Swaddling and safe sleeping practices in an inner city population

Background: SIDS is the leading cause of death in infants and its prevalence is higher in African American populations. Sleeping prone and co-sleeping are major risk factors for SIDS. Swaddling has been shown to decrease the likelihood of SIDS but has not been evaluated as a strategy to promote safe sleeping practices. Objective: to assess the acceptability of swaddling and its association with safe sleeping practices in an inner city patient population. Methods: A systematic sample of postpartum mothers was offered a swaddling blanket, taught how to use it, and followed for up to 6 months to explore use and satisfaction with swaddling and implementation of safe sleeping practices. Results: 70 mothers were enrolled: mean age 24 yrs (17-42 yrs); 84% African American; 21% less than high school; 90% Medicaid. 59% primipara; 60% of infants initially breastfed. 78% were followed for up to 6 months. The majority of mothers (85%) swaddled their babies; 74% for at least 6 weeks. Most mothers felt their babies liked being swaddled. When babies were swaddled, 95% were placed on their backs to sleep and 90% slept in a crib/bassinette. There was a positive correlation between swaddling and back sleeping (Spearman corr 0.287, p 0.03) at the one week visit. Conclusion: In an inner city population, swaddling was well accepted and the majority of mothers used safe sleeping practices when swaddling their infants. Swaddling appears to be a promising public health strategy to promote safe sleeping practices in infants and should be explored further.