The effect of swaddling on infant sleep and arousal

In reporting the findings of a systematic mixed-methods review narrative synthesis is an effective approach for explaining potentially conflicting outcomes. Where contradictions arose, our goal was to ascertain epistemological explanations.

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Preliminary synthesis

An initial list of 171 studies was retrieved from the initial searches. Studies were assessed against the inclusion criteria with 115 discarded following title review. A further 43 were discarded following a review of abstracts, and 7 were discarded following review of full text. At each stage reviews were conducted by the first author and verified by the second author with discussion of any discrepancies. Where two publications reported on the same study (19, 20) (confirmed by contacting authors) the information extracted was combined as a single study (20), meaning 6 studies met the inclusion criteria (see ).

The six studies that met the inclusion criteria all used swaddling as their primary intervention and measured infant sleep and arousal outcomes, but varied in their approach to study design and setting. Richardson et al. (20), Meyer and Erler (21), and Narangerel et al. (22) each sought to evaluate the effects of swaddling on different stages of infant arousability, although Narangerel et al. (22) narrowed their focus to respiratory rate and oxygen saturation. The remaining studies, sought to ascertain the effects of swaddling on the temporal nature of infant sleep and arousal. Three studies (20&#;22) used clinical measures such as polysomnography to assess sleep and arousal while the other three studies (11, 23, 24) were conducted in a home setting and used participant self-report instruments (see ).

Table 2

Richardson et al Narangerel et al Meyer and Erler McRury and Zolotor Kelmanson Öztürk and Bayik Randomised controlled trialXXQuasi-experimentalXXXXOutcomes assessed byObjective measurementObjective measurementObjective measurementSelf reportSelf reportSelf reportPeriod of sleep (nocturnal or diurnal) statedXXXXXStudy environmentLabHomeLabHomeHomeHomeSwaddle technique detailedXXEnvironmental temperature detailedXXFeeding method detailedXXSwaddle tightness measuredOpen in a separate window

The main findings identified from two clinical studies (20, 21) and one self-report study (24) were that swaddling of infants naïve to the intervention was associated with decreased arousal and increased sleep duration. These findings were consistent across nocturnal and diurnal sleep periods. However, two self-report studies did not report any difference in duration of crying or sleeping as a result of swaddling (23) or of any effect of swaddling upon &#;infant sleep disturbances&#; (11). The remaining clinical study (22) did not report any measurable effect of swaddling on SaO2 or respiratory rates. The authors of two studies (22, 23) cited Type II Errors as explanations for not reporting significant outcomes.

Discrepancies between studies

A key factor explaining the discrepancy between study outcomes is the study environment. Two of the three studies detecting measurable outcomes for swaddling (20, 21) were conducted in the controlled environments of sleep laboratories. Those studies that did not report measurable outcomes were conducted in home settings. The only home study to report a measurable outcome (24) did not isolate swaddling but combined it with other interventions simultaneously (holding on side or stomach, shushing, and swinging).

Study population characteristics may also explain the heterogeneity in findings. Narangerel et al. (22) compared swaddled to non-swaddled infants, but did not report whether the swaddled infants were habituated or naïve (unaccustomed) to swaddling. While Richardson et al. (20) found significant outcomes for sleep and arousal in infants naïve to swaddling, this study did not report a significant outcome for routinely swaddled infants. Kelmanson (11) focused only on routinely swaddled infants and did not report significant sleep outcomes. The habituated vs. naïve dichotomy may also explain why McRury and Zolotor (23) did not report significant outcomes, however the latter study did not verify whether the intervention was actually applied. Mothers in the intervention group may have decided against using the intervention, while those who implemented it may have done so using different techniques.

Differences in data collection methods (physiological vs. self-report measures) may also account for the inconsistent outcomes. The self-report studies used bespoke questionnaires (11) and diary methods (23, 24). These are vulnerable to the subjective perceptions of the participants, making it difficult to combine and synthesise the results with those of the other studies. They highlighted a strong discrepancy between maternal perceptions of swaddling effectiveness and physiological markers of effectiveness. Thus, if a sensitivity analysis was conducted in which self-report studies were excluded from the review, swaddling would appear to have an impact upon sleep and arousal in naïve infants. That Narangerel et al. (22), a physiological study whose sample consisted entirely of routinely swaddled infants, did not report significant outcomes would support this hypothesis.

