Swaddling Increases Risk for Sudden Infant Death Syndrome

Summary and Comment |
May 9, 2016

Swaddling Increases Risk for Sudden Infant Death Syndrome

  1. Louis M. Bell, MD

Swaddling doubled the risk for SIDS in the supine sleep position and was even more dangerous in the side or prone position.

  1. Louis M. Bell, MD

Swaddling is gaining popularity in the U.S. because it seems to improve an infant's sleep, with fewer spontaneous arousals during quiet sleep. Conversely, there is some concern that swaddled infants may be at increased risk for sudden infant death syndrome (SIDS) because they may be in a state of reduced arousability. To determine if swaddling is associated with SIDS, researchers conducted a meta-analysis of four observational case-control studies from the U.K, the U.S., and Australia.

The studies included a total of 760 SIDS cases and 1759 controls; 17.5% of SIDS cases were swaddled compared with 10.8% of controls. In models adjusted for differences between studies, swaddling increased the overall risk for SIDS slightly (odds ratio, 1.4). However, sleep position had a dramatic effect on risk for SIDS: swaddled infants had 13 times higher risk for SIDS than controls in the prone position, 3 times higher in the side position, and 2 times higher in the supine position. In addition, risk increased with age, and was 2.5 times higher in swaddled infants older than 6 months compared with controls the same age.


These are worrisome results. 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 that swaddling is very dangerous with side and prone sleeping positions. Finally, swaddling should be abandoned after 4 to 6 months, or earlier if the infant is starting to try to turn over.

Editor Disclosures at Time of Publication

  • Disclosures for Louis M. Bell, MD at time of publication Grant / Research support NIH Institutional Clinical and Translational Science Award; Agency for Healthcare Research and Quality National Center for Pediatric Practice Based Research Learning; Patient-Centered Outcomes Research Institute Editorial boards Current Problems in Pediatric Adolescent Healthcare (Associate Editor)


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