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Daycare Center and Family Home Forum>Something I Did Not Know Re: Swaddling and Hip Dysplasia
MyAngels 08:21 PM 06-28-2012
I have not done a lot of swaddling with babies in my care, but there have been a couple, at the parent's instruction, that I've swaddled.
I've always been concerned with doing it because of the risk of SIDS, and during a recent safe sleep webinar that I attended I asked Dr. Rachel Moon, who is one of the preeminent researchers in that field, whether swaddling was safe and whether it was acceptable. I had no idea that swaddling could cause hip dysplasia.
I cut and pasted the follow-up e-mail here in case anyone is interested.
Thank you for your question from the Safe Sleep Webinar. Please see below.
Q: Can you address swaddling. Is it allowed or helpful?
A: Caring for our Children, 3rd Edition, includes a standard on Swaddling, please see below.
STANDARD 3.1.4.2: Swaddling
Table of Contents
In child care settings, swaddling is not necessary or recommended.
RATIONALE: There is evidence that swaddling can increase the risk of serious health outcomes, especially in certain situations. The risk of sudden infant death is increased if an infant is swaddled and placed on his/her stomach to sleep (4) or if the infant can roll over from back to stomach. Loose blankets around the head can be a risk factor for sudden infant death syndrome (SIDS) (3). With swaddling, there is an increased risk of developmental dysplasia of the hip, a hip condition that can result in long-term disability (1,5). Hip dysplasia is felt to be more common with swaddling because infants’ legs can be forcibly extended. With excessive swaddling, infants may overheat (i.e., hyperthermia) (2).
COMMENTS: Most infants in child care centers are at least six-weeks-old. Even with newborns, research does not provide conclusive data about whether swaddling should or should not be used. Benefits of swaddling may include decreased crying, increased sleep periods, and improved temperature control. However, temperature can be maintained with appropriate infant clothing and/or an infant sleeping bag. Although swaddling may decrease crying, there are other, more serious health concerns to consider, including SIDS and hip disease. If swaddling is used, it should be used less and less over the course of the first few weeks and months of an infant’s life.
TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home
RELATED STANDARDS:
Standard 3.1.4.1: Safe Sleep Practices and SIDS/Suffocation Risk Reduction
REFERENCES:
1. Van Sleuwen, B. E., A. C. Engelberts, M. M. Boere-Boonekamp, W. Kuis, T. W. J. Schulpen, M. P. L’Hoir. 2007. Swaddling: A systematic review. Pediatrics 120:e1097-e1106.
2. Franco, P., N. Seret, J. N. Van Hees, S. Scaillet, J. Groswasser, A. Kahn. 2005. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 115:1307-11.
3. Contemporary Pediatrics. 2004. Guide for parents: Swaddling101. http://www.aap.org/sections/scan/pra...1/swadling.pdf.
4. Richardson, H. L., A. M. Walker, R. S. Horne. 2010. Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants. J Pediatrics 157:85-91.
5. Mahan, S. T., Kasser J. R. 2008. Does Swaddling Influence Developmental Dysplasia of the Hip? Pediatrics 121:177-78.
I hope this is helpful to you.
Best regards,
Cassie Bernardi, MPH
Program Coordinator
Healthy Child Care America
American Academy of Pediatrics
I've always been concerned with doing it because of the risk of SIDS, and during a recent safe sleep webinar that I attended I asked Dr. Rachel Moon, who is one of the preeminent researchers in that field, whether swaddling was safe and whether it was acceptable. I had no idea that swaddling could cause hip dysplasia.
I cut and pasted the follow-up e-mail here in case anyone is interested.
Thank you for your question from the Safe Sleep Webinar. Please see below.
Q: Can you address swaddling. Is it allowed or helpful?
A: Caring for our Children, 3rd Edition, includes a standard on Swaddling, please see below.
STANDARD 3.1.4.2: Swaddling
Table of Contents
In child care settings, swaddling is not necessary or recommended.
RATIONALE: There is evidence that swaddling can increase the risk of serious health outcomes, especially in certain situations. The risk of sudden infant death is increased if an infant is swaddled and placed on his/her stomach to sleep (4) or if the infant can roll over from back to stomach. Loose blankets around the head can be a risk factor for sudden infant death syndrome (SIDS) (3). With swaddling, there is an increased risk of developmental dysplasia of the hip, a hip condition that can result in long-term disability (1,5). Hip dysplasia is felt to be more common with swaddling because infants’ legs can be forcibly extended. With excessive swaddling, infants may overheat (i.e., hyperthermia) (2).
