Frequently Asked Questions/CFOC Clarifications

Reference: 3.1.4.2

Date: 04/05/2013

Topic & Location:
Chapter 3
Health Promotion
3.1.4.2: Swaddling

Question:
Does CFOC ban swaddling?

Answer:

CFOC Standard 3.1.4.2: Swaddling states: “In child care settings, swaddling is not recommended or necessary.”

This specific language was carefully chosen and reviewed by national contributors and stakeholders, and then approved by the CFOC Steering Committee and each author organization (AAP, APHA, NRC). A child care setting is a group care setting, and therefore presents different health and safety concerns when compared to a private home. One of these concerns is inconsistency with caregivers/teachers. As noted in CFOC Standard 3.1.4.1: Safe Sleep Practices and SIDS/Suffocation Risk Reduction, “Infants who are cared for by adults other than their parent/guardian or primary caregiver/teacher are at increased risk for dying from SIDS” (Moon, 2005). To that end, implementing swaddling guidelines, training, and compliance across child care programs would be a significant challenge.

We recognize the many benefits of swaddling (when done correctly) by parents/guardians for newborns and young infants in hospital nurseries and in private homes. However, the primary target audience for the CFOC standardsis caregivers/teachers in early education and child care settings.

The majority of standards in CFOC use the phrase “should” or “should not.” The national contributors that developed Standard 3.1.4.2 made the conscious decision not to use this terminology in the standard language.Thus, CFOC does not ban or prohibit swaddling. Instead, it states that swaddling is not recommended or necessary.

CFOC does, however, account for programs that may choose to swaddle in this same standard (Standard 3.1.4.2). The last sentence of the Comments section states: “If swaddling is used, it should be used less and less over the course of the first few weeks and months of an infant’s life.”

Moreover, it is important to note that CFOC also includes Standard 1.1.2.1: Minimum Age to Enter Child Care, which states that “Healthy full-term infants can be enrolled in child care settings as early as three months of age.” The national contributors recognized that swaddling becomes less necessary for older infants, a time at which CFOC recommends entering a child care setting. 

Frequently Asked Questions/CFOC Clarifications

Reference: 3.1.4.2

Date: 04/05/2013

Topic & Location:
Chapter 3
Health Promotion
3.1.4.2: Swaddling

Question:
Does the AAP have a Policy Statement prohibiting Swaddling?

Answer:
The American Academy of Pediatrics (AAP) does not have a Policy Statement prohibiting swaddling. The AAP does have a Policy Statement on the Safe Sleep Environment, which does recommend against loose blankets in a safe sleeping environment. “Loose bedding, such as blankets and sheets, might be hazardous and should not be used in the infant’s sleeping environment” (Task Force on Sudden Infant Death Syndrome, 2011).

The AAP Technical Report specifically addresses swaddling (page e1356) in expanded recommendations for a safe infant sleep environment. The Technical Report states that “there is insufficient evidence to recommend routine swaddling as a strategy for reducing the incident of SIDS” (Task Force on Sudden Infant Death Syndrome, 2011).
CFOC is co-authored by AAP, APHA, and NRC, and published by the AAP. It is consistent with AAP Policy, but is not “AAP Policy”, nor “APHA Policy”.

Citations:
Moon, R. e. (2005). Stable prevalence but changing risk factors for sudden infant death syndrome in child care settings in 2001. Pediatrics, 116(4):972-7.

Task Force on Sudden Infant Death Syndrome. (2011). Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe infant Sleeping Environment. Pediatrics, 128:5 1030-1039.

Task Force on Sudden Infant Death Syndrome. (2011). Technical Report: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe infant Sleeping Environment. Pediatrics, 128:5 e1341-e1367.