How To Swaddle A Preemie? The 13 New Answer

Caring for your preterm baby at home is in many ways not very different from how you imagined life with a newborn. You will have plenty of time to cuddle and play with your baby and watch how they react to everyday things that they didn’t experience in the baby unit. Here are a few things to keep in mind.

Before your baby leaves the baby station, the health team will help you take care of your baby at home. This can include:

What temperature should my baby be?

Your baby’s body temperature should be between 36.6°C and 37.2°C.

You don’t need to take your baby’s temperature regularly. But check her temperature if she’s feeling hotter than usual, she’s sweaty, she looks or feels unwell, or if you have any other concerns.

The health team will show you how to take the temperature at home. You may want to buy a digital thermometer suitable for babies.

Premature babies are less able to control their body temperature than term babies. If their environment is too cold, they can lose heat very quickly. When it’s too hot, babies can overheat, increasing the risk of cot death (see below).

Although the baby unit is very warm, your baby can now cope with lower temperatures. Try to keep the room temperature at 16-20°C. It can be difficult to estimate the temperature in the room, so you could try a room thermometer. Some baby monitors also show the room temperature.

The best way to keep your baby’s temperature at a comfortable and safe level is to dress them in layers such as a vest, pajamas, blankets or a zip-up sleeping bag. You can add or remove an item based on how warm or cold it is. But it’s important to know that babies shouldn’t wear a hat indoors, otherwise they may overheat.

Contact your GP or call 911 if your baby’s temperature is very high or low, or if they are also showing other signs of illness such as a rash.

How can I help my baby fall asleep?

Newborns spend most of their time sleeping. Some premature babies may have more disturbed sleep patterns than full-term babies. But it’s normal for all babies to wake up regularly at night for feedings, whether they’re breast-fed or bottle-fed.

A newborn baby doesn’t have a great sleep pattern and doesn’t know the difference between day and night. Showing your baby the difference between day and night can help them learn to soothe themselves at night. For example, you could dim the lights and keep noise to a minimum during the night. Learn more about your baby’s sleeping habits.

Also read how to cope with sleepless nights.

Sudden Infant Death Syndrome (SIDS)

Rarely can babies die suddenly and unexpectedly from unknown causes. This is called sudden infant death syndrome (SIDS) or sudden unexplained death of an infant (SUDI). The chance of a baby dying from SIDS is small, but premature babies are more at risk than term babies.

The cause of SIDS isn’t known, but there are some things you can do to reduce the risk. For example, we know that sleeping babies on their backs has greatly reduced the number of SIDS cases. It is also important not to fall asleep with your baby on a bed, sofa or armchair.

Talk to your midwife, doctor or baby center team if you are concerned about your baby’s risk of SIDS.

How can I reduce the risk of SIDS?

Unless otherwise advised by your medical team, place your baby on their back to sleep with their feet on the bottom of the crib, bassinet or stroller.

Use light blankets that are tucked in tightly. Make sure they can only reach your baby’s shoulders and not cover his head. Never use duvets, pillows or bumpers for children’s beds.

Use a firm, flat, waterproof mattress for your baby to sleep on.

Keep the cot or Moses basket in your bedroom for the first 6 months.

Avoid sleeping with your premature baby. Never fall asleep with your baby on a sofa, chair or bed, especially if you are very tired or have used alcohol, drugs or medication. If you feel like you are getting tired, put your baby safely in his crib or Moses basket.

Make sure your baby doesn’t get too hot or too cold. Keep the cot away from radiators or heaters and out of direct sunlight. The room temperature should be 16-20oC.

Make sure nobody smokes in the house. Find out more about smoking after pregnancy.

Breastfeed your baby if you can.

Don’t put your baby in a hat indoors. Babies cannot regulate their own temperature and this can lead to overheating.

The Lullaby Trust has more information on advice for safer sleep for premature and light weight babies.

Your baby’s sleeping position

Some babies born very prematurely may have slept on their stomachs in the hospital for medical reasons. But now that they are home you should put them to sleep on their backs. Babies can have a hard time adjusting to a new sleeping position at first, but keep putting your baby on their back. If you have any questions about this, you can contact your health visitor, community health team or midwife.

You shouldn’t put your baby on his stomach to sleep or use any devices like sleep positioners or rolled-up blankets to hold him in one position when you get home. Unless your baby’s doctor or pediatrician has told you to because of a medical condition.

Babies who need oxygen at home should sleep on their backs. You may have been told to increase the amount of oxygen when your baby is on their back instead of their tummy, but this is still the safest way to sleep.

How do I care for my baby’s skin?

Bathe your baby

Once your baby’s temperature and health are stable, they can take their first bath. The health team will show you how to care for your baby’s skin before you leave the baby unit.

How often you wash your baby depends on how early they are and what their skin is like. To avoid skin irritation, limit baths and hair washes to no more than 2 or 3 times a week. Between baths, you can use cotton wool soaked in lukewarm water to wash your baby’s head and tail, face, neck and buttocks.

Pure water is best for washing your baby’s delicate skin. If you must use soap, the Baby Unit team can help you find one that is safe to use.

The water should be warm, not hot. Check it with your wrist or elbow and mix well so there are no hot spots.

Cuddle her dry

Babies freeze easily when wet. To keep your baby warm, wash in a warm, draft-free place and keep a towel handy to dry and wrap afterwards.

Change your baby’s diaper

Keep your baby’s bottom clean and dry to reduce diaper rash. You only need water and cotton wool when you change your baby’s diaper. You can gently pat the area dry or leave your baby out of your diaper for a while.

