Swaddling and SIDS

Swaddling and SIDS

Richardson HL, Walker AM, Horne RS. Minimizing the risks of sudden infant death syndrome: to swaddle or not to swaddle? J Pediatr. 2009 Oct;155(4):475-81. Full Text | Full-Text PDF (496 KB)

OBJECTIVE: To evaluate the effects of swaddling on infant arousability, particularly the progression of subcortical activation (SCA) to full cortical arousal (CA), because impaired arousal may contribute to sudden infant death syndrome.

STUDY DESIGN: Healthy term infants, who were routinely swaddled (n = 15) or unswaddled (n = 12) at home, were studied with daytime polysomnography at 3 to 4 weeks and 3 months after birth. When both swaddled and unswaddled, arousability was assessed with a pulsatile jet of air at the nostrils.

RESULTS: Larger increases in overall arousal thresholds (SCA plus CA) with swaddling were observed in infants who were easiest to arouse when unswaddled. Swaddling did not alter SCA or CA frequencies of routinely swaddled infants at either age. In infants who were naïve to swaddling, arousal thresholds were increased and CA frequency decreased during swaddled quiet sleep at 3 months.

CONCLUSIONS: This study provides a scientific basis for assessing the safety of swaddling in infant care practice. The decreased cortical arousals observed in infants unfamiliar with swaddling may correspond to the increased risk of sudden infant death syndrome for inexperienced prone sleepers.

Comments. Swaddling is a common child care practice in many societies to stop excessive crying. It has been shown that swaddled infants arouse less and sleep longer (Pediatrics. 2007 Oct;120(4):e1097-106.). In this study, authors asked if swaddling altered respiratory arousal responses that are important to terminating SIDS-like events. More interestingly, they found that swaddling did decrease cortical arousal responses in infants who had not previously been swaddled for sleep which may correspond to the increased risk of SIDS in these infants. This study added that even swaddling can affect respiratory control in infants. Moreover, this study did not compare the effect of positioning the infant with swaddling, as it is known that prone-swaddled infants are at greatly increased risk for SIDS. SAA

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