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Swaddling and Sudden Infant Death Syndrome (SIDS):
A Selected Annotated Bibliography
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These articles have been selected by Resource Center staff from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.
Richardson HL, Walker AM, Horne RS.
Minimizing the risks of sudden infant death syndrome: To swaddle or not to swaddle?
J Pediatr. 2009 Jun 19 e-pub
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.
Abdulrazzaq YM, Kendi AA, Nagelkerke N.
Child care practice in the United Arab Emirates: the ESACCIPS study.
Acta Paediatr. 2008 May;97(5):590-5.
AIMS: This study was undertaken to monitor infant care practice associated with SIDS and establish the incidence of SIDS in the UAE. METHODS: A total of 996 families were recruited for the study. One questionnaire was completed during the first 7 days after delivery, and was used to collect information about the socio-demographic features, mother's medical history, delivery status and infant's medical history, and another questionnaire was completed after 12 weeks through telephone interviews of the mothers. 716 completed both questionnaires. Registers at the two hospitals, and at the Preventive Medicine Department were studied and all infant deaths in a 5-year period were recorded. RESULTS: In all 18.9% of infants were placed in the prone position. Mothers preferred supine position (49.3%) to other positions when putting their babies to bed. Ninety eight percent preferred that their infant slept in the same room as the parents. On the whole, 40% occasionally shared their beds with their infants. Swaddling the babies was quite common (83.2%) and 91.9% of their mothers were also swaddled when they were babies. More than 80% of all infants used bedding duvets for their infants both in the summer and in the winter. SIDS mortality rate was 0.66 per thousand live births and contributed 7.25% to the infant mortality rate. CONCLUSION: These data provide useful baseline information on child care practice and should be of immense benefit to the understanding of the risks and causal mechanisms of SIDS and to the UAE health authorities should they wish to develop strategies to reduce the risk of SIDS.
van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TW, L'Hoir MP.
Swaddling: a systematic review.
Pediatrics. 2007 Oct;120(4):e1097-106.
Swaddling was an almost universal child-care practice before the 18th century. It is still tradition in certain parts of the Middle East and is gaining popularity in the United Kingdom, the United States, and The Netherlands to curb excessive crying. We have systematically reviewed all articles on swaddling to evaluate its possible benefits and disadvantages. In general, swaddled infants arouse less and sleep longer. Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled. When compared with massage, excessively crying infants cried less when swaddled, and swaddling can soothe pain in infants. It is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions. It can be helpful in regulating temperature but can also cause hyperthermia when misapplied. Another possible adverse effect is an increased risk of the development of hip dysplasia, which is related to swaddling with the legs in extension and adduction. Although swaddling promotes the favorable supine position, the combination of swaddling with prone position increases the risk of sudden infant death syndrome, which makes it necessary to warn parents to stop swaddling if infants attempt to turn. There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling. Furthermore, swaddling does not influence rickets onset or bone properties. Swaddling immediately after birth can cause delayed postnatal weight gain under certain conditions, but does not seem to influence breastfeeding parameters.
Franco P, Scaillet S, Groswasser J, Kahn
A.
Increased cardiac autonomic responses to auditory
challenges in swaddled infants.
Sleep. 2004 Dec 15; 27(8):1527-32.
Study Objectives: When infants have been swaddled and sleep supine, their risk of dying from sudden infant death syndrome (SIDS) is reduced with an odds ratio of 0.64 to 0.69. Alternatively, the risk for SIDS in swaddled infants shows a 3-fold increase in the prone position. The protective role of swaddling during supine sleep has remained unexplained. This study was designed to evaluate the effects of swaddling on cardiac reactivity to auditory stimuli during sleep in both the prone and the supine position. Design: Thirty healthy infants with a median age of 11 weeks (range 8 to 15 weeks) were studied polygraphically for 1 night while sleeping successively prone and supine, or vice versa. The infants were studied while swaddled and nonswaddled in both positions. Heart rates were studied during rapid eye movement sleep, before and after exposure to 90 dB(A) of white-noise. Results: Ten infants were excluded from the study because they woke up during the position change or the auditory challenge. Before the administration of the noise stimulus, swaddling decreased values of basal heart rates in the supine position only (P = .049). Following swaddling, the values of basal heart rate were significantly lower in the supine than in the prone position (P = .003). Auditory challenges were followed by a greater increase in heart rate when the supine sleeping infants were swaddled than when not swaddled (P = .018). When swaddled, beat-to-beat heart-rate variability increased following auditory stimulation in the supine position only (P = .012). Conclusion: When sleeping supine, swaddled infants had greater cardiac autonomic changes in response to noise challenges than when they were not swaddled.