Parents all have the same hope for their newborns when venturing home from the hospital: Please, let this one be a sleeper!

From shushing to rocking, amid many mom tricks for getting babies to sleep, there are a few dangers, too. The American Academy of Pediatrics (AAP) warns against having loose blankets or sheets in the crib with babies younger than 12 months of age, which is a hard sell for parents who innately want to keep their kids cozy and warm.

Enter swaddle wraps.

By wrapping a baby snugly and safely, the best swaddles keep a newborn baby calm and create a perfect recipe for a good night&#;s sleep for both baby and parent.

Starting at the hospital and continuing at home, our mom testers spent the first three months of their babies' lives testing every type of swaddle imaginable. During this experience, they determined the best swaddle is the Happiest Baby Sleepea (available at Amazon) . It&#;s tight, easy to get on and off a baby, easy to change a diaper in, and just great all around.

If you&#;re looking for a swaddle that can grow with your baby, we highly recommend the Halo Cotton Sleepsack Swaddle. This swaddle is what parents are often sent home with from the hospital&#;and with good reason. It&#;s breathable, easy to use, and features Velcro wings that safely tuck your baby&#;s arms to their sides.

Credit: Reviewed / Lisa Lawrence

The Sleepea was our overall winner for best swaddles.

Best Swaddle

Happiest Baby Sleepea 5-Second Baby Swaddle

The Happiest Baby Sleepea, designed by Dr. Harvey Karp, boasts itself as the world&#;s first 5-second swaddle. With its double zipper that can open from top or bottom, inner arm wrap with extra-quiet Velcro, and breathable cotton and mesh to reduce overheating, this swaddle was the number one winner for both of our summer babies.

This swaddle was a game changer, especially for babies who had several dirty diapers in the night during those first few weeks home. This swaddle allowed for easy diaper checks and changes and both babies settled into the swaddle almost by the time the zipper was up.

One of the babies slept so soundly in this baby swaddle that mom was reluctant to switch it up to continue testing. And the other, a veritable swaddle Houdini, failed to bust out of this swaddle even during an extra-long night of sleep. Overall, we have very few negative things to say about the Sleepea, and feel confident crowning it the best swaddle you can buy.

The Sleepea comes in three sizes&#;small (5-12 lbs), medium (12-18 lbs), and large (18-26 lbs)&#;and several adorable prints and patterns, and can be configured for arms-out sleep once babies start rolling.

Pros

• 100% organic cotton

• Extra-quiet Velcro

• Double zipper

Cons

• None that we could find

Buy now at Amazon

Credit: Reviewed / Kate Tully Ellsworth

The Halo Sleepsack is the best swaddle you can buy for transitions.

Most Versatile

Halo Cotton Sleepsack Swaddle

There&#;s a reason the hospital literally sent our babies home in a Halo&#;it&#;s the best. We used the Halo Sleepsack Swaddle for nighttime sleep for one of our baby&#;s first six months. She lives in a warmer climate, so breathability is incredibly important, especially for sleep. In this area, the Halo excelled&#;it&#;s lightweight, but still keeps babies warm and snug throughout the night.

The Velcro arms are incredibly easy to use. Once you zip up the sleep sack, you can pin baby&#;s arms down with the Velcro wings, tucking gently one at a time. The Velcro pad is so large that we never had an issue securing our babies; it always had a secure place for attachment. As a newborn, our tester didn&#;t stir when wrapped in her Halo.

Once she discovered she had the ability to move her arms (about 2-3 months), she was able to start breaking out of her swaddle, no matter how tightly we wrapped it. We didn&#;t mind as much when she was just trying to bring a thumb to her face, but it made us nervous when I&#;d check her on our Nanit and see the wings close to her mouth.

But what we love most about the Halo is its versatility&#;once she needed to start sleeping arms out, we could keep her in her favorite swaddle, just without her arms pinned. We love that you can still secure her around the chest and provide that feeling of security without worrying that she&#;d get trapped.

From a purely aesthetic perspective, we love how many colors and patterns this swaddle comes in. She slept in a &#;Finding Nemo&#; Halo for the first three months, then transitioned to these adorable hedgehogs.

