Safe Sleep Update: No Swaddles in Indiana Child Care Programs

New views on swaddling via the National Resource Center For Health and Safety in Child Care and Early Education.


In response to emergent research, the state of Indiana has updated their licensing requirements around safe sleep. The new safe sleep directive is that infants can no longer be swaddled in regulated child care settings. This update is based on both national recommendations and pediatric research. Specifically, swaddling can increase the risk of serious health outcomes in specific situations:

  • The risk of sudden infant death is increased if an infant is swaddled and placed on his/her stomach to sleep (1,2) or if the infant can roll over from back to stomach.
  • Loose blankets around the head can be a risk factor for sudden infant death syndrome (SIDS) (3).
  • With swaddling, there is an increased risk of developmental dysplasia of the hip, a hip condition that can result in long-term disability (4,5). Hip dysplasia is believed to be more common with swaddling because infants’ legs can be forcibly extended.
  • With excessive swaddling, infants may overheat (i.e., hyperthermia).
Most infants in child care centers are at least six-weeks-old. Even with newborns, research does not provide conclusive data about whether swaddling should or should not be used. Benefits of swaddling may include decreased crying, increased sleep periods, and improved temperature control. However, temperature can be maintained with appropriate infant clothing or an infant sleeping bag. Although swaddling may decrease crying, there are other, more serious health concerns to consider, including SIDS and hip disease. 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.
Safe sleep training is now required for all staff in child care programs that work or might work with infants, and there should be a Safe Sleep Certificate in their files. At a safe sleep training, child care and early education staff learn what SIDS (sudden infant death syndrome) is and also what accidental suffocation is. Staff learn how to avoid situations where an infant would die of SIDS or accidental suffocation. 
Do you have questions? Need help? Contact your local infant toddler specialist at your child care resource and referral agency! They can come to your program, offer you free resources, train your staff and help you make sure that your sleeping environment is safe as possible.
  1. Pease AS, Fleming PJ, Hauck