Does Swaddling Cause Sensory Processing Disorder (SPD)?

(Hint:  No, it does not!!)

Swaddling has become a bit of a controversial topic these days. Some people and professionals are still using and recommending this age-old practice, and some have done a 180 and turned completely against it.

Historically, swaddling has been used all over the world, in various cultures, for thousands of years, with the goal of calming a baby, and reducing night wakings by promoting a deeper sleep.

Lately though, particularly here in our Western culture, there have been a lot of questions as to whether swaddling is safe or whether it is detrimental to a baby’s development.  And I have even been hearing and reading about some healthcare professionals saying that swaddling causes sensory processing disorder.  Eek!!! #saywhat?

Yup, scary, right?!  There are unfortunately some occupational therapists and likely other healthcare professionals who are taking the stand that swaddling causes Sensory Processing Disorder (SPD).  Their reasoning?  Because it prevents the Moro reflex from being expressed and thus integrated, which can lead to sensory sensitivities, which apparently then leads to Sensory Processing Disorder.

Holy cow!  Way to increase the overwhelm of motherhood and make moms feel like they may have caused their baby or child’s sensory processing difficulties. Oy!

I have been getting a lot of questions from friends, colleagues, and my mama clients, so I thought I would address this and hopefully ease your mind. Hopefully,  reducing the unnecessary fear (and overwhelm) around swaddling that these healthcare providers and even the various pediatric associations have created.

First of all, to make a long story short, if you have a child that has sensory processing disorder or differences, no, you DID NOT cause this in your baby or child.

And no, swaddling does not cause sensory processing disorder.

Now that your mind is hopefully more at ease, I want to unpack this a bit. 

But first let’s take a look at what swaddling is, what the pros and cons of swaddling are, and what the current recommendations are in terms of swaddling.

What is Swaddling?

Although swaddling styles vary across cultures, it is generally defined as wrapping an infant, usually with a light cloth (or now with more modern swaddling sleep sacs), with the arms held close and the head exposed.

As I mentioned, the purpose of swaddling in young infants (usually 8-ish weeks or younger) is to promote quieter sleep, fewer spontaneous arousals during this quiet sleep, and also reduce the excessive crying in infants. 

Other benefits can also be seen for specific populations, including improvements in neuromuscular development for very low birth weight infants,¹ reduced physiologic and behavioural distress among premature infants,² and improved calming and sleep for infants born with various additions.

Why is Swaddling Helpful?

In my opinion, with a clinical background as a pediatric occupational therapist with training in infant development, sensory processing, and primitive reflexes, swaddling can 100% have some benefits, depending on the baby and the circumstances.

Is it right for all infants?  No, probably not.

Will some babies calm and others fuss when swaddled, yes, most definitely.

This is why it is really important to arm yourself with the knowledge of the pros and cons. Ultimately, you need to tune into your unique baby and their cues, as well as your mama instinct, to make the decision on whether swaddling is right for your baby and your family dynamic.

From my perspective, based on development and neurobiology, here are 4 reasons why swaddling may be helpful:

1. The MORO reflex (aka startle reflex) is hugely active in newborns and does not get integrated until 3-4 months. Which means that every time the baby startles, it’s a large startle  and this often is what wakes them up.  The swaddle helps to prevent the reflex from being fully expressed to the extent of waking up the baby.
   
2. Babies are born with a c-shaped spine, and like the curled up, fetal position.  So putting baby to sleep on their back, in an extended position (ie. arms and legs out) is quite unnatural for them. Especially in those first few weeks of life outside the womb.  The swaddle, when done correctly, helps mimic this curled up, fetal position.
   
   
   In Europe, they actually recommend babies to be placed on their sides to sleep (and encourage switching sides each night). This helps baby keep that tucked flexed (fetal) position in which case, the swaddle is not needed or recommended.
   
   
3. Babies are used to the tight, squished, position and warmth of the womb. In this space, they are only able to move arms and legs a little bit before they hit the edge of the sac.  So when they are born, in that 4th trimester, swaddle can help to mimic this nice, warm, tight womb like space, which is part of the reason it helps them to calm…..the tightness of the swaddle also provides the deep pressure, which is also very calming and soothing.
   