Pros

• Comfortable, light fabric

• Variety of patterns

• Easy to use

Cons

• Bulky to wash

Buy now at Amazon
$29.99 from Walmart

Credit: Reviewed / Kate Tully Ellsworth

My summer baby absolutely loved her breathable swaddle from SwaddleMe.

Best for summer

SwaddleMe Luxe Perfect Temp Swaddle

The SwaddleMe Luxe Perfect Temp Swaddle is the same as our Best Value pick, but it has vents that provide for greater air flow if you live in warmer climates (or your baby&#;s a sweaty sleeper, like one of ours). One of our babies was born in a hot Tennessee summer, so she needed a swaddle that would keep her pinned, but not cause night sweats. Her mom called this the best swaddle any Southern baby could have.

Four breathable slits sit on the front and back of this swaddle, while a large horizontal slit falls across the lower back. Each helped keep our babies cool during those sweltering nights. The easy-access zipper bottom also made diaper changes breezy.

Unlike the standard SwaddleMe swaddle, this one only comes in one design&#;green basket weave. If you&#;re looking for function, this swaddle will do the trick&#; but if you care about cute designs, this one doesn&#;t offer variety.

The Velcro attachments also left a bit to be desired. There are two circular pieces that attach to a larger Velcro base, but the circles often extend past the adhesive pad, meaning they&#;d only be half attached and easy for a baby to break out of.

Pros

• Breathable

• Helps control sweating

• Easy to use

Cons

• Limited patterns

• Velcro pad too small

$24.20 from Amazon
$47.87 from Walmart

Credit: Reviewed / Lisa Lawrence

SwaddleMe makes great, affordable swaddles.

Best Value

SwaddleMe Natural Position 2-in-1 Swaddle with Easy Change

Like the winning swaddle, the SwaddleMe is secure and does a good job of preventing the startle reflex that will wake your baby. This wearable blanket is slightly more versatile than our top pick, in that you can swaddle your little one with their arms over their chest or by their sides.

All our babies started the night with their hands by their sides, but worked them up towards their chests as the night went on. But they all stayed asleep, which is what mattered.

Our swaddle Houdini did manage to bust out of the SwaddleMe once she hit the 3-month mark, but this kept her securely compressed during the early days.

The material is soft and durable, the designs are cute, and a bottom zipper makes for quick, and unobtrusive diaper changes no matter the hour. With a low price point, this swaddle is a really solid, budget-savvy purchase to have in your sleep arsenal.

Be warned, however, that over time, the Velcro may break down due to being washed.

Pros

• Tight and secure

• Versatile

• Allows for some arm movement

Cons

• Velcro pad too small

• Babies can break out

Buy now at Amazon
$14.99 from Walmart

Other Swaddles We Tested

Halo Micro-Fleece SleepSack Swaddle

If you live in a colder climate, you&#;ll love the Halo micro-fleece swaddle, which zips up like a little suit and then has two wings that cross over the front with Velcro. Of all the swaddles we tested on cold nights, this was our baby&#;s favorite. In fact, both test babies slept so well in this swaddle that both moms had to make sure they were breathing. One family took this swaddle camping and found it to be a perfect way to keep baby warm in 40 degree temperatures. As a bonus, one of our test moms used this with her son three years ago, and it&#;s held up well enough to be used for her daughter now, too.

However, this one had some drawbacks. It&#;s incredibly warm, so unless you&#;re in a cooler climate, it&#;s not advisable to use (the AAP notes that overheating is a risk factor for SIDS).

Our testers also found this swaddle bulky&#;it&#;s got a sleep sack and two large Velcro arms, all made from fleece. It also tended to attract other clothing in the washing machine, like socks, shirts, and onesies, so be ready to pull things off of it once it&#;s out of the dryer.

Pros

• Material is soft

• Affordable cold weather option

Cons

• Bulky

• Velcro is loud

• Too warm for everyday use

Buy now at Amazon
$29.99 from Target
$29.99 from Walmart

Ollie Swaddle

If you use social media, chances are you&#;ve seen the popular Ollie Swaddle featured in Instagram ads and on influencer&#;s accounts. Was it the best swaddle we tried? Not quite.