If you are afraid of diaper rash, you can use a thin layer of protective ointment to protect your baby’s skin from moisture. Talk to your doctor if your baby’s skin is broken.

Care for dry skin

If your baby has dry skin, it’s important not to use any moisturizing products without asking your healthcare team for advice. Oils and lotions can increase the risk of infection and your baby’s skin should improve over time.

First aid for parents

Your department may offer to train you in techniques for resuscitating your baby or managing choking episodes. If you would like to further develop these skills, ask your healthcare team, contact your local British Red Cross branch or look online for private courses.

Your health visitor may also know if there are any local classes in your area.

bond with your baby

Some parents bond with their baby right away, while others find it takes longer. We’ve put together some ideas on how to spend quality time with your newest member of the family.

Learn more about bonding with your baby.

Do premature babies sleep badly?

(Gardener 2013)

(Gardner 2013, Schwichtenberg 2013)

(Gardner 2013, Schwichtenberg 2013)

(Gardner 2013, Yates 2014)

(Gärtner 2013, Schwichtenberg 2013)

How can I get my premature baby to sleep?

(Gardener 2013)

(Gardener 2013)

(gardener 2013, shoe brand 2015)

(Gardner 2013, NHS 2014)

(Gardner 2013, Schwichtenberg 2013)

(Cleveland Clinic 2015, March of Dimes 2014)

(NHS 2014 and 2015)

(Lullaby Trust nd)

(bliss nd)

(NHS 2015)

When does my premature baby sleep through the night?

(AAP 2015)

(NHS 2014)

References AAP. 2015. Preemie Sleep Patterns. American Academy of Pediatrics. www.healthychildren.org [Accessed September 2016]

bliss. nd. What is the best sleeping position? www.bliss.org.uk [Accessed September 2016]

Cleveland Clinic. 2015. Kangaroo Care. health information. www.my.clevelandclinic.org [Accessed September 2016]

Gardner SL, Goldson E, Hernandez JA, et al. 2013. The Newborn and the Environment: Implications for Development. In: Merenstein & Gardner’s Handbook of Neonatal Intensive Care, 8th edition. Eds. S Gardner, B Carter, M Enzman Hines, J Hernandez. St Louis: Mosby

lullaby trust. nd. co-sleeping with your baby. Safer sleeping habits. www.lullabytrust.org.uk

March of Dimes. 2014. Kangaroo care. health issues. www.marchofdimes.org [Accessed September 2016]

NHS. 2014. Help your baby fall asleep. NHS Choices, Pregnancy and Baby. www.nhs.uk [Accessed September 2016]

NHS. 2015. Reduce the risk of sudden infant death syndrome (SIDS). NHS Choices, Pregnancy and Baby. www.nhs.uk [Accessed September 2016]

Schwichtenberg AJ, Shah PE, Poehlmann J. 2013. Sleep and attachment in preterm infants. Infant Mental Health Journal 34(1):37-46. www.ncbi.nlm.nih.gov [Accessed September 2016]

Shoemark H, Hanson-Abromeit D, et al. 2015. Building an optimal experience for the hospitalized newborn through neuro-based music therapy. Frontiers in Human Neuroscience 9. www.ncbi.nlm.nih.gov [Accessed September 2016]

Yates CC, Mitchell AJ, Booth MY, et al. 2014. The Effects of Massage Therapy to Induce Sleep in Preterm Infants. Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association 26(4):405. www.ncbi.nlm.nih.gov [Accessed September 2016]

Premature babies sleep differently than term babies. This means they are less likely to follow a predictable sleep schedule. Premature babies may sleep more overall, but their sleep cycles are shorter. They also spend more time in the lighter stages of sleep when they can be easily awakened. In addition, your baby may be unsettled by the time he has spent in the hospital. Nurses in the neonatal unit try to keep the environment quiet for babies, but it can still be a stressful place with too much stimulation. Bright lights, noise, and routine care or medical procedures can disrupt your baby’s sleep. Babies in the hospital are just overwhelmed and it can take a while for them to settle down once they get home. As your baby matures, he should start having longer periods of deep sleep. It’s important to help your baby learn the difference between day and night. Darkness and a quiet environment promote deeper sleep. Some premature babies find soft music or the sounds of nature soothing. At night you should turn off the light or at least turn it down. Don’t wake your baby to change his diaper. If he wakes up for feedings, a turn, or just wants to be reassured, keep a low profile while you tend to him. Keep your voice low and don’t arouse it with too much chatter or activity. Provide your baby with regular naps to get them used to a restful routine and to ensure they get enough sleep Kangaroo care, which means holding your baby in skin-to-skin contact against yours Breast, can help your baby calm down. Nurses will usually teach you this in the neonatal unit, and you can continue caring for the kangaroo once your baby is home. Let your baby sleep in a crib or Moses basket next to your bed until they are six months old. You will also find it easier to nurse him at night. This is standard advice for all babies, whether they were born prematurely or not. Don’t sleep with your baby. It is not safe for premature babies as it increases the risk of sudden infant death syndrome (SIDS). You may be tempted to put your baby on his tummy just to see if it helps him sleep. But unless you’ve been told there’s a medical reason to put her in a different position, your baby needs to be sleeping on her back. This reduces the risk of SIDS. It’s just impossible to say, although it’s the one question every parent wants answered! Newborn babies, whether premature or not, need time to settle into a regular sleep pattern. Your baby may not sleep long nights until he is between six and eight months old (corrected age). This may be later than some full-term babies, who are able to walk longer distances at around four months. But every baby is different, and some babies are naturally more alert than others. If you’re concerned, ask your baby’s nurse on the ward or your doctor at home what to expect for your baby. Read how to create a bedtime routine for your baby.

