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Swaddling and SIDS

The ancient practice of wrapping babies tightly in a cloth is becoming more popular, as it is thought to quieten distressed infants, particularly those undergoing postnatal drug withdrawal. However there have been concerns that swaddling might increase the risk of sudden infant death syndrome (SIDS). A literature search and meta-analysis came up with only four suitable papers (two of which came from the authors' Bristol-based unit) (Pease A, et al. Pediatrics 2016. doi:10.1542/peds. 2015-3275). All were observational studies involving confirmed SIDS cases where sleeping position and other circumstantial factors were compared with surviving matched controls. The studies spanned a time period (1988–2006) over which recommendations changed from prone to supine sleeping. There was thus considerable heterogeneity, and they felt able to meta-analyse only three studies. They used a fixed-effects model to compute a modestly increased SIDS risk in the swaddled babies (OR 1.38; 95% CI 1.05–1.8). Sleeping position was important: the highest risk was for prone (OR 13.0) followed by side (OR 3.2) and supine (OR 1.9). This is double the positional risk increase seen in unswaddled babies. Swaddling did not appear to protect from SIDS by preventing babies from rolling on to their fronts. …

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