We felt pretty neutral about the Ollie Swaddle&#;s fit and fabric. It comes with a carrier/delicates wash bag and simply folds across your baby&#;s body tightly with heavy-duty (loud) Velcro, like a little straight jacket. It can also be adjusted by tying off the end, so it can fit a baby of any age. And because it can be shifted downwards, it can transition as your child ages and needs their arms free.

Our test baby managed to get her tiny fists out of this swaddle every so often, no matter how tightly we cinched it together. Plus, again, the Velcro is loud. But if you need to change a diaper in the night, you can do so without causing too much of a ruckus, and the material is soft and stretchy.

It wasn&#;t our favorite in the bunch but it&#;s worth trying if your baby resists traditional swaddles. However, it was also one of the pricier options as well.

Pros

• Soft material

• Simple design

• Makes for easy diaper changes

Cons

• Hard to cinch tight enough

• Loud Velcro

Buy now at Amazon

Summer Infant SwaddleMe Pod

Like the SwaddleMe Original, this swaddle is made with breathable cotton and the price is hard to beat. The SwaddleMe Pod zips up the front, containing the baby tightly in a bodysuit. The zipper is two-way meaning it extends to the bottom making midnight diaper changes easier.

One of our newborns loved this option, although after about a month she quickly learned how to move her hands from her sides up to the top, where they&#;d peek through by the end of a nap. Another of our newborns, however, made it through one&#;and only one&#;nap in this swaddle. She kept herself awake by moving her arms all around the inside of the sack, which did a poor job of keeping her arms pinned to the side.

The material is also less durable and may start to pill after many washes. Unlike the other swaddles on this list, it doesn&#;t transition to arms-out sleep, so the shelf life is limited&#;you&#;ll really only be able to use this for about one to two months, at which point you can graduate to a transition swaddle which SwaddleMe also makes but is a separate purchase.

Pros

• Easy to use

  The company is the world’s best Personalized Swaddle Blanket supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.

• Compressive for baby

• Breathable material

Cons

• Not durable

• May not work for older babies

Buy now at Amazon
$30.39 from Walmart

Aden + Anais Essentials Easy Swaddle

You can snag a pack of Aden + Anais Swaddle Wraps for a great discount at Target, but when it comes to usability, these were solidly in the middle of the pack.

Our babies easily busted free from the swaddles, the Velcro arms didn&#;t fit too snugly, and they took quite a bit of maneuvering to keep arms at bay. When you hit the exact right balance of arm placement and Velcro security, they worked just fine&#;but nine times out of 10 that didn&#;t happen, especially if we were moving quickly.

You can snag some cute designs from this line, and these swaddles are available in packs of three or five both with or without a bottom zipper. Overall, we found them to be better than just loose blankets, but ultimately, you&#;d be better off shopping from Halo or SwaddleMe.

Pros

• Affordable

• Cute patterns

Cons

• Velcro hard to clasp

• Easy to break out of

Buy now at Amazon

Aden + Anais 47" Classic Swaddle Set 4-Pack

These versatile swaddle blankets are made of muslin cotton and are extremely soft. We tested them as a swaddle blanket and eventually got pretty good at getting our babies wrapped nice and tight, but there&#;s certainly a learning curve.

Compared to the other options we tested, both babies were able to bust out of these swaddles much more easily, especially as they got older.

The classic Aden + Anais swaddles are soft, breathable, and only get better the more you wash them. Even if you don&#;t use them to wrap up your baby, we think everyone should have a couple of these blankets to use as a throw over the car seat during a spontaneous nap, an extra layer on breezy stroller trips, or for a quick picnic.

Pros

• Durable

• Versatile

• Extremely soft

Cons

• Not escape-proof

• Requires learning curve

Buy now at Amazon

Norani Snugababe Swaddle

Billed as a nearly inescapable swaddle, the Norani is a bit complicated: You put baby&#;s arms in what are essentially wings, then fold the bottom like a traditional swaddle and secure the rest of the fabric across their body.

While this setup does keep the baby strapped in tight, the whole process is a bit complicated if you need to execute it in the middle of the night (though the zipper bottom for diaper changes was a thoughtful touch). We also found the swaddle to be bulky with tons of extra fabric&#;probably ideal for larger babies, but also too much fabric for most babies under four months old, which is when you&#;d stop using it.

Overall, we wanted to like this&#;and we loved the prints and fabric!&#;but it was a bit too much for a process that needs to be simple.