Because preterm babies often make it home from the hospital before they reach their original due date, they don’t always behave like a baby born closer to 40 weeks. Premature babies show differences in the way they sleep, eat and manage daily life. And while some premature babies are quiet and sleep a lot, others are very picky. Here are some of the things that can cause anxiety in preterm babies and what you can do to help them.

Common reasons for anxiety

Some causes of agitation in term infants are the same as in preterm infants. However, premature birth can also have other reasons.

Premature Nervous System

A premature baby has an immature nervous system. The nervous system controls the movements of the body, the senses and the regulation of bodily functions. A premature baby’s brain and nerves may have trouble processing the world around them. They may react more sensitively and restlessly to light and noise, being touched or fed.

medication

Premature babies are more likely to leave the hospital with medication. Some medications are stimulants, particularly those that prevent apnea. Stimulants increase activity in the body. They can make a baby nervous and irritable, as well as causing difficulty in calming down and getting a good night’s sleep.

Missing NICU

After spending weeks or months in the neonatal intensive care unit (NICU) or a special care unit, your baby may become accustomed to the alarm ringing and constant light source day and night.

When you finally get home, the quieter, darker environment may be too different, allowing your child to be finicky trying to adjust.

It can help to leave one light on and the radio or TV on for background noise. You don’t have to do this forever. Try it for a few days, then gradually turn it down and down as your baby adjusts to their new surroundings.

reflux

When a baby eats, food travels from the mouth through the esophagus to the stomach. When the food and some of the acid moves backwards in the stomach and up into the esophagus, it is called reflux. It is uncomfortable, so your baby may fuss and cry after feeding.

If your child has reflux, the doctor may recommend holding them upright after breastfeeding while watching them, thickening formula or breast milk, or using medication.

food allergies

A reaction to the protein in certain foods can cause an allergy in some babies. Preemie and infant formula made from cow’s milk or soy can cause stomach problems, pain and anxiety. Breastfed babies can also have allergic reactions to dairy or other foods in their mother’s diet, although this is not as common.

If you suspect your child is being picky because of a food allergy, talk to your pediatrician about switching to a different formula or eliminating common allergens from your diet if you’re breastfeeding.

colic

Colic is excessive crying and excitement lasting more than three hours on at least three days a week for more than three weeks. The cause of colic isn’t known, but it’s thought to be related to a stomach problem such as gas, an intolerance to food, or an immature digestive system.

In term newborns, colic can appear a few weeks after birth. It usually stops on its own by the time the baby is four months old. Colic can last longer in premature babies. It’s only a matter of time, but it may go away closer to the corrected age of four to six months.

Illness

If your child is unwell because of a cold, fever, earache, or an underlying medical problem, they will try to let you know in the only way they know. So if your baby is more restless than normal, take their temperature and look for signs that they might be sick or in pain. If your child has a fever or you suspect an illness, call the doctor.

hunger

Just like term babies, premature babies make a fuss when they’re hungry, wet, or unwell. It might seem obvious, but if your child is picky (even if it’s a lot), it’s always a good idea to check the basics first.

Babies tend to be fussier near feeding time, but sometimes they are hungry between feedings as well.

If your child spits up or nurses after feeding and doesn’t get enough when fed, they may still be hungry. Babies are also more picky during growth spurts because they need to eat more.

Dirty diaper

Many toddlers don’t like having a dirty diaper and get annoyed when the diaper gets wet or dirty. It can happen at any time, even immediately after the last diaper change. So there’s no harm in checking again. Try to keep your baby’s skin as dry and clean as possible and also watch out for diaper rash. Diaper rash can be painful, especially if the diaper is soiled.

air in the stomach

If your baby did not burp well after the last feeding, the air that is still trapped in his tummy can cause discomfort. Even if he gave you a mighty burp after the last feeding, he may need to burp again, especially if he cried.

lack of comfort

Make sure your baby isn’t upset about being uncomfortable. Hair can get caught around little fingers or toes, or a tag on clothing can irritate your child’s skin and cause pain. Babies also get annoyed when they are too warm or too cold, so adjust the room temperature or your child’s clothing if necessary.

How to calm a restless baby

If you have met all of your baby’s basic needs and he is still crying, what should you do? It can be difficult to figure out why your child is finicky or crying and you may not be able to find an answer. But you can try to find a way to calm her down.

You may have to try many different things or a combination of techniques because what works for one baby may not always work for another. Here are some tips to calm a fussy preemie.

Reduce the stimulation: Some babies need a little light and noise after being in the NICU for weeks. However, most preemies need less stimulation. When there is too much going on, it can be troublesome for a baby with an immature nervous system. A calm, simple environment that does not overwhelm the senses is more likely to have a calming effect on your child. It can be helpful to move away from a room with a lot of people or activity, dim the lights, and reduce the noise.

: Some babies need a little light and noise after being in the NICU for weeks. However, most preemies need less stimulation. When there is too much going on, it can be troublesome for a baby with an immature nervous system. A calm, simple environment that does not overwhelm the senses is more likely to have a calming effect on your child. It can be helpful to move away from a room with a lot of people or activity, dim the lights, and reduce the noise. Swaddling: Swaddling can help a baby feel warm and secure. Wrapping a baby snugly in a thin blanket will scare them less and possibly sleep better.

Swaddling can help a baby feel warm and secure. Wrapping a baby snugly in a thin blanket will scare them less and possibly sleep better. Holding: Another way to help your preemie feel safe, warm, and secure is to hold them close to your body with your arms and legs tucked in. A carrier or sling can also keep your baby close to your body while keeping your hands free. Just be sure to use the sling or stretcher correctly and safely.