Full-text available at: http://www.journalsleep.org/
Gerard CM, Harris KA, Thach BT.
Physiologic studies on swaddling: an ancient child
care practice, which may promote the supine position for
infant sleep.
J Pediatr. 2002 Sep; 141(3):398-403
Objective: The calming effects of swaddling may help infants accept back sleeping and so reduce the risk of sudden infant death syndrome. We hypothesized that swaddling, with minimal leg restraint, would be accepted by postneonatal infants with minimal respiratory effects. Study design: Postneonatal infants (n = 37) were studied for the introduction of swaddling. Four infants were studied by using traditional swaddling techniques. Swaddle tightness was increased in 13 infants, simulating traditional swaddles. Respiratory variables-respiratory rate, tidal volume, oxygen saturation, heart rate, sigh rate, and "grunting"-were measured. Results: Hips were flexed and abducted in the swaddle. The majority of infants accepted swaddling while supine, including 78% of infants who slept prone at home. Acceptance decreased with increasing age. With increased swaddle pressure, respiratory rate increased during quiet sleep (P <.05). In rapid eye movement sleep, a slight effect on heart rate was observed (P <.05). Other variables did not change. Conclusions: Older infants including usual prone sleepers generally accept a form of swaddling that has minimal respiratory effects. The reintroduction of swaddling, without restricting hip movement or chest wall excursion, combined with supine sleeping, may promote further sudden infant death syndrome reduction.
Full-text available at: http://journals.elsevierhealth.com
Gerard CM, Harris KA, Thach BT.
Spontaneous arousals in supine infants while swaddled
and unswaddled during rapid eye movement and quiet sleep.
Pediatrics 2002 Dec; 110(6):e70
Objective: Supine sleep is recommended for infants to decrease the risk of sudden infant death syndrome, but many parents report that their infants seem uncomfortable supine. Many cultures swaddle infants for sleep in the supine position. Swaddled infants are said to "sleep better"; presumably they sleep longer or with fewer arousals. However, there have been no studies of the effect of swaddling on spontaneous arousals during sleep. Arousal is initiated in brainstem centers and manifests as a sequence of reflexes: from sighs to startles and then to thrashing movements. Such "brainstem arousals" may progress to full arousal, but most do not. Methods: Twenty-six healthy infants, aged 80 +/- 7 days, were studied during normal nap times. Swaddled (cotton spandex swaddle) and unswaddled trials were alternated for each infant. Sleep state (rapid eye movement [REM] or quiet sleep [QS]) was determined by behavioral criteria (breathing pattern, eye movements) and electroencephalogram/electrooculogram (10 infants). Respitrace, submental and biceps electromyogram, and video recording were used to detect startles and sighs (augmented breaths). Full arousals were classified by eye opening and/or crying. Frequencies of sighs, startles, and full arousals per hour were calculated. Progression of events was calculated as percentages in each sleep state, as was duration of sleep state. Results: Swaddling decreased startles in QS and REM, full arousal in QS, and progression of startle to arousal in QS. It resulted in shorter arousal duration during REM sleep and more REM sleep. Conclusions: Swaddling has a significant inhibitory effect on progression of arousals from brainstem to full arousals involving the cortex in QS. Swaddling decreases spontaneous arousals in QS and increases the duration of REM sleep, perhaps by helping infants return to sleep spontaneously, which may limit parental intervention. For these reasons, a safe form of swaddling that allows hip flexion/abduction and chest wall excursion may help parents keep their infants in the supine sleep position and thereby prevent the sudden infant death syndrome risks associated with the prone sleep position.
Free full-text downloading available at: http://www.pediatrics.org
August 2009