Pros

• Cute prints

• Quality fabric

• Hard for baby to escape

Cons

• Too complicated

• Too much fabric

Solly Baby Swaddle

We&#;re big fans of the Solly baby wrap, which allows you to wear your baby around via a soft Tencel carrier that you wind around your body. The swaddle is made with the same breathable material, and comes in twenty-four beautiful hues, but you have to learn how to swaddle tightly and our baby managed to get out of the blanket over and over again.

That said, it is a lovely, soft blanket to have around the house&#;and is useful as it can double up as a car seat cover, nursing cover or quick blanket&#;but it&#;s a bit too simple of a swaddle for the price.

Pros

• High quality material

• Versatile

Cons

• Learning curve

• Tough to make tight enough

Buy now at Solly Baby

How We Tested the Best Swaddles

The Testers

Ilana Cohn is a writer and performer living in Los Angeles, and she used to run a podcast called, &#;Yer Mama.&#; She loves reading about the latest baby gear and sharing her opinion, so she was excited to have the opportunity to review products with baby number two, starting from day one.

Jenni Gritters tested swaddles on her second child, Lily Ray, who was born mid-summer and was a tenacious tester, escaping most of the swaddles she tried. Jenni previously worked full time as an editor at Wirecutter, and she now reviews all kinds of gear for Wirecutter, Reviewed, Forbes, Slate and beyond.

Kate Ellsworth is the Executive Editor of Lifestyle at Reviewed and her baby girl, Vivienne, was more than excited to try out a bunch of swaddles, especially when they had fun designs. Vivienne was born in the summer with the heart of a dancer, so she was adept at breaking out of even the tightest wraps.

The Tests

Over the course of the first three months of our baby&#;s lives, we tried out many different swaddles. We would test each swaddle through at least two sleeps and we revisited each a month later. We wrote down the results as they were happening because as anyone who has a newborn knows, those first few months are a whirlwind of feed, burp, change, sleep (hopefully) and repeat.

To find the best swaddle, we looked at the fabric quality, ease of use, special features, storage, fit, comfort, ease of wrapping and adjustability, ability to change a diaper and overall experience.

We looked at several types of fit, as well, including Velcro wraps, traditional swaddle blankets, and more unique offerings (like the Ollie).

We also washed each swaddle in the laundry along with other clothing to see how the fabric changed with each wash and which got stuck to each other (spoiler alert: if it had Velcro, it got stuck to something).

What To Consider When Buying the Best Swaddle

Credit: Reviewed / Kate Tully Ellsworth

Here's what you need to know about buying the best swaddles.

Why Should You Swaddle A Baby?

By immobilizing the baby's arms, a swaddle helps minimize their natural Moro&#;or startle&#;reflex, which can interrupt their (and your!) slumber, thereby helping everyone sleep longer.

Because the best swaddles mimic the feel of the womb&#;a warm, compact environment&#;they help calm a baby's anxiety, and ultimately help them to learn to self-soothe.

In addition, swaddles help prevent SIDS by keeping a baby on their back while they sleep and ensuring that there are no loose blankets in the crib

Swaddles may also help soothe colicky babies.

Do You Have to Swaddle a Newborn?

While swaddling works for most babies, every newborn is different. If your baby has hip dysplasia or any other hip problems, a tight swaddle may not be comfortable for them.

Other babies may prefer being swaddled with their arms placed across their chest, or with their arms outside the swaddle. As with much of parenting, finding the right swaddling method for your particular baby may take some practice.

How Many Swaddles Do I Need?

Newborns spit up&#;and poop through their night diapers&#;often. You'll very likely be faced with having to change your baby's swaddle several times a night. Don't put yourself in the position of being without a clean swaddle when you're most desperate for sleep.

Once you find one that works for you, invest in at least three of them so that you'll always have a clean one on hand.

If you go to daycare, you&#;ll also need to invest in a swaddle to send along with your baby. Most daycares won&#;t allow blankets under one year, nor do they allow swaddles without arm holes, so it may be worth investing in one of our favorite swaddles that can transition to arms-out sleep.

When To Stop Swaddling

You should stop swaddling your baby once they begin trying to roll over, as this may increase the risk of suffocation. This usually occurs around two months of age, but all babies develop on their own timeline.

