Why is Newborn Sleep Wrap Better?

Tummy sleeping increases the risk of SIDS and must be avoided. Wrapping a baby in the tummy position is even more dangerous as it prevents baby moving to a position of safety.

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When wrapping a baby

Ensure that baby is positioned on the back with the feet at the bottom of the cot, that he/she is wrapped from below the neck to avoid covering his/her face and always sleep baby with face uncovered (no doonas, pillows, cot bumpers, lambswool or soft toys in the sleeping environment).

Use only lightweight wraps such as cotton or muslin (bunny rugs and blankets are not safe alternatives as they may cause overheating).

For wrapping to be effective, the wrap needs to be firm but not too tight. Techniques that use tight wrapping with legs straight and together increase the risk of abnormal hip development, while loose wraps are also hazardous as they can cover baby's head and face.

Ensure that baby is not over dressed under the wrap. Use only nappy and singlet in warmer weather and dress baby in a lightweight grow suit in cooler weather.

When not to wrap baby

If you wrap your baby, consider baby's stage of development. Leave arms free once the startle reflex disappears around 3 months. Most babies eventually resist being wrapped. Wrapping style should be appropriate for the baby's developmental stage.

It is essential to discontinue wrapping as soon as baby starts showing signs that they can begin to roll, usually between 4-6 months of age but sometimes younger. Babies must not be wrapped if sharing a sleep surface with another person. Baby should not be wrapped while sleeping in a baby sleeping bag.

Every new parent has likely heard the term 'burrito' baby, referring to a newborn who is wrapped securely in a blanket or sleep sack from neck to toes. Swaddling is a very common practice for newborns and can be helpful for a variety of reasons, including:

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• A snug swaddle helps babies maintain their body temperature when they are first born.
• Swaddling can make the very young newborn feel more secure and calm as it mimics the tight quarters of the womb.
• There is some evidence that swaddling may help a baby sleep longer by limiting the startle response, which can wake them up.

'Sometimes there is a medical indication for swaddling,' says Ganga Srinivas, MD, MBBS, FAAP, Medical Director of the UH MacDonald Women's Hospital Newborn Nursery. 'When an infant sustains a collarbone fracture during delivery, swaddling can be very useful to reduce pain from the injury. Collarbone fractures during birth are not uncommon, particularly with larger infants.'

What are the Potential Risks of Swaddling?

'It's important to remember that once a baby starts being more active and moving, often within a few weeks of birth, swaddling is less helpful and can actually become a health hazard to the child,' says Dr. Srinivas.

Some of the biggest risks of swaddling include:

• Overheating. Swaddling may keep a baby snug and warm, but too warm is not a good thing when they are sleeping. In general, babies only need one layer more than the parent. A quick check with a hand on baby's chest under the wrappings or clothes will tell if a baby is too warm. Overheating is one of the risks for Sudden Infant Death Syndrome, commonly known as SIDS.
• Suffocation/Choking. Babies are increasingly mobile by 2-4 weeks and some infants will fight free of a swaddle within a few days of birth. This can cause the sleep sack or blanket to come undone and become tangled around the baby's neck, causing a choking hazard, or cover the baby's face and mouth and block their airway.
• Hip Dysplasia. Swaddling a baby so tightly that the hips cannot move increases the incidence of hip dysplasia, a condition where the top of the thigh bone is not seated well in the socket of the hip. Whatever swaddle is used, it is very important that the hips are able move in all directions to promote healthy hip joint development.

A Useful Strategy'But Not For Long

Swaddling can be very helpful in the first days and weeks of life. However, it should be discontinued once the baby is actively trying to flip from back to front, which can happen as early as 6-8 weeks of age.

'Actually, the goal should be to swaddle as little as possible,' says Dr. Srinivas. 'In particular, an awake baby should never be swaddled. Once fed, if they are awake and active, it is essential that they have free use of their arms, legs and voice (no pacifier) to promote development. As they begin falling asleep, parents can choose to swaddle, but should remain aware of their infant's ability to wriggle free. If their infant is able to 'escape' the swaddle, it is preferable and safer to dress them in layers appropriate to the weather.'

'Parents should remember that sleep is just one of the things that newborns need. They also need to eat well, explore their world and connect with their family. Infants learn to self-regulate from the adults they are bonded with,' says Dr. Srinivas.

'A parent who is calm, and is calming to the baby, is essentially teaching them to self-soothe. Swaying, rocking and soothing, shushing noises can also be helpful. Self-soothing is a skill that takes time, and over time (weeks to months) babies can learn to self-soothe for sleep if a parent is consistent and present in the early weeks and months.'

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