Another way to help your preemie feel safe, warm, and secure is to hold them close to your body with your arms and legs tucked in. A carrier or sling can also keep your baby close to your body while keeping your hands free. Just be sure to use the sling or stretcher correctly and safely. Non-Nutrient Suckling: Sucking is comforting for some babies. Breastfeeding is comforting, so if you’re breastfeeding, put her on your breast. If you are not breastfeeding, you can offer a pacifier.

For some babies, sucking is soothing. Breastfeeding is comforting, so if you’re breastfeeding, put her on your breast. If you are not breastfeeding, you can offer a pacifier. Constant noise: The constant, repetitive noise of the vacuum cleaner or washing machine seems to help some babies calm down. Music can work too. Research suggests that playing music can help relieve stress, reduce crying, and reduce excitement in premature babies. So you can try singing a lullaby, popping in a classic CD, or shuffling through your iPod until you find a song your child likes.

The repetitive noise of the vacuum cleaner or washing machine seems to help some babies calm down. Music can work too. Research suggests that playing music can help relieve stress, reduce crying, and reduce excitement in premature babies. So you can try singing a lullaby, putting on a classic CD, or shuffling through your iPod, until you find a song your child likes. Bath: Some premature babies don’t like being in the water at all, others do. The sound of running water and the warm feeling against the skin can calm and soothe a fussy baby.

Some premature babies don’t like being in the water at all, others do. The sound of running water and the warm feeling against the skin can calm and soothe a fussy baby. Exercise: The gentle movements of walking, rocking, or dancing with your baby can help calm him down. If your child doesn’t like being held and rocked in the traditional cradle hold, place them on your shoulder or try holding their face down over your forearm while rubbing their back with your other hand.

The movement and sound of the car calms some babies and can put them to sleep. If you can’t drive out, put the baby in the stroller and go for a walk. The fresh air is good for both of you and the movement of the stroller can be comforting for the baby. If you have to stay indoors, try a baby swing or a vibrating booster seat.

Just make sure you use a car seat, stroller, booster seat or swing safely. Your baby should fit properly so that they are secure and can breathe easily. A baby should never sleep in it unattended

Taking a break

If your baby is picky most of the time, it can be exhausting and stressful. If possible, have someone give you a break. Your mom, a friend, or your partner can stay with the baby so you can get away, even if it’s just for a little while.

An hour to yourself can make a world of difference, allowing you to return to baby feeling calmer and refreshed.

If your baby is monitored at home, your helper should know how to handle alarms and emergencies. If not, you can always take a little break, but don’t go far in case you’re needed.

When excitement is too much

Sometimes babies cry inconsolably. It seems like you’ve tried everything and just don’t know what to do. It’s always a good idea to take the baby to the doctor for a check-up to make sure there isn’t a medical problem. Of course, sometimes a specific problem can’t be found, and you just have to deal with the crying and fussing until your child grows out of this stage.

If you ever feel like you can’t take it anymore, take your baby to a safe place and walk away for a few minutes. It’s okay to take a moment when you need it, and it’s definitely okay to ask for help.

Of course, if your baby is having episodes of apnea with crying, you should not leave them alone. You can put her down to cry, but stay close to watch her while you call for help. And remember, you should never shake a baby. Shaking a baby is very dangerous. It can cause serious harm or death to a child.

A word from Verywell

Not all premature babies are demanding and difficult to comfort, but many premature babies require more care than expected. As a parent, it’s only natural to want to comfort your child when they’re unhappy. So when helping your baby to calm down and settle down is difficult, it can be heartbreaking and frustrating. It can make you feel like you don’t know how to take care of your child. Then when you finally figure out what works, it might not work next time.

Preemie babies can certainly be unpredictable, and it may take some patience and persistence to get you through the first few months. Luckily, it gets easier as your baby grows. Not only will your child’s nervous system become more mature and less sensitive, but as the days go by you will learn to understand your child’s signals and understand the things that help calm them down. It may just take a little longer than if your baby were born full-term, so stay tuned.

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Don’t expect your premature baby to sleep through the night for many months. Unlike a term baby who can sleep a full 6 to 8 hours a night by 4 months of age, your baby may not be able to complete this task until 6 to 8 months or later.

During this transitional period, play with your baby during waking hours throughout the day. Keep nighttime feedings as quiet and matter-of-fact as possible, with minimal or soft lighting. This will help your baby learn the difference between day and night and can help you get much-needed sleep at appropriate times. But remember that it can take several weeks for your baby to get his days and nights in order!

Follow a routine

Babies can fall asleep at different rates. Follow the same steps every time you put your baby to bed to help them learn a personalized bedtime routine. At first you will probably jump up at the first cry and go to your baby. But as you get to know each other and notice your baby’s self-soothing skills, you need to allow your baby to comfort himself and go back to sleep on his own.

Self soothing

Self-soothing is an important skill for your baby. Starting early to teach your baby to fall asleep on her own will guide you through the later stages of development (at the corrected age of 6-9 months) when sleep problems may recur.

Setting the sleep mood

To help your baby rest, try playing the radio softly at home for the first few weeks or having a ticking clock in the room. In addition, a soft night light can be soothing for both of you. Let your baby suck on his fist or a pacifier if it is soothing.

grunt

grunting in premature babies

Grunting in preterm babies is normal and very common. It is due to an immature nervous system that they will eventually outgrow. Premature babies spend most of their time in light sleep (REM, or active sleep) compared to deep sleep (non-REM, or quiet sleep), and sometimes have difficulty transitioning from a sleeping state to a waking or waking state. This is why sleep cycles are so important in the NICU – giving your baby time to rest, sleep and undisturbed rest is so important to the developing neurological system. As time goes by and the neurological system matures and your baby grows, the grunting will stop.