COMMENTS: Most infants in child care centers are at least six-weeks-old. Even with newborns, research does not provide conclusive data about whether swaddling should or should not be used. Benefits of swaddling may include decreased crying, increased sleep periods, and improved temperature control. However, temperature can be maintained with appropriate infant clothing and/or an infant sleeping bag. Although swaddling may decrease crying, there are other, more serious health concerns to consider, including SIDS and hip disease. If swaddling is used, it should be used less and less over the course of the first few weeks and months of an infant’s life.
TYPE OF FACILITY: Center; Large Family Child Care Home; Small Family Child Care Home
RELATED STANDARDS:
Standard 3.1.4.1: Safe Sleep Practices and SIDS/Suffocation Risk Reduction
REFERENCES:
1. Van Sleuwen, B. E., A. C. Engelberts, M. M. Boere-Boonekamp, W. Kuis, T. W. J. Schulpen, M. P. L’Hoir. 2007. Swaddling: A systematic review. Pediatrics 120:e1097-e1106.
2. Franco, P., N. Seret, J. N. Van Hees, S. Scaillet, J. Groswasser, A. Kahn. 2005. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 115:1307-11.
3. Contemporary Pediatrics. 2004. Guide for parents: Swaddling101. http://www.aap.org/sections/scan/pra...1/swadling.pdf.
4. Richardson, H. L., A. M. Walker, R. S. Horne. 2010. Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants. J Pediatrics 157:85-91.
5. Mahan, S. T., Kasser J. R. 2008. Does Swaddling Influence Developmental Dysplasia of the Hip? Pediatrics 121:177-78.
I hope this is helpful to you.
Best regards,
Cassie Bernardi, MPH
Program Coordinator
Healthy Child Care America
American Academy of Pediatrics
Solandia 04:49 AM 06-29-2012
I do swaddle, especially with infants that are used to falling asleep in *things*, like a swing, rock n play, bouncer and the sort. Or if the baby moves their arms excessively and wakes themselves up all the time (usually those babies sleep on their tummies at home). Or used to co-sleeping. It is a great way to transition them to healthy sleep habits, since I cannot duplicate their sleep habits from home (like tummy sleeping/cosleeping/sleeping in things other than a crib). I have only ever swaddled the torso, I leave the bottom open and free. Partly because of the hip concern-which was even a concern when my 13yo was an infant, and partly because I want to transition out of the swaddle and into a sleep sack asap.
If I was no longer able to swaddle, I would not take infants that are not already 1) sleeping in a crib for all sleeping periods 2) sleeps on their back 100% of the time 3) allowed to use a nuk/paci
I just cannot do any CIO with babies, and without *something* physical to help transition to sleep, it is just isn't worth the time and effort....for me.
If I was no longer able to swaddle, I would not take infants that are not already 1) sleeping in a crib for all sleeping periods 2) sleeps on their back 100% of the time 3) allowed to use a nuk/paci
I just cannot do any CIO with babies, and without *something* physical to help transition to sleep, it is just isn't worth the time and effort....for me.
GotKids 05:18 AM 06-29-2012
I wonder if the risk of hip problems is lessened with the new "swaddlers" than traditional baby swaddling with a normal blanket.
DCBlessings27 05:58 AM 06-29-2012
This isn't really an issue in KS when it comes to daycare. A new regulation states that infants must sleep on their backs (of course) and that only a light blanket loosely tucked may be used. However, at our meetings, we were told that they *really don't want ANY blankets used with infants. We're to use sleep sacks or sleeper jammies and nothing at all with the child in the crib/pack n play.
We did swaddle our now 3yo dd, but I don't think we'll swaddle at all after I have this baby.
We did swaddle our now 3yo dd, but I don't think we'll swaddle at all after I have this baby.
Springdaze 09:01 AM 06-29-2012
no more baby burittos? 
Michelle 10:38 AM 06-29-2012
Originally Posted by chellenj:
no more baby burittos?
no more baby burittos?
Unregistered 11:49 AM 06-29-2012
Both my recent dck were swaddled, excessively-like almost all hours and both until 9-10 months old which is way too long imo. One had hip dysplasia, the other has general motor delays, late walker now tiptoe walker, falls a lot, cant kick a ball or throw, no hand eye coordination etc. I do think it could be related to the swaddling. I mean they dont get to experience anything when wrapped in that dumb baby blanket all day and night.