A Physical Therapist’s Guide To Swaddle Use

Swaddling has been used off and on for many, many years. During the 1990s-2000s it became increasingly popular to help keep babies from startling when put to sleep on their back with the “Back to Sleep” campaign.

Now, this is an absolutely judgement free zone. As a mom, I swaddled my firstborn for all of his nighttime sleep and often during naps. I bought every swaddle out there thinking it would miraculously “make him sleep.” I noticed my son startling well past the 6 month mark when the Moro reflex should have been fully integrated. He had body tension, head turn preference, and significant oral dysfunction with difficulty breastfeeding for the first ~3 months of life. Hindsight is 20/20, of course.

I knew enough as a PT to treat his torticollis/head turn, but did not even truly consider the negative impact swaddling him could and would have on his already tense body. I worked hard during wake windows to treat his tension, but essentially made it worse during sleep.

Fast forward…

My daughter was born about 3 years later, and I used a swaddle a handful of times, and only wrapped it around her trunk, allowing her arms to move freely. She startled, but not for long, and I never noticed it happening past about 2 months of age.

WHY?

The Moro reflex is present at birth. It is a protective reflex causing a baby to essentially cling to a caregiver when startled by a loud noise/bright light, feeling like they’re falling, or moved abruptly. It should lessen between 2-4 months and be completely integrated (or absent) by 6 months old.

As a pediatric physical therapist, I have seen babies being swaddled at 4-4.5 months and they have a lot of difficulty transitioning out of the swaddle because of an overactive Moro reflex.

So… what do I recommend?

We have to allow the reflex to occur to be able to timely integrate. In a sense, by swaddling, we are reducing the babies’ ability to experience this NORMAL protective reflex and making it more challenging in the long run. I recommend a swaddle that is “transitional” like the Halo Swaddle Sack (linked below) where you can remove one arm at a time before transitioning to both arms out. This is best done within the first 8 weeks of life. This way, you have transitioned completely out of the swaddle well before the time baby should begin rolling. A slower transition versus having to remove a swaddle cold turkey is going to go more smoothly, for most babies, and be less stressful for families.

Halo Swaddle Sleep Sack - Amazon Link (click on photo above)