Once your baby begins to roll over, you can transition them to a sleep sack, which provides many of the same benefits as swaddles, but enables their arms to be free

Thankfully, many of our favorite swaddles can ease that transition. The Halo Sleepsack is our favorite versatile choice. It allows your baby to sleep with their arms free, but keep that tight feeling around her chest so she feels more secured.

What Is The Best Fabric For A Swaddle?

This is going to depend on where you live. If you live in a temperate climate, a lightweight cotton swaddle may be adequate for your baby at anytime of the year.

On the other hand, if you have a winter baby and live in a cold area, a fleece swaddle&#;like the Halo&#;may be the best option for keeping your newborn warm and toasty.

No matter where you live, remember to never put extra blankets in the crib with your newborn, as they can increase the risk of SIDS.

What TOG Swaddle Should I Buy?

If you&#;ve been shopping for swaddles, you&#;ve likely noticed a TOG rating. The TOG&#;thermal overall grade&#;helps you determine which thickness is best for your baby. If you&#;re in a cooler climate, you want a higher TOG; if you&#;re in a warmer climate, you want a lower TOG. The higher the TOG, the warmer the fabric will be.

The highest TOG we tested was the Halo Fleece Sleepsack, which comes in at 3.0. The Halo website recommends it for sleep environments between 61 and 64 degrees (not outside&#;physically within your nursery).

The AAP warns against overheating, which can be a risk factor for SIDS. So while you can use a heavier swaddle for chilly nights, you should not dress your baby in more layers than necessary. Ideally, the agency recommends putting babies in no more than one more layer than an adult would wear.

If your sleep environment runs warmer, opt for a lower TOG. You should also use a lower TOG if you&#;re layering a swaddle on top of warmer pajamas. You wouldn&#;t want to use a fleece swaddle on top of fleece pajamas, but you could put a TOG 1.5 swaddle over fleece pajamas.

How to Swaddle a Baby Using a Blanket

Credit: Aden + Anais

Here's how to wrap a baby in a swaddle.

Step 1: Lay the blanket out on a flat surface and fold down one of the corners.

Step 2: Lay your baby face-up on the swaddle blanket, with their head just above the folded corner.

Step 3: Making sure that your baby's arm is positioned straight down by their side, wrap the right corner over your baby, and tuck the end underneath them.

Step 4: Bring the bottom corner of the blanket over your baby's feet and tuck it underneath their bottom.

Step 5: Wrap the left corner over your baby, again ensuring that their arm is positioned straight by their side, and tuck the end of the swaddle blanket underneath the baby's bottom.

Still lost? We recommend YouTube. Something about watching the process can help it click in your brain. Aden + Anais has a great tutorial video on its website.

How to Transition Out of a Swaddle

Credit: Reviewed / Lisa Lawrence

Once your baby reaches six months, you should transition from a swaddle to a sleep sack.

The AAP recommends ditching the swaddle as soon as your little one can roll, but that&#;s so much easier said than done, especially if that swaddle is the only thing that seems to help them sleep. As with all sleep-related baby advice, there is no one golden rule all babies abide by&#;you can follow these tips to make the transition easier, but ultimately, every baby is unique, and how they tolerate life after the swaddle will vary.

First, we recommend using a swaddle that can transition with your baby, like the Halo Sleepsack. That way, once they do need to start sleeping with their arms out, they are still sleeping in a swaddle or sack that looks, feels, and smells familiar. If you&#;ve been using a swaddle like the SwaddleMe Pod, consider transitioning to a different swaddle around two months, right before those first rolls start.

Between two and six months, your baby can stay in that swaddle if her arms are free. Most swaddles that allow for arms-out sleep come with guidelines about how to re-wrap your baby with one or two arms out, so keep those instructions handy even if your baby is just a few weeks old at this point.

After six months, you&#;ll have to say goodbye to even the best swaddles. It&#;s time to transition to a sleep sack, or a wearable blanket. Halo makes a 0.5 TOG sleepsack that one of our babies is obsessed with. Burt&#;s Bees Baby also has a great sleepsack for taller babies.

Once your baby crosses that one-year mark, you can start introducing blankets.

For more Custom Made Baby Clothesinformation, please contact us. We will provide professional answers.

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