The months of waiting are over. Your infant you have waited for so long to arrive is here. Your bundle of joy, as adorable and wonderful as you imagined him or her would be, has been hugged and kissed by every relative you have ever known and even some you are not so sure you know. You set a personal record with 30 Facebook updates in 5 minutes about the first smile, first wet diaper, first smile while having a wet diaper, etc. parenthood thing is bliss. Except for one thing, your little bundle of joy is turning you into a giant bundle of nerves with non-stop crying. If your child is not being fed, he or she is screaming to wake every neighbor on the block. Thank goodness for the only reprieve you have- the swaddle. Then as you prepare to once again, put into practice an all-important parenting skill CNN issues this headline “Swaddling babies may increase risk of SIDS, study says.” 
WHAT?
This is exactly the scenario that many parents found themselves in May when an article was released in the journal Pediatrics. This study was ripe for headlines and took off as quickly as most pediatrics related topics. The article seemed to put at odds a parent’s sanity, (giving up a soothing technique that has worked for many crying infants), against an infant’s safety. Now let’s back things up a little and look at the evidence.
The study that was released was a very specific type of study called a meta-analysis. This type of research takes several previous studies and attempts to combine the results to gain a larger pool of data. This type of data may sometimes result in a more powerful look at the information. For example, if you can get a pretty good idea about a disease or how a drug works by looking at 100 patients, imagine combining ten such studies to get a total of 1,000 patients. Well, in theory, this should give us more information and, oftentimes, meta-analyses work this way. There are also significant limitations to meta-analysis, several of which are highlighted by this particular study. For instance, how did each study define a “swaddle”? Does it mean a child who is tightly wrapped or loosely wrapped is also a swaddle? Is it swaddling if the arms or the legs are loose? The four studies that made up this meta-analysis did not have a clear definition of what the term means which limits the results. In addition, how do you control other factors? For instance, bed sharing which is a known risk factor for SIDS, was not taken in account for all studies, so its impact on this meta-analysis could not be factored. To summarize, the data in each study was not defined and collected in the same way; it is unclear how well these results can be combined.
Consequently, we should not discount the findings of the study as they highlight the need to look at the safety issues related to swaddling. Fortunately, the data is not as worrisome as the headlines. The study indicated that there was a notable increase in SIDS risks when babies were swaddled and placed on the stomach. In fact, the risk of SIDS was 13 times greater. In addition, swaddling and being placed on the side increased the risk of SIDS by 3 times which appeared to be likely related to an increased risk of those infants rolling over from the side to the stomach. While these are alarming numbers, they actually highlight the great risk of these sleeping positions in infants much more so than the concerns for swaddling. We have known for some time, and this article only serves to support that putting a baby to sleep on its back is the only safe sleeping position for the great majority of newborns.
The most important aspect of the article lies in the information we can gain from swaddling in infant placed on its back as most parents are instructed. This research did show an increased risk (about 2 times great risk); but almost exclusively from older infants of about six months of age. The analysis shows that as a child gets older their risk of SIDS appears to increase if they are kept swaddled, which is possibly related to the greater ability of these infants in getting themselves to roll over while still swaddled. Whatever the underlying cause of this increased risk, the study shows there is probably an age when getting a child out of the swaddle is likely healthier for the infant. The study does not have the ability to define this age but I have begun telling my families to target having the infant out of the swaddle by about 3-4 months of age, well before any potential increased for SIDS events may occur.
So remember, if you are a new parent, you can sleep easier. Unless you are putting your child to sleep on their belly or side or are still swaddling at six months, this study should not be life changing for you. In fact, here is the exact quote from the author of the study, "We only found four studies and they were quite different, making it difficult to pool the results," said senior author Peter Blair, a professor in social and community medicine at the University of Bristol in the United Kingdom. "This we have emphasized as strongly as any of the findings, but does not seem to get as much media coverage. Given the weak evidence, we do not conclude that swaddling is a risk factor for SIDS but rather that more evidence is needed."
Lastly, the best information about preventing SIDS still comes from the American Academy of Pediatrics: Babies should always sleep on their backs. Always use a firm sleep surface. Keep soft objects or loose bedding out of the crib. No pillows, blankets or bumper pads. Do not let your baby get too hot. Place your baby to sleep in the same room where you sleep but not in the same bed. Keep your baby away from smokers and places where people smoke. Breastfeed as much and for as long as you can. Offer a pacifier at nap time and bedtime. Schedule and go to all well-child visits. Do not use products that claim to reduce the risk of SIDS, such as wedges, positioners or special mattresses. Do not use home cardiorespiratory monitors to help reduce the risk of SIDS.
