By Susan Klemm, MS, OTR/L and Stacy Conder, PT. 

While swaddling isn’t for every baby, it is a helpful tool for many.  Prior to birth, neonates are in a very snug environment for many weeks.  There is compression created by fluid and the walls of the uterus.  Going from this environment to the birthing process is a HUGELY physical process, be it vaginal or cesarean.  

Infants arrive into a place where new sensory input abounds. Sound is no longer muffled; there are sensations of light and dark and shapes; the prior compression is gone except for when being held; and the baby is no longer head down so is experiencing gravity into multiple positions for the first time.  There are many other changes, but these are a few when thinking about why swaddling can be helpful for many infants.  

Perhaps the best way to describe it is that swaddling can be organizing for an infant.  When hungry or uncomfortable or just because, newborns cry.  When a newborn cries, arms and legs flail in random movements.  A very young infant is learning where their body is, they simply do not know yet that they have arms and legs, and they haven’t yet learned about where midline is.  When picked up, the baby gains a sense of organization from the compression that happens when being held.  Swaddling can also help some infants reorganize into a calm, alert state or a drowsy calm state to allow them to drift into sleep.  We will do another blog post on the details of swaddling and how to do it correctly, especially in relation to hip positioning, but this post is geared toward when, why and how to transition out of the swaddle.

Why are there products designed to “transition out of swaddling”?  

A common theme in our blog posts is that we try to educate parents on how heavily marketed to they are by baby equipment and product manufacturers, and how, as a new parent, one is in a vulnerable time of life.  We strongly encourage parents to look to experienced professionals for guidance, such as their child’s pediatrician or a pediatric occupational or physical therapist.  It may help to know that up until about 10 years ago there was not a phase of “transitioning out of swaddling.”  That is, a baby simply stopped being swaddled and several nights of sleep may have been disrupted until the baby adjusted to the change.  

In our experience, products such as the Merlin Magic sleep suit are designed to circumvent this process by deterring normal development and, for those infants that are vulnerable, exacerbating head shape issues.  The sleep suits are weighted and actively impede movement that leads to rolling.  

The marketing tells a parent that it is safer for a baby to remain on their backs longer.  It is combined with the notion that it’s a doable and realistic goal for a parent of a young infant to consistently have a full night’s sleep.  In our view, these concepts are detrimental to an infant’s development and a parent’s sense of confidence in their parenting.  Changes in sleep patterns are normal for many months of infancy and are related to various factors such as growth spurts, learning skills when awake that are exciting to the infant, and any changes in routine.

We are not minimizing the need a parent has for sleep.  The caregiving needs of a young infant are extremely demanding and we encourage parents to check in with themselves frequently and gauge their exhaustion level.  Parenting a young infant is a marathon of sorts (albeit exhilarating and joyful)!  It makes sense that if a product is promoted to be safer for your baby AND be a sleep aid designed so the parent can get more rest, it is alluring.  

If you are reading this, and you are using the Merlin and possibly questioning yourself, we invite you to stay on “When I knew more, I changed course” Avenue and stay off of “I’ve ruined my child and I’m a terrible parent” Highway.  Parenting is a constant course correction based on learning, making decisions, implementing changes, and then doing it all again as your baby grows and changes.  

We hope to help equip you with needed information and respect the decisions you make.

More about development being affected by weighted sleep suits . . .

Product descriptions often say that it is safer to delay a baby from rolling so that the baby sleeps on her or his back for a longer period of months.  This is in direct opposition to what the American Academy of Pediatrics recommends.

The AAP recommends stopping swaddling when a baby shows any signs of trying to roll over.  It further states that many babies start working on rolling at around 8 weeks of age.  Pre-rolling signs can be lifting feet up and down, rocking over to one side, and bringing hands to feet.

As occupational and physical therapists whose caseloads are full of infants every day, we strongly agree with the AAP recommendations from a developmental standpoint.  Developmentally supportive routines do not apply to when your infant is awake, they are just as important, albeit different, for a sleeping infant.  Drowsy and sleep states are a time when important practicing and experimenting with movement occurs.  

We frequently see infants at 6 or 9 months who come into our office for a developmental delay.  The baby may be sitting but needs to be placed into the sit position (not yet able to get to sitting from lying on the floor).  The baby is often not rolling or rolling a few times a day, not the hundreds of times a day that is desirable.  The baby is not crawling.  The baby is unable to get to a toy unless it is placed in easy reach in front of her or him. The baby is missing out on important problem-solving and frustration tolerance as they are not doing trial and error motor planning (“how do I get to that piece of lint I see on the floor over there?”).  

It’s not unusual for a baby to come in with arms outstretched from her or his sides (a scarecrow position).  This arm position remains, regardless of how the baby is moved.  When we see these characteristics, a first thought for an occupational or physical therapist is to wonder how the baby is sleeping.  That’s how important sleep positioning is to development.

How can a weighted sleep suit affect head shape?  

The routines that best support development also support head shape.  So if a baby has a preference for turning one way, the baby will then nestle more deeply into that side when in a weighted sleep suit.  It becomes more difficult for the baby to overcome the preferred side.  

Day time routines of tummy time and sidelying while supervised and very important.  Positioning when asleep is equally important.

See this post for information on which infants are more vulnerable to head shape issues.

Specific sleep suits to avoid: 

We give a thumbs down to the Merlin Magic Sleepsuit.  We consider the Nested Bean to be better, yet still not recommended.  There are probably others on the market or soon to be released.  The basic concept of impeding rolling is one that is not the best for development and head shape in those infants that are vulnerable, therefore any sleep sack that is weighted would not be recommended. Instead of moving from a swaddle to a sleep suit, consider moving away from swaddling altogether.

So how do I stop swaddling?

Around 8ish weeks, when you notice signs of pre-rolling, it’s time to remove the swaddle.  If your baby is sleeping well, it’s normal to feel hesitant about removing it!  There are two strategies, both support development equally so choose the one best for you and your situation.  Whatever you choose, the worst-case scenario is generally three days of disrupted sleep and then a new normal begins. 

Strategy 1:  On Day 1, remove an arm from the swaddle.  On Day 2, remove both arms from the swaddle.  On Day 3, remove the whole swaddle and begin sleeping in something like the Halo arms out sleep sack  Wearable Blanket 100% Cotton | Jungle (halosleep.com).

Strategy 2:   Remove the swaddle on Day 1 and begin sleeping in something like the Halo arms out sleep sack Wearable Blanket 100% Cotton | Jungle (halosleep.com)

Note:  When we recommend a product, please note that Carolina Kinder Development has no financial relationship to any products.

A parent at our clinic recently sent this text (note that the parent is also a PT):

“Oh my goodness you were so right.  It was exactly 3 days of chaotic sleep and now she sleeps beautifully in a plain sleep sack.”

For the most part, it takes a baby a maximum of three days to adjust to changes in routine.

We hope there is something to help you in this article.  We love comments and questions!