Swaddling is a smart strategy to help your newborn sleep better. Putting her in a snug-fitting sleeve can help her feel safe and secure while she adjusts to life outside the womb, keeping her snuggly and warm while her internal thermostat kicks up and preventing her from using her arms and legs to hit and trigger the startle reflex.

But within a few months it will be time to say goodbye to the practice. Although safe for newborns (provided you swaddle in accordance with other safe sleep guidelines), swaddling becomes risky as your baby gets older and more mobile.

So when exactly should you stop swaddling your baby, and how can you ease your little one’s transition to nappy-free sleep? Here’s what you need to know.

At what age should you stop diaper changing?

Not every parenting question has a simple answer. But the question of when to stop swaddling is pretty straightforward: you should unwrap the swaddle as soon as you notice your little one becoming more active and trying to roll over.

This can happen as early as 2 months, which is the safest time to stop swaddling. Although many babies turn over around 3 or 4 months of age, if your baby is showing signs of trying to roll over, saying goodbye to the swaddle should be done earlier.

What makes this the best age to stop swaddling? Once your baby is mobile enough to potentially be knocked off their blanket, the blanket poses a potential choking or strangulation hazard. (Remember, the rules for safe sleep state that it’s not loose until baby’s first birthday blankets or bedding in the cradle or bassinet.)

And it’s not just a security issue. As your baby becomes more mobile, being confined to a sling can prevent them from practicing age-appropriate motor skills, which could negatively impact their development.

With all of this in mind, you might be wondering if it wouldn’t make more sense to stop changing diapers even earlier, say when your baby is one month old. If your baby isn’t showing signs of becoming more mobile and trying to roll over, you don’t need to stop changing early, especially if it seems to be helping your baby sleep better.

But if you want to quit sooner — maybe you’re tired of the whole swaddling thing, or your baby doesn’t seem to sleep better with a swaddle than without — that’s totally fine. Babies don’t need to be swaddled, and some even sleep better unwrapped.

Before giving up swaddling altogether, you might want to consider looking for a swaddle with a Velcro or zipper closure. Some parents find them easier to use, and some babies seem to prefer them over old-fashioned blankets.

How do you get out of a wrap?

After swaddling and unwrapping your baby more times than you could possibly count, quitting swaddling can feel like the end of an era. And if her swaddle blanket has become a regular part of her sleep routine, you might worry that quitting could seriously mess things up.

The good news is that all babies eventually get used to sleeping without a swaddle. And of course, you could of course try to go cold turkey to see how your baby reacts. You never know – she might as well sleep as before!

But if you suspect that wouldn’t be the case (or you don’t want to risk a bad night’s sleep to experiment), you can also try a more step-by-step approach. That’s how it’s done:

Start by wrapping your baby out of the swaddle with one of his arms.

A few nights later, after she gets used to having one arm outstretched, wrap her free with both arms.

A few nights after, stop using the swaddle entirely.

Swaddling your baby with one or both arms is perfectly safe as long as you keep wrapping his blanket securely. In fact, some newborns prefer to be swaddled with one or both arms from the start.

Another option for changing swaddles: swap your swaddle blanket for a transitional sleeping bag. These hybrids of swaddle and wearable blanket offer similar coziness to a swaddle but without the risk of potentially being thrown off while your baby sleeps.

If you choose one of these sleeping bag products, keep in mind that at some point you will have to pull your baby out of it too – either because he outgrows him or because he also becomes unsteady as he moves around more.

Ultimately, there is no one best way to stop changing diapers, so do what you think works best for you and your baby. And if you’re unsure or have any questions, consult your baby’s pediatrician.

How do I put my baby to sleep without being swaddled?

It’s understandable that you’re worried that your baby won’t sleep as well without his swaddle. But rest assured, even if your baby has trouble adjusting at first, they will eventually get used to it.

Remember that you still have many tools at your disposal to help your little one fall asleep. A calming bedtime routine with a predictable pattern — like a bath, feeding, rocking, and a lullaby or story — can help your baby relax and hopefully fall asleep.

It can also be helpful to create a calming atmosphere by dimming the lights, speaking softly, and playing white noise. Finally, don’t forget the power of touch: baby massage can soothe a fussy baby and get them in the sleep zone.

And even if you can no longer use a swaddle blanket, you may still be able to use a swaddle-sleeping bag hybrid to help bridge the transition. You can also go straight to a regular sleeping bag – basically a wearable blanket that your child can use well into toddlerhood, depending on the model (although you may need a larger size as they grow).

Swaddling is a smart sleep strategy for newborns. But once your little one is around 2 months old and gets to the point where he’s trying to roll or kick himself out of his swaddle blanket, it’s time to move on. Here’s to the next exciting phase of babyhood!

Sudden Infant Death Syndrome (SIDS), the unexplained sudden death of an infant under the age of one year, affects approximately 1500 infants annually. The exact cause remains a mystery, but a recent study in pediatrics uncovered a possible risk factor. Researchers have found that an infant who is diapered — wrapped tightly in a blanket or sheet and with restricted limbs — while lying prone or prone to sleep is at a higher risk of SIDS.

Thomas Keens, MD, faculty member in the Division of Pediatric Pulmonology and Sleep Medicine and director of the Cystic Fibrosis Care Center at Children’s Hospital Los Angeles, spoke to us about the implications of this study. Keens also chairs the California SIDS Advisory Committee, which advises the California Department of Health and Human Services on SIDS-related issues.

Is there a hypothetical cause of SIDS?

The cause of SIDS remains unknown. However, most SIDS researchers believe in the triple risk hypothesis of SIDS. That is, SIDS is not due to an abnormality in any physiological system. Rather, researchers today assume that it is due to an interaction of three factors. The first is the development window of vulnerability. SIDS is most common between the ages of 2-4 months, when all infants’ cardiorespiratory systems are in rapid transition and therefore unstable. Therefore, all infants in this age group are at risk for neurological respiratory control dysfunction.

The second factor is environmental challenges, ranging from sleeping prone (on your stomach) and soft bedding to overheating and second-hand smoke. Third, some infants are inherently vulnerable and have different abilities to respond to different stresses.

This hypothesis is supported by recent research from Harvard University, which showed that levels of brainstem serotonin — a neurotransmitter important for life-sustaining functions in the brain like breathing and heart rate — are reduced in children who have died from SIDS. This suggests that in this triple risk hypothesis, the infants who die have increased susceptibility (decreased life-sustaining neurotransmitters). In another scenario, not all babies sleeping on their stomachs in soft bedding would die, but those that did die were likely less able to cope with the environmental challenge of the prone position and soft bedding.

This remains a hypothesis, but most SIDS researchers believe that this combination of multiple factors is the mechanism of death in these babies.

How could swaddling potentially increase SIDS risk?

Sleeping on your stomach is the most important risk factor for SIDS. When a baby is swaddled and put to sleep, that child cannot attempt to raise or turn their head to avoid a potentially dangerous face-burying situation. Even when babies are laid on their backs to sleep, they begin to roll over around 3-4 months of age, some earlier. When a swaddled infant rolls from their back to their stomach, they cannot move to try and correct the position. Therefore, the child is in the most dangerous position. Choking is possible. Wrapping an infant in thick blankets can cause overheating, which is another high risk factor for SIDS. Swaddling the child with blankets that cover the face is another risk factor for SIDS.

Therefore, when infants are swaddled, which is often done to encourage sleep, they should always be placed on their backs and wrapped in thin blankets to prevent overheating. The face should not be covered and swaddling should be discontinued when the infant begins to roll from supine (on their back) to prone, which occurs at about 3 months. Doctors are increasingly recommending stopping diaper changing when the infant is 2 months old.

What are some other risk factors for SIDS?

Other risk factors for cot death (which have been shown to increase, but not necessarily cause, the risk of cot death) are unsafe bedding (a soft mattress versus a firmer one), having items in the crib with the infant, cigarette smoke, sharing a bed ( i.e. toddlers sleeping in their parents’ bed) and overheating.

What SIDS related research has been done here at CHLA?

CHLA is proud to have contributed to SIDS research. As recently as the late 1980s, many believed that SIDS was due to babies not breathing (apnea) during sleep. We were among the first to show that recordings of respiration and heart rate do not predict SIDS or severe apnea events in high-risk infants.

So we turned our attention to another question. Because infants have immature breath control, all infants have many pauses in breathing. We thought that maybe it’s not as important to know why they have apneas as to understand if and how they can break out of these breaks. If an infant has a prolonged pause in breathing, he/she may become hypoxic (low oxygen). So, can these infants rescue themselves from a breathing pause by waking up in response to low oxygen levels? We found that even normal infants appear to be born with the ability to wake up in response to low oxygen levels, but they lose this ability around 2-3 months of age when the incidence of SIDS peaks. We do not believe this is the cause of SIDS, but we believe it is one of the factors that makes any child at the peak age of 2-4 months more susceptible to SIDS. We were also the first to describe an increased risk of SIDS in infants born to drug-abusing mothers.

CHLA continues to promote SIDS risk reduction and safe infant sleep education, including promoting a safe infant sleep environment at CHLA. We have been active in training county public health nurses to support families who have experienced the devastating death of an infant from SIDS.

Any additional comments?

My interpretation of this study is that it is not perfect. There are relatively small numbers of SIDS and controls, but the data obtained differed between studies. I agree with the authors that this study is not powerful enough to prove that swaddling increases the risk of SIDS. However, it reinforces two current recommendations: (1) swaddled infants should never be placed in the prone (on the stomach) position; and (2) if started, swaddling should be stopped at 2-3 months of age when an infant begins to roll over because of the risk of a swaddled infant lying on his stomach and unable to move.

Image courtesy of Shutterstock.

All parents are concerned about their children reaching certain milestones on time. But when your baby comes early, those first few months and years can be a time of watching and waiting. Because preterm babies face greater health risks, you may be more concerned about whether your child will get things done on time. Laurel Bear, MD, a pediatrician at Children’s Hospital of Wisconsin, can allay your concerns. Premature babies have the same milestones as babies born on time — if you adjust the typical schedule for their preterm birth, she says.

Adjusted age explains Newborns less than 37 weeks in the womb are considered preterm. A normal pregnancy lasts about 40 weeks. To figure out what a child should be doing and when, it’s important to look at their adjusted age (also known as corrected age). That’s based on Mom’s original due date, Bear says. For example, if a baby is born 2 months early and is now 4 months old, “we will not expect them to do what a 4-month-old does. We’re really looking at what a 2-month-old should be doing,” she says.

When your baby first visited the hospital infirmary, it likely came back wrapped in a cute little package with only its fluffy little head sticking out. That’s because nurses know one of the secrets of a happy, calm baby: swaddling.

Swaddling is an ancient method of wrapping newborns in a thin blanket or cloth. It’s adorable (who doesn’t love a baby burrito!), but it also serves the all-important purpose of helping your sweet pea stay calm and sleep more soundly. Here’s how:

A swaddle helps your baby feel safe and secure as they adjust to life outside the womb.