   
4. Swaddling can help regulate a baby’s temperature – of course when it is done right. Think,  baby in a diaper or even just a short-sleeve onesie – rather than all the fleece pjs, etc.  Support for temperature regulation can be very helpful in the first few months of life, as babies are not really able to regulate their own temperature yet.

Differing Viewpoints for Swaddling

Okay, so now you might be nodding your head and thinking, yes, all of this makes sense, so why is swaddling such a controversial topic these days?

Some modern medical studies indicate that swaddling helps babies fall asleep and to remain asleep and helps to keep the baby on their backs, which is thought to lower the risk of sudden infant death syndrome (SIDS). However, one recent study indicated that swaddling increased the risk of SIDS, namely when babies are placed on their bellies or sides to sleep while swaddled.

I know that new guidelines are now coming out advising parents to no longer swaddle their child. But is this too big of a jump?   I think there are times when swaddling continues to be beneficial, especially when done properly (ie. not the straight jacket swaddle that seems to be going around).

It is true, that babies who are swaddled too tightly may develop a problem with their hips. The International Hip Dysplasia Institute indicates that studies have found that straightening and tightly wrapping a baby’s legs can lead to hip dislocation or hip dysplasia, an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.

The Pediatric Orthopaedic Society of North America, with the AAP Section on Orthopaedics, promotes “hip-healthy swaddling” that allows the baby’s legs to bend up and out.

They indicate that it is fine to swaddle your baby with some of the following conditions: 

• Make sure that the baby is always on his or her back when swaddled. 
• Don’t make the swaddle too tight to avoid   making it hard for the baby to breathe or move his or her hips. 
• Stop swaddling, when your baby looks like he or she is trying to roll over, .

The Canadian Paediatric Society (CPS) and the Public Health Agency of Canada do not have official statements on swaddling.

I do agree education is important to avoid serious concerns if swaddles are done wrong.For instance, swaddles shouldn’t be kept on baby throughout feedings (I definitely NEVER ever recommend this as it also affects digestion), and swaddles shouldn’t be kept on for longer than they should be (ie. when baby is not sleeping or needing the swaddle to help them calm), and there needs to be more education around proper and safe swaddling techniques.

I also recommend that swaddling be stopped once baby starts to roll, which is usually around the 3-4 ish month mark (or even earlier, around 8-10 weeks, when it might happen unexpectedly).

Okay, so by now you have developed some of your own thoughts about swaddling in general, but let’s get back to this idea that swaddling causes sensory processing disorder.  My clinical opinion and every bone in my body says, no!  But let’s take a look at some of the reasoning from these therapists and healthcare professionals.

Does Swaddling Cause Sensory Processing Disorder (SPD)?

As I mentioned before, the short answer to this is no.  Swaddling does not cause sensory processing disorder, so you can rest assured that if you have a baby or child that sensory processing difficulties, you DID NOT cause them (even if you swaddled them).

I mean really, if this were even a little bit true, then we would have a HUGE percentage of our population that was affected by sensory processing difficulties, all over the world in all different cultures, way more than what is currently the case. 

Why?  

Well, as you learned swaddling was a very common practice for many centuries, and continues to be a common practice today.  If it were true that swaddling caused sensory processing disorder, pretty much every child would have it.

Now, I have mentioned that a few therapists are talking specifically about swaddling and how it causes sensory processing disorder and their reasoning behind it.

While I sort of understand how and why they might come to such a conclusion, I wholeheartedly disagree with the way they are sharing  educating about it. Essentially scaring mamas into thinking that swaddling  has caused or will cause sensory processing disorder or difficulties.

One of the reasons provided is that swaddling inhibits the expression of the Moro reflex.  Now, the Moro reflex is our startle reflex and it is a primitive reflex. 

Primitive reflexes are reflexes that develop before or shortly after birth, within the first year, to equip baby with automatic movements, which will help with his/her survival in the first few weeks of life. Babies are meant ‘integrate’ (or get rid of, move past) these so that we can consciously control our movements.  These reflexes provide a foundation for all later functioning.

The Moro reflex in particular is very closely linked to our limbic system in the brain, and therefore our emotional health, as well as our ability to handle stress and regulate. This reflex serves as a baby’s primitive fight or flight reaction.  It is usually inhibited (or integrated) by around 4 months of life and replaced by an adult “startle” reflex.  

