Professor Ed Mitchell
SUDI Academic Expert
Auckland University

Ed Mitchell qualified at St George’s Hospital Medical School in London and has worked in the UK, Zambia and New Zealand.

He was the Cure Kids Professor of Child Health Research at the University of Auckland from 2001 to 2015 and is now a Professorial Research Fellow. He has published over 400 original papers, particularly on the epidemiology of sudden infant death syndrome (SIDS). He was awarded a Doctor of Science for his work on “The Epidemiology and Prevention of SIDS” by the University of London. He has received several awards for his landmark studies of SIDS and in 2009 was made a fellow of the Royal Society of New Zealand.

Professor Ed Mitchell answers questions from the community.

Does swaddling pose a risk of SUDI?

The jury is still out on whether or not it is related to SUDI. There is a good paper published a few years ago: Anna S. Pease, Peter J. Fleming, Fern R. Hauck, Rachel Y. Moon, Rosemary S.C. Horne, Monique P. L’Hoir, Anne-Louise Ponsonby and Peter S. Blair. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics June 2016, 137 (6) e20153275; DOI: 

Basically it found that there was a non-statistically significant increased risk of SIDS from swaddling. The risk was high for babies placed prone and moderate risk for on the side compared with babies on the back. This makes sense from an airway obstruction perspective.

Infants in sleeping sacks or bags are at lower risk of SUDI. These babies are not swaddled.

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What do people mean by swaddling?

It varies from being very restricting of arms and legs to being lightly wrapped in a muslin cloth.

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What is developmentally supportive swaddling?

Developmentally Supportive swaddling (DOI: and below) has its advocates, and I would support its use in NICU. It may have some value in managing the unsettled infant at home, but I definitely would not recommend it for normal infant care (babies born at full term).

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What are the advantages of swaddling?

This was discussed by Bregje E. van Sleuwen, Adèle C. Engelberts, Magda M. Boere-Boonekamp, Wietse Kuis, Tom W.J. Schulpen and Monique P. L'Hoir. Swaddling: A Systematic Review. Pediatrics October 2007, 120 (4) e1097-e1106; DOI: “In general, swaddled infants arouse less and sleep longer [EM: Not necessarily a good thing]. Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled. Excessively crying infants cried less when swaddled, and swaddling can soothe pain in infants. It is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions [EM: This justifies its use in NICU].”

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Are there adverse effects?

There is an increased risk of the development of hip dysplasia, which is related to swaddling with the legs in extension and adduction (straight and together). There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling. Swaddling immediately after birth can cause delayed postnatal weight gain under certain conditions, but does not seem to influence breastfeeding parameters.

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