Is swaddling an infant a good idea?

Swaddling

Though first-time parents, the couple already seemed calm and at ease with their four-week-old bundle of joy. They had done a lot of reading before the baby's birth and were well-prepared for the rigors of parenthood.

Since there had been some initial concern about the baby's hips - which subsequently were found to be perfectly fine - the duo was also aware that improper bundling of a baby can put little hips at risk.

"Now that we know his hips are OK, can we swaddle him for sleep?" the dad asked.

I told the parents that though swaddling was an option, I personally was not a big fan, mostly because I favor the "less is more" approach to sleep initiation.

For many kids, healthy "going-to-sleep" habits develop when familiar routines are established for bedtime. At the end of this bedtime prep, the baby, or child, is put in bed and expected to fall asleep as is, without being bundled up, fed into a deep sleep, or rocked into dreamland.

Now, of course, that's the ideal. This minimalist bedtime approach is often easier said than done, since some infants are a lot more challenging than others where sleep is concerned.

So back to our original question: Is swaddling OK for sleep promotion?

And, here's the answer: perhaps … for younger infants … if done correctly.

Experts at the American Academy of Pediatrics helped develop guidelines for child care providers in the document Caring for Our Children.

These guidelines state that, "Even with newborns, research does not provide conclusive data about whether swaddling should or should not be used."

Guideline authors note that the possible benefits of swaddling include decreased crying, increased periods of sleep, and improved temperature control.

Swaddling risks are generally linked to the use of improper swaddling techniques. As one example, if swaddling layers are excessive, babies may overheat.

There is also some concern about an increased risk of sudden infant death syndrome (SIDS) if, contrary to the recommended "back to sleep" position, a swaddled infant is put to sleep on his/her stomach, or if a swaddled child rolls from back to stomach during sleep time.

Babies soon figure out how to roll over on their own, so the child care guidelines advise using swaddling, "less and less over the course of the first few weeks and months of an infant's life."

The authors also find that if little legs are kept tightly wrapped together in an extended position that some swaddled babies also face an increased risk of developmental dysplasia of the hip.

It turns out that babies need to make like Elvis and be allowed to freely move their hips for healthy joint development.

In an article in the British journal Archives of Disease in Childhood, orthopedic specialist Professor Nicholas Clarke notes that even when swaddled, infants should be able to bend their legs "up and out" at the hips.

For tips and a video on proper, hip-healthy swaddling, follow the link to the International Hip Dysplasia Institute site: http://hipdysplasia.org/developmental-dysplasia-of-the-hip/hip-healthyswaddling/.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights