In the article by Blair et al. (BMJ;339:b2009), swaddling was found
to be a risk for cot death. It is noteworthy that up to now the added risk
of swaddling has been limited to infants lying prone. The added risk
associated with supine swaddled infants is a new finding that needs more
in depth research. Twelve swaddled SIDS infants were placed supine, 4 in
side position and 3 prone. Seven of the 19 infants were at high risk
because of their position already (prone or side). Detailed information on
other possible hazardous circumstances and interactions between predictors
in relation to swaddling is lacking, such as swaddling cloths over the
face, if the swaddles were too tight or too loose (tight swaddling can
impair lung function)1. Finally of course, swaddling may be dangerous for
infants, for an unknown reason.
Swaddling can be applied in various ways and there are large cultural
differences2. Were the cases and controls swaddled similarly (swaddled or
wrapped; one or two pieces of cloths)? Are there differences between the
way that infants are swaddled in the U.K. and elsewhere, that might
account for this new finding? There have been several studies that have
shown swaddling to actually decrease the risk2. These questions need be
answered before a definitive judgement can be made.
1. Thach BT. Does swaddling decrease or Increase the Risk for Sudden
Infant Death Syndrome? J Pediatr 2009;155:461-2
2. Sleuwen BE van, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen
TWJ, L’Hoir MP. Swaddling – a systematic review. Pediatrics 2007;120:e1097
-1106
Rapid Response:
Swaddling and cot death risk
In the article by Blair et al. (BMJ;339:b2009), swaddling was found
to be a risk for cot death. It is noteworthy that up to now the added risk
of swaddling has been limited to infants lying prone. The added risk
associated with supine swaddled infants is a new finding that needs more
in depth research. Twelve swaddled SIDS infants were placed supine, 4 in
side position and 3 prone. Seven of the 19 infants were at high risk
because of their position already (prone or side). Detailed information on
other possible hazardous circumstances and interactions between predictors
in relation to swaddling is lacking, such as swaddling cloths over the
face, if the swaddles were too tight or too loose (tight swaddling can
impair lung function)1. Finally of course, swaddling may be dangerous for
infants, for an unknown reason.
Swaddling can be applied in various ways and there are large cultural
differences2. Were the cases and controls swaddled similarly (swaddled or
wrapped; one or two pieces of cloths)? Are there differences between the
way that infants are swaddled in the U.K. and elsewhere, that might
account for this new finding? There have been several studies that have
shown swaddling to actually decrease the risk2. These questions need be
answered before a definitive judgement can be made.
Bregje van Sleuwen (PhD)
Monique L’Hoir (PhD)
Bradley Thach (MD) (Prof)
1. Thach BT. Does swaddling decrease or Increase the Risk for Sudden
Infant Death Syndrome? J Pediatr 2009;155:461-2
2. Sleuwen BE van, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen
TWJ, L’Hoir MP. Swaddling – a systematic review. Pediatrics 2007;120:e1097
-1106
Competing interests:
None declared
Competing interests: No competing interests