Swaddled infants at risk for developing SIDS

1. Infants who were swaddled (close wrapping of infant with head exposed) had a greater risk of developing sudden infant death syndrome (SIDS) than those who were not, and this risk appeared to increase with age.

2. The risk of SIDS and swaddling varied by sleep position, with tummy and side positions conveying the highest risk.

Study Rundown: Infant swaddling has been shown to improve sleep, reduce arousals, and decrease excessive crying, though several studies have indicated a potential connection of this sleeping method with SIDS. Presently, there is no official recommendation concerning this topic and the potential association of swaddling with SIDS remains unclear. Authors of the current study conducted a meta-analysis of the literature in order to investigate swaddling and SIDS. Pooled data from 4 studies suggested that there was a 1.5 times increased risk of SIDS with infant swaddling. Of all age groups, children greater than 6 months of age were at the highest risk of SIDS when swaddled and had a 2.5 times greater risk than children the same age who were not swaddled. The association varied by sleep position, with tummy sleeping being the greatest risk, followed by side sleeping and swaddled infants who were placed on their backs. Study results may be limited as there was considerable heterogeneity between included studies, swaddling was never properly defined, and other SIDS-related factors (such as parental co-sleeping) were not controlled for. Nonetheless, pediatric providers should continue to discourage parents from placing swaddled infants on their side or tummy during sleep as well as educate about the potential risks of swaddling at older ages.

Click to read the study, published today in Pediatrics

Relevant Reading: Swaddling: A systematic review

In-Depth [meta-analysis]: Authors searched 3 online databases (PubMed, Web of Science, and Ovid SP) from 1950 to 2014 for observational studies pertaining to swaddling. Unpublished data were also examined from several international and national SIDS conferences. Articles were excluded if they did not mention swaddling/SIDS and if they were not case-control or cohort based. A total of 4 studies met all criteria and were included for analysis. The odds ratio for the outcome of SIDS when swaddling was 1.53 (95% CI, 1.18-1.97; P = .001). Furthermore, the risk of developing SIDS was found to vary according to infant sleep position. The highest risk was seen in the prone position (OR 12.99; 95% CI, 4.14- 40.77), followed by side-sleeping (OR 3.16; 95% CI, 2.08- 4.81), and supine sleeping (OR 1.93; 95% CI, 1.27- 2.93). The greatest risk of SIDS with swaddling was seen in the ≥6 month age group (OR 2.53; 95% CI, 1.21- 5.23); this association appeared to increase with age from birth to 6 months.

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