When the moro reflex is retained it becomes an automatic uncontrollable overreaction to any type of stimulus, therefore overriding the higher decision making centre of the brain. It can present as hyperactivity, extreme sensitivity to sudden movement, noise or light. It is also identified as contributing to sleeping problems, impulsive behaviours, inappropriate behavioural responses, food sensitivities, emotional and social immaturity, and even poor adaptation skills.

Now, all or some of these things can also be seen in children who have sensory processing disorder. And yes, there is some hypothesis and queries out there that sensory processing difficulties, in particular sensory sensitivities or defensiveness, can be traced back to having an unintegrated Moro reflex. 

I can get on board with this reasoning, to a certain extent. However, keep in mind that there is no conclusive or concrete evidence showing that having a non-integrated MORO reflex causes sensory sensitivities. We have to remember that sensory processing difficulties present in a wide spectrum of ways,  more than just sensory sensitivities or sensory defensiveness.  

I Iooked at this issue from my 12 years of experience as a pediatric occupational therapist working in the sensory processing world,  and the countless courses I have taken on sensory processing and reflex integration. I came to the personal conclusion that I believe the presence of a non-integrated MORO can be one of many factors that may contribute to sensory sensitivities.

One of the reasons for swaddling a baby is to temporarily inhibit this MORO or startle reflex so that a young baby is not woken up each and every time they startle (and express that MORO reflex), which could happen multiple times even in one hour.  We have to remember that babies, especially in that fourth trimester, find themselves in a totally new and different environment the second they are born.

They go from the nice warm, cozy, muffled, dark, and gravity free environment in the womb to the loud, bright, cold environment once they are born. And then they also have to contend with gravity.  

Swaddling helps babies feel similar sensory input to what they had in the womb – warm, tight and cozy with that deep pressure, and something for them to kick and stretch against.

And while swaddling may ‘inhibit’ the MORO while they are sleeping (or needing to be calmed), babies get plenty of time during a 24-hour period to be unswaddled – during diaper changes, feeding, play time and when parents or family are holding them.

And really, if we think about it even further, then baby-wearing could also be seen as ‘inhibiting’ the MORO reflex, as baby is held against your body and not fully expressing the MORO – and we all know the huge benefits to baby-wearing (I will leave that for another blog).

So while swaddling may inhibit the expression of the MORO reflex, it does not necessarily cause it to not be fully integrated. In fact, there is another reflex, called the Fear Paralysis Reflex (FPR), which integrates in the womb, that if this is not fully integrated upon birth can actually lead to the MORO not being able to fully integrate.
 

As per the Rhythmic Movement Training International research and training group, the FPR is more of a cellular response physiologically to stress with underlying triggers including: electromagnetic irradiation, environmental toxicity, heavy metal poisoning, food intolerance (especially to casein and gluten), underlying neurological or genetic conditions.  If this is not integrated, symptoms can include low tolerance to stress, and over-sensitivity to sensory stimulation (ie touch, sound, light or sudden changes in the visual field, vestibular or proprioceptive stimulation).

So as you can see, there could be various things that might contribute to sensory processing disorder. And a black and white statement like this one, that swaddling causes sensory processing disorder, or on any topic for that matter, is problematic.  

So Is It Safe To Swaddle Your Baby?

To answer this question, we first have to understand that all individuals, including all babies and kids, are different.

The American Academy of Pediatrics (AAP) says that when done correctly, swaddling can be an effective technique to help calm infants and promote sleep. As I mentioned, the Canadian Pediatric Society unfortunately does not have a specific position statement on this topic.

Recently the AAP updated their safe sleeping recommendation which says that swaddling is recommended ONLY when baby sleeps on the back, and it should be stopped as soon as babies can roll over.

This is important parents – if there is one thing you take away from this article it’s to PLEASE stop swaddling once your baby can roll. This can prevent Sudden Infant Death Syndrome (SIDS). 

We also need to know that there are definitely babies who benefit from swaddling, and actually need it, for organizing, or other reasons.  This can be true babies born pre-maturely or those born addicted to various substances.  Often those babies that have lower thresholds to sensory input (they are over-registering sensory input and are more sensitive or defensive to it), need this type of deep pressure input to effectively remain in a calm state to feed, sleep, and develop.  

So whether you decide to swaddle your baby or not, and ultimately the choice is yours, remember to read your baby’s cues and watch for any signs of distress. Keep in mind the importance of varying a baby’s positioning throughout the day, whether they are swaddled to sleep or not. 

But please, please, please know that you have NOT caused sensory processing disorder or difficulties in your child, nor will you cause it in the future if you do decide to swaddle your baby.

How To Swaddle Correctly

Here is a guideline as per American Association of Pediatrics (AAP) – truth be told I don’t love this one since it requires the arms to be extended by baby’s side, which is not actually developmentally appropriate (remember I mentioned that babies gravitate towards that flexed or curled position). You ideally want them to have access to their hands, to suck on and soothe, as they would have inside the womb.  But, I am including this here because this is often the ‘swaddle’ position many people think of when they think of swaddling.

• To swaddle, spread the blanket out flat, with one corner folded down.
• Lay the baby face-up on the blanket, with her head above the folded corner.
• Straighten her left arm, and wrap the left corner of the blanket over her body and tuck it between her right arm and the right side of her body.
• Then tuck the right arm down, and fold the right corner of the blanket over her body and under her left side.
• Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.
• Make sure her hips can move and that the blanket is not too tight. “You want to be able to get at least two or three fingers between the baby’s chest and the swaddle,” Dr. Moon explains.

Personally I don’t love the above, and actually prefer the swaddle position in which babies’ legs are tucked into that froggy leg type position, the swaddle loser around the hips (allowing the legs to still be able to move), and arms tucked in will simulate more of that fetal position, which is their natural position the first few months.

So really it is the torso and the arms that should have the snugness, rather than the legs. The International Hip Dysplasia Institute has more information about this and also a great video demonstrating how to swaddle in a hip healthy way.

And if folding and wrapping your baby seems a bit too complex, there are some really wonderful swaddle sleep sacs on the market. These  make it much easier to swaddle correctly – giving baby enough resistance and pressure while still allowing them to move somewhat freely, especially at the hips.  

Some of my favourites are: 

• Love To Dream Swaddle,
• Nested Bean Zen Swaddle, 
• BBlüv Sleëp.  

And if you are worried about the transition from swaddle to non-swaddle then most of these companies have transition sleep sacs as well like the Love to Dream Swaddle Up or even something like the Zipadee Zip Swaddle Transition.

And last but not least, I am here to help you get more sleep without sleep training.  I’m here to show you how to  follow your instincts, and supporting you in your decisions, while providing you with the information on normal development, and best practices.  

Whether you swaddle your baby or not, I am here.  I can help you transition out of the swaddle, and I can help if you decide not to. In the end, I can help you get more sleep using a holistic, developmental, and attachment-focused approach.

Book your complimentary connection call today, to see if we are a good fit! Book Now.

XO,

Kaili

P.S. Join my FREE group on Facebook – Mamas, Minis, Milestones & More to learn about baby development, sleep and more, while also connecting with other mamas.

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References

1.Short MA, Brooks-Brunn JA, Reeves DS, Yeager J, Thorpe JA. The effects of swaddling versus standard positioning on neuromuscular development in very low birth weight infants. Neonatal Netw. 1996;15(4):25–31pmid:8716525PubMedGoogle Scholar

2.Neu M, Browne JV. Infant physiologic and behavioral organization during swaddled versus unswaddled weighing. J Perinatol. 1997;17(3):193–198Google Scholar

Pease, A. et al. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics June 2016, 137 (6) e20153275; DOI: https://doi.org/10.1542/peds.2015-3275.

Certification in the Level 1 & 2 Rhythmic Movement Training & Reflex Integration Foundation Series. 2017

https://www.caringforkids.cps.ca/handouts/swaddling
https://en.wikipedia.org/wiki/Sudden_infant_death_syndrome
https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Swaddling-Is-it-Safe.aspx

Hip-Healthy-Swaddling

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114804/

https://www.ncbi.nlm.nih.gov/pubmed/17908730/
https://rhythmicmovement.org/fear-paralysis-reflex