Louis M. Bell, MD, Dr. Bell is an associate editor with NEJM Journal Watch Pediatrics and Adolescent Medicine
Swaddling is associated with double the risk for sudden infant death syndrome in the supine sleep position and is even more dangerous in the side or prone position, a Pediatrics study finds.
Researchers conducted a meta-analysis of four case-control studies in which 18% of 760 cases and 11% of 1759 controls were swaddled.
In adjusted models, swaddling was associated with a slightly increased risk for SIDS (odds ratio, 1.4). However, sleep position had a dramatic effect: swaddled infants, compared with controls, had 13 times higher risk for SIDS in the prone position, 3 times higher in the side position, and 2 times higher in the supine position.
Risk increased with age, and was 2.5 times higher in swaddled infants older than 6 months compared with controls.
The take-home message is that the supine sleeping position is safest and swaddling in this position may double the risk for SIDS. The findings suggest swaddling is very dangerous with side and prone sleeping positions, and that it should be abandoned after 4 to 6 months, or earlier if the infant is trying to turn over.
Personal comment: This is the kind of information that parents should get in the hospital and repeated on the first visit to the primary care doctor.