Swaddling: The Whys and the Hows

By Dr. Donna Kleyman, PT, DPT
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Baby swaddled in bed

Swaddling is an oldie but goodie when it comes to what babies like. Swaddling is the practice of wrapping a fussy baby in a blanket (or sleep-sack, zippered pouch, and whatever else the baby industry thinks of next). The intent is to provide the baby with compression (skin is our largest organ for a reason) and to reduce disruptive, jerky and reflexive movements that may startle a baby awake. After all, calm bodies make sleep a little easier.

When do we swaddle: During naps and at nights. Start at birth and stop swaddling when baby is able to roll.

Where do we swaddle: Only on a safe sleep surface. If you’re not sure what that means, speak with your pediatrician about some safe sleep guidance.

Who should swaddle the baby: Anyone (and everyone) who may be lying baby down for sleep

How do we swaddle?  We swaddle by wrapping the baby up like a burrito, and yes – this is as cute as it sounds. The how is actually a multi-faceted answer because there are so many varieties of swaddles.

Here are some of the most common examples of swaddle types and how to do it!

The Zipper:

  • Place baby face-up.
  • If it is a traditional zipper swaddle then tuck arms to trunk. Do not bring legs together – let baby choose most relaxing position within the swaddle. Zipper.
  • If it is a SwaddleUP swaddle then place each hand into the “space” and zipper with hands up.

The Velcro:

  • Place Swaddle with each side splayed out.
  • Place baby into “bag” or “sock” compartment, lying face-up (in case you’re on to me, this is a very important step for ALL swaddles).
  • Secure one side across the trunk & repeat on other side. Test for looseness.

The Cloth/Blanket:

  • Spread the blanket out into a diamond position. Fold top corner down.
  • Lay baby face-up with head/neck above the blanket fold. It is important not to have anything touching their faces as it may elicit a reflex to root (and eat) instead of to relax/sleep.
  • Side Tuck & Wrap: Tuck one arm to the trunk & take the blanket on the same side wrap over baby/behind their back. Example: Tucking the left arm, taking the left blanket & folding over the trunk. Tucking it behind the baby’s back should be tight, but without compromising safety.
  • Foot Tuck & Wrap: Take the blanket at the feet and bring up/across to tuck behind shoulder/back.
  • Last Side Tuck & Wrap: Bring the remaining corner across and gather material. Be sure cloth is not loose and no material is near baby’s face/neck.

An lastly, some important notes about safety:

  • Babies should be cozy but comfortable. If you’re not sure if the swaddle is too tight, do the “Finger Fit Test.” Test the swaddle by sliding two fingers between chest and swaddle to check tightness.
  • Also, be mindful of temperature and layers. A swaddle actually counts as one layer of clothing.
  • Take a look at your baby’s arms and legs (especially hips and knees). They should all be able to bend comfortably at baby’s sides. Straightening the baby’s arms or legs too early or too frequently causes risk for hip or shoulder dislocations and poor joint development.
  • During diaper changes, make it a habit to check rolling skills by imitating the activity with your baby. Once the baby is able to roll onto the side, belly to back, or back to belly, (even any one of these), it is not safe to keep the baby swaddled. The use of their hands may be needed to turn back from an unintentional roll during sleep.
  • As with anything baby related – watching for cues & expressions is key when trying something new. When swaddling, you should see the baby become pleased and calm – there should not be resistance or a struggle. It’s swaddling – not wrestling.
  New Mothers CenterPostpartum
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