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August 13, 2019

To Swaddle or Not to Swaddle

Sleep baby

New views on swaddling via the National Resource Center For Health and Safety in Child Care and Early Education.

The state of Indiana has updated their child care provider licensing requirements around safe sleep. As on July 1, the new safe sleep guideline is that infants can no longer be swaddled in child care settings.

This update is based on both national recommendations and pediatric research. New findings show that swaddling can increase the risk of serious health outcomes. It can also be a risk factor for developmental dysplasia of the hip, child overheating and sudden infant death syndrome (SIDS).

What this means for parents with infants in child care programs:

    • Providers can no longer swaddle any infant.
    • Sleep sacks may still be used, but they cannot have any swaddling pieces attached to them.
    • Families should continue to expect child care providers to adhere to safe sleep practices.

What families can look for in provider settings:

Is the program licensed or registered?

All programs working with infants that are licensed and registered have to comply with safe sleep practices. And they get oversight from the state to make sure they do. Family child care homes that care for five or less children don’t have to be regulated or licensed. If a program is not licensed, they aren’t getting visits from external parties to check on their practices. Illegally operating facilities are less likely to practice safe sleep. The vast majority of infant deaths in child care happen in those unregulated settings.

Did you know documentation of health and safety orientation training is required for all caregivers including teachers, directors in child care centers, child care homes licensees, volunteer caregivers, and anyone else included in the child-staff ratio? Click here to learn more about identifying quality care in Indiana.

Does the program have a safe sleep policy?

Licensed and registered providers are required to have a safe sleep policy that is part of both their family handbook and their staff handbook. One way to know if your provider’s safe sleep policy is a good one is comparing it to the American Academy of Pediatrics (AAP) recommendations and guidelines for safe sleep. If your family chooses an unregulated setting, they may also have a safe sleep policy. Either way, asking to see the policy and about staff training is a good idea.

Is the staff trained in safe sleep practices?

Safe sleep training is now required for all staff in child care programs that work or might work with infants. Each program should have a Safe Sleep Certificate on file. At a safe sleep training, early education staff learn what SIDS (sudden infant death syndrome) is and also what accidental suffocation is. Staff learn how to avoid situations associated with SIDS or accidental suffocation. They learn of risk factors associated with SIDS and about the aspiration myth: the idea that if an infant sleeps on their back they are more likely to choke when they throw up — that idea is not true.

Safe sleep environments protect children from harm. Read more about what child care providers should be doing to keep your tiny dreamer safe and sound.

  1. Pease AS, Fleming PJ, Hauck FR, et al. 2016. Swaddling and the risk of sudden infant death syndrome: A Meta-analysis. Pediatrics;137(6):e20153275.
  2. Richardson, H. L., A. M. Walker, R. S. Horne. 2010. Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants. J Pediatrics 157:85-91.
  3. Contemporary Pediatrics. 2004. Guide for parents: Swaddling 101.
  4. Van Sleuwen, B. E., A. C. Engelberts, M. M. Boere-Boonekamp, W. Kuis, T. W. J. Schulpen, M. P. L’Hoir. 2007. Swaddling: A systematic review. Pediatrics 120:e1097-e1106.
  5. Mahan, S. T., Kasser J. R. 2008. Does swaddling influence developmental dysplasia of the Hip? Pediatrics 121:177-78.
  6. Franco, P., N. Seret, J. N. Van Hees, S. Scaillet, J. Groswasser, A. Kahn. 2005. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 115:1307-11.

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