-down, it also might make smothering more likely.

This is what I meant before about common sense. Just because something works sometimes doesn’t mean it’s right for everyone or every situation — and doesn’t mean you shouldn’t think before you do it.

Here’s what parents should consider when they think about swaddling:

• Babies don’t have to be swaddled. If your baby is happy without swaddling, don’t bother.
• Always put your baby to sleep on his back. This is true no matter what, but is especially true if he is swaddled.
• Make sure that whatever you are using to swaddle can’t come loose. Loose fabric and babies is a dangerous combination.
• For the healthy development of the hips, babies’ legs need to be able to bend up and out at the hips. Swaddling for short periods of time is likely fine, but if your baby is going to spend a significant amount of the day and night swaddled, consider using a swaddling sleep sack that lets the legs move. It may not be quite as effective from a calming standpoint, but it is safer for the hips.