I had my fourth child recently and, like his older sisters, have been swaddling him for every nap and at bedtime. Also like his sisters, the baby is going to a wonderful local day care. I was shocked when the day care administrator politely informed me that our son could not be swaddled for naps. In the three years since my third child began day care, Pennsylvania, along with several other states, has changed day care regulations to include a ban on swaddling.
The basis for the ban stems from "Caring for our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs," a guidebook produced by the HHS-funded National Resource Center for Health and Safety in Child Care and Early Education (NRC) in conjunction with the American Academy of Pediatrics and the American Public Health Association. "In child care settings," the manual states, "swaddling is not necessary or recommended."
Until 2011 there were no rules about swaddling in day care. "Swaddling wasn't part of Caring for Our Children before [the 2011 edition]," an employee at the NRC helpfully explained during a phone interview. "The optimal age for children to be in group care settings is three months and [so we looked at whether babies should] still be swaddled after three months."
According to the NRC's conclusions, swaddling isn't necessary. The official line is that they are "worried about monitoring children in a group care environment. Swaddling can be done differently by different providers, i.e., incorrectly and blankets [can end up] covering faces. We're looking at group care environment for blankets becoming loosened." The unelected busybodies who write these rules are convinced that swaddling isn't safe because the day care workers may incorrectly wrap the baby, the blanket could come loose, the baby might roll over into the loose material, and then the baby could possibly die of Sudden Infant Death Syndrome (SIDS).
There are no known cases of a baby dying at day care from suffocation by a swaddling blanket. In fact, there has been a 50 percent decrease in SIDS since 1994. Additionally, as Melinda Wenner Moyer reported in Slate, a New Zealand study that tried to determine any bedding-related factors that contribute to SIDS, concluded that tight swaddling significantly decreases the risk of death.
According to Pennsylvania state rules, a baby may not be swaddled in the day care without written authorization from a physician. The regulation states that "Infants shall be placed in the sleeping position recommended by the American Academy of Pediatrics (i.e., on their backs) unless there is a medical reason an infant should not sleep in this position. The medical reason shall be documented in a statement signed by a physician, physician's assistant or CRNP and placed in the child's record at the facility."
Although swaddling a baby helps them to sleep on their backs (they naturally want to sleep on their tummies), there is no "medical reason" for swaddling. It isn't the same as a child needing prescription antibiotics for an ear infection. When I tried to get my pediatrician to write the waiver, I got a definite no, along with the official line from the AAP, which states that swaddling isn't recommended after two-months of age. No swaddling without a waiver and no way to get a waiver, so essentially there is a ban. Similar bans are already in effect in Minnesota and California.
Dr. Harvey Karp, who wrote Happiest Baby on the Block and Happiest Baby Guide to Great Sleep, the bibles of swaddling and sleep, is furious about the ban. He argues that between two and four months of age is the "absolute worst" time to stop swaddling because it is the time that SIDS is most likely to occur. "Evidence shows that swaddling may well reduce infant sleep deaths. By reducing crying and boosting sleep, swaddling lessens a parent's temptation to bring the baby into bed with them or to put the baby to sleep on the stomach," Karp argues.
"Young babies that were sleeping an hour [or] an hour and a half are now sleeping 20 minutes," a day care worker in Texas, where swaddling has effectively been banned, told the Huffington Post. "I have some babies who are not sleeping at all." Speaking for others at her facility, the employee complained that [teachers] feel "they are not able to meet the needs of the infants they are caring for … They are not allowed to do what they feel is needed."
As a parent, I feel the same way. Why should the decision to wrap or not wrap my baby be made by an unaccountable stranger? It would make more sense and be more efficient if the day care workers and me had a conversation and decided how best to care for him. Also remember that, as the NRC admits, they are making policy based on what might happen. They are not basing their recommendations on reported cases of babies who were swaddled and died from SIDS while in day care.
The NRC even claims that it is not anti-swaddling. When I asked an NRC representative why they had enacted the regulations, the answer was positively Orwellian. NRC standards, she explained, are based on the recommendations of Dr. Rachel Moon at the American Academy of Pediatrics. Dr. Moon isn't anti-swaddling, she's just against any blankets in cribs in day care. But you have to have a blanket to swaddle the baby, I sputtered. "We aren't anti-swaddling," the woman replied. "We're just against blankets in cribs." So there you have it, no blankets in cribs and another unreasonable, unnecessary standard becomes law.