Swaddling helps prevent her from flailing her arms and legs, which can trigger her startle reflex and possibly cause her to wake up.

A swaddle will keep your baby snug and warm until its internal thermostat kicks in.

In short, there are many good reasons to try this age-old practice. But figuring out how to do it yourself can be a little intimidating (especially when you’re feeling overtired).

Here’s a step-by-step guide to how to swaddle a newborn like a pro, the keys to sticking to safe swaddling techniques, and when it’s time to stop.

How to wrap, step by step

It might seem a little daunting to master your swaddling skills, but swaddling your baby takes just a few steps.

Here’s how to swaddle a blanket, including how to swaddle a baby with your arms outstretched (if that’s what your little one prefers!), plus tips on how to swaddle a wobbly baby:

Step 1: Find a flat surface.

Spread out your baby’s swaddle blanket in the shape of a diamond, with one corner facing up, on a flat surface (e.g. the middle of your bed). Fold the top corner down about 6 inches.

Step 2: Lay your baby face up on the blanket.

Her head should sit over the folded edge of the blanket and her body should extend straight down to the bottom corner.

Step 3: Straighten your baby’s left arm.

Then take the left side of the blanket and wrap it over her left arm and chest. Tuck the blanket under your right arm and back. At this point, your baby’s left arm is covered but their right arm is free.

Step 4: Bring the bottom up.

Fold the bottom corner of the blanket over your baby’s body and tuck it under the first crease, under her chin. Extend your baby’s right arm and pull the right side of the blanket over your baby’s body and tuck it under his left side.

Step 5: Attach the ceiling.

Loosely twist the bottom of the blanket and tuck under your baby.

A few important things to keep in mind: The wrap should fit snugly, but not too tight. You should be able to place two to three fingers between your baby’s chest and the blanket, and the blanket should be loose around her waist to allow her legs to move freely.

If your baby prefers to keep his arms free, it’s okay to keep one or both arms out of the swaddle.

If your baby is too wobbly for you to get a snuggly swaddle, take a break and give your little one a few minutes to work out his coils before trying again. But if your baby seems like he’s always trying to wriggle out of his swaddle, maybe he’s just not a fan (not all babies are!) or he might be getting too active to swaddle it.

In either case, it’s a good idea to try an alternative swaddle (such as a Velcro or zippered swaddle) or skip it altogether, as a blanket kicked off while your baby is asleep can present a choking or strangulation risk.

Is the method of swaddling a preemie different? Swaddling is just as beneficial for premature babies as it is for term newborns. But consider bringing your hands together on your chest in front of you instead of stretching them out at your sides, which may be more reassuring for some premature babies.

Chances are you’ll become a winding expert in no time. But if you’re unsure, ask your baby’s pediatrician. He or she can review your swaddle skills and offer some helpful hints if you’re not quite getting it right.

How to wrap with a wrap

Like the idea of ​​swaddling but don’t want to use a blanket? Velcro or zippered swaddles are as secure as blankets and offer the same benefits without the need to fold or pack. Specific instructions will vary depending on which film you are purchasing. But they’re generally easier to manage than blankets and far less likely to come loose.

Is diaper changing safe?

Baby sleep and blankets don’t usually mix, so swaddling makes it dangerous?

It is true that swaddling is not without its dangers. But the American Academy of Pediatrics (AAP) says swaddling can encourage your newborn to doze better — as long as it’s done correctly and practiced in accordance with other safe sleep guidelines.

Swaddle blankets that are too loose or unwrapped while sleeping can cover a baby’s face and pose a choking hazard.

The risk is compounded by the fact that swaddled babies tend to sleep particularly soundly. So if swaddling blankets cover their faces, they are less likely to wake up and change position.

Swaddle blankets that are too tight, especially around your baby’s hips, are also not good. Tight swaddles prevent your baby from straightening or bending their legs, which can injure their hips, joints and cartilage.

To encourage healthy hip development, the bottom of the swaddle should be loose enough to allow your baby’s legs to remain bent up and out as they naturally would with a newborn lying on their back without a swaddle. You should also make sure that the swaddle allows your baby to bend and straighten their legs as they please.

Wrapping your baby properly will encourage your little one to sleep better and give you peace of mind (so you can get some sleep yourself!). Some important diaper safety tips to keep in mind:

Wrap tightly, but not too tightly. At the top of the swaddle, two to three fingers should fit between the blanket and your baby’s chest. The bottom of the swaddle should be loose enough to allow your baby’s legs to remain bent and flared.

At the top of the swaddle, two to three fingers should fit between the blanket and your baby’s chest. The bottom of the swaddle should be loose enough to allow your baby’s legs to remain bent and flared. Always lay your baby on their back to sleep. It is the safest position whether you are diapering or not. Make sure you tuck the bottom part of the blanket under your baby as well.

It is the safest position whether you are diapering or not. Make sure you tuck the bottom part of the blanket under your baby as well. Keep your baby cool. Swaddling can cause overheating, which can increase the risk of sudden infant death syndrome (SIDS). Keep the room at a comfortable temperature (between 68 and 72 degrees Fahrenheit year-round). And resist the urge to wrap your baby in extra layers—pajamas and the swaddle blanket are probably enough to keep them comfortable. Sweating, damp hair, flushed cheeks, heat rash and rapid breathing are all possible signs that your baby may be overheating. As a general rule of thumb, dress your baby in one more layer than you would wear.

Swaddling can cause overheating, which can increase the risk of sudden infant death syndrome (SIDS). Keep the room at a comfortable temperature (between 68 and 72 degrees Fahrenheit year-round). And resist the urge to wrap your baby in extra layers—pajamas and the swaddle blanket are probably enough to keep them comfortable. Sweating, damp hair, flushed cheeks, heat rash and rapid breathing are all possible signs that your baby may be overheating. As a general rule of thumb, dress your baby in one more layer than you would wear. Swaddle for nighttime sleep and naps. Swaddling can help your baby sleep better during the day and night. If tucking them into a small burrito blanket for hours overnight makes you nervous, know that changing at bedtime is no more risky than changing during your nap, as long as you follow safe swaddling and sleeping guidelines. You also have many built-in ways to check on her, as she often wakes up to eat. But if you check your swaddle while you sleep, feel free to check more often.

Is it okay not to swaddle a newborn?

Many parents swear that swaddling is the key to soothing their newborn. But if your baby doesn’t seem like a fan, you might be wondering if it’s absolutely necessary.

The truth is that not every baby likes to change diapers. Some seem to find diapers restrictive and try to fight their way free every time. So if swaddling makes your baby more mad than calm, you don’t have to do it.

However, before you give up entirely, you might want to experiment with some alternatives. If your baby wants to stretch out his arms, try keeping his arms out of the swaddle. The extra freedom might make swaddling more attractive to them.

Do you have a little one who likes to kick? She might do better with a velcro sweater (they’re harder to slip off and some secure baby arms with swaddle wings) or a zippered cocoon or a sleeping bag swaddle hybrid (which allows for more leg movement). .

You may have to try a few different swaddles to find the one your baby likes best—but once you’ve done it, stock up on a few so you have extras on hand in case the nappy leaks or spits.

What if none seem right? Feel free to keep going. You don’t have to force your baby into a swaddle if he doesn’t like it.

When to stop diapering

Swaddling can be a smart move for newborns. But it’s dangerous for older babies who can free themselves from their blankets. Being swaddled can also affect healthy development in older babies, as it prevents them from practicing age-appropriate motor skills.

So at what age should you stop diaper changing? You will want to stop as soon as your child becomes more active and tries to roll over, which can happen as early as 2 months but usually by around 3 or 4 months.

Even after your baby has outgrown the swaddle, he’s still too young to sleep with a blanket. Try a sleeping bag to keep her snug and still following safe sleep guidelines. These wearable blankets add an extra layer of warmth, and some come with features designed to help babies move away from their swaddles more comfortably.

Swaddling can be intimidating at first, but rest assured, parents have been swaddling their babies to sleep for ages, and with so many opportunities to practice, you’ll quickly perfect your technique too.

Lay your baby on their back so their feet are near the bottom of the cradle. Make sure the surface is firm and flat and nothing else is in the crib. Put a blanket over your baby, but make sure it doesn’t go higher than the armpits. Then tuck the blanket securely into the sides and bottom of the crib. This makes them feel constricted and reduces the risk of suffocation.

There can be problems with the transition from swaddle to wearable blanket. If your baby wants to feel “pulled in” like in a swaddle, you can try another method.

Dangers of continued swaddling

There has been a lot of discussion about the pros and cons of diapering. Ultimately, it is up to you and your family whether you want to swaddle your newborn.

It can be dangerous to ignore the signs that your baby is trying to roll over if you keep changing him. If your baby is restless and moves more, it can overheat when changing. Signs of overheating are:

Sweat

damp hair

flushed cheeks

heat rash

Rapid breathing

After two months, you should reassess your baby’s sleep situation. Stop changing diapers if someone is babysitting or moving around for you. Swaddling can be dangerous for babies every month if not done properly. Because of this, some daycare centers refuse to swaddle babies. Some doctors suggest that diaper changing for infants after 2 months could be dangerous.

Another danger of continued diaper changing is the increased risk of SIDs. It’s also possible for your baby to overheat if he’s not properly dressed for bed. A swaddle that is too tight can restrict breathing and cause hip problems. If the swaddle blanket is too loose, there is a risk that the blanket will unravel and your baby will suffocate. Adhering to safe diaper changing practices can reduce these risks.

If you have questions about whether or how to safely swaddle or remove your baby from the swaddle, your doctor can help. Together you decide on the best course of action.

Do you know how to position your baby’s arm when swaddling is important to their development? Parents and caregivers are routinely advised to swaddle newborns. Swaddling infants inhibits the moro reflex, which allows them to sleep better. Although there are many benefits to the practice, certain wrapping methods are better than others.

Health and development experts recommend wrapping your baby’s arms on your chest. They suggest positioning your child’s arms so that their hands meet at the midline of their body. This method has advantages over swaddling with your child’s straight arms at the sides.

Keeping your arms closed feels cozy and natural, and babies who are comfortable sleep better. Additionally, this swaddling method has several health and wellness benefits for your child.

Gives comfort. This natural position is very similar to your baby’s position in the womb. It feels familiar and safe. Finally, we don’t see ultrasound images of babies with their arms hanging straight down by their sides. Supports neurodevelopment. Bringing your baby’s hands together at the midline of the body will support the developing brain. It helps cells and neurons connect across the right and left hemispheres. Stimulates the sense of touch. The skin is the body’s largest organ and the fingertips are very sensitive. There are up to 100 pressure receptors in one cubic centimeter of fingertip skin. If you wrap your arms towards the middle of your body, your baby can play with their fingers. This game stimulates the development of touch receptors. Keeps joints flexible and healthy. Orthopedists recommend that the baby’s hips, knees and elbow joints flex and remain flexible. Proper swaddling enables this and encourages proper co-development. It also avoids the risk of overextending the elbow joint by placing your baby’s arms at the sides.

Want to learn more about the benefits of swaddling? Next, read “The Benefits of Swapping Your Baby”.

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