To swaddle or not to swaddle? That’s the new parental question

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There was breast versus bottle. Then crib-sleeping versus co-sleeping. Now the latest infant-rearing technique to stir controversy and confuse even the most confident BabyBjorn-clad parents is swaddling.

For the uninitiated, swaddling involves snugly wrapping infants in a blanket to restrict movement. It's been around for thousands of years (see Bible, Jesus), but it has grown steadily in popularity even in the past decade.

Swaddled babies, according to proponents of the technique, sleep longer, fuss less and have a lower risk of Sudden Infant Death Syndrome (SIDS).

As the practice gains a bigger following, however, questions about safety are prompting some hospitals to speak out against it and are causing many converts to have second thoughts.

"Really, [parents] shouldn't be doing this," said Maureen Luther, a pediatric physiotherapist at Sunnybrook Health Sciences Centre in Toronto. "[Swaddling] is really not that beneficial."

Few, if any, Canadian institutions endorse or recommend the practice and some of the country's largest maternity hospitals, including Mount Sinai Hospital and Sunnybrook Health Sciences Centre in Toronto, as well as the agency that oversees perinatal services in the province of B.C., are moving away from swaddling healthy newborns. (In most institutions, it is still recommended that premature infants or those exposed to drugs in utero be swaddled to provide comfort.)

Several studies have linked swaddling to a higher risk of respiratory infections and, if done improperly, hip dysplasia. Swaddled babies may overheat, especially if their heads are partially covered, which can cause hyperthermia and even death. There is ongoing debate over whether swaddling prevents infants from waking easily, hinders weight gain or, most troubling, increases the chance of SIDS.

There's also a fundamental question of whether the very function of swaddling – keeping the movements of infants restricted in order to soothe – is good for babies, or is just good for parents.

"To have them pinned down by a tight blanket doesn't make a lot of sense," said Susan Guest, a clinical nurse specialist in Maternal Newborn Care at Mount Sinai. "You need to know that, developmentally, they need to move, they need to be able to put their hand in their mouth."

One of the factors complicating the issue, according to medical experts, is not enough quality research into swaddling has been done.

The rise of the "Back to Sleep" campaign in the 1990s, which advised parents to place babies on their backs when sleeping to prevent SIDS, set the stage for the increase in swaddling. Many parents found their babies had a difficult time sleeping on their backs or would startle themselves into waking up, so they turned to swaddling.

In 2002, pediatrician Harvey Karp published the bestseller The Happiest Baby on the Block that tells parents swaddling is key to reducing crying and helping babies sleep on their backs.

"That's why I recommend [swaddling] for all babies," Karp said in a recent interview. "Even a calm baby will sleep longer and be calmer."

Many other doctors and parents agree with Karp's thesis, that the benefits of swaddling outweigh the potential risks. "If the swaddling is done properly, there seems to be an additional benefit of better sleep," said Denis Leduc, past-president of the Canadian Paediatric Society.

Heather Lochner, who lives in Etobicoke, Ont., swaddled her son and, later, her daughter, even though a sleep consultant told her that infants need to learn to sleep without swaddling. "I had to trust my instincts," she said, "and trust that I knew what was best."

There is some research that links swaddling to better sleep and less crying. But despite what proponents say, the results aren't conclusive. One 2006 study published in the Journal of Pediatrics, for instance, found the difference in crying time between swaddled and unswaddled infants was 10 minutes.

Many believe swaddling should prevent SIDS because it encourages parents to put babies on their backs. But some pediatric experts are concerned that swaddled infants can overheat, end up with a blanket over their faces or have a difficult time rousing – all SIDS risk factors.

A growing segment of the pediatric medical community sees swaddling as a crutch for parents, even though it might not be what's best for the baby. And similar to driving around the block until baby falls asleep, once swaddling becomes part of the routine, it's difficult to stop.

Yoni Freedhoff, an Ottawa doctor, had a "very long transition" to get his firstborn daughter unswaddled. He and his wife only swaddled their second for about a month and didn't at all with their third – and found they had no major sleep issues. "The more requirements, I think, that you give a child in order for them to be able to fall asleep, the more things can go wrong in terms of your child not falling asleep," he said.

One major concern revolves around a supposed benefit of swaddling. When babies' limbs are confined, they're less likely to startle themselves awake, a natural reflex found in all infants. "Are you really supposed to be preventing the [startle reflex]? Is it not there as a protective mechanism?" Luther asked. "It keeps the engine going."

Aside from safety, some pediatric experts say swaddling prevents babies from moving around, an important part of development. "I don't think [swaddling] is anything that we've dealt with or would cross our minds or think of recommending for a healthy baby," said Aideen Moore, a neonatologist at Toronto's Hospital for Sick Children. "It's almost a form of restraint."

However, the practice is unlikely to become less common, in part because there are few definitive recommendations, pro or con. Even the Canadian Paediatric Society hasn't taken a stance. Meanwhile, many nurses still show parents how to swaddle their newborns. "We just need to change old practice," Guest said. "Those changes take years and years."

One Canadian organization, Perinatal Services B.C., published guidelines last year that warn against swaddling because of the potential risks. There has since been a noted decline in the popularity of swaddling in B.C., according to executive director Kim Williams.

But across the country, few parents are hearing that message. Betsy Hilton, whose son, Theo, was born Aug. 31, was taught to swaddle in the hospital. It helps her son sleep up to three hours at a stretch.

"My feeling on swaddling is this is really working," Hilton said. "I'm very reluctant to mess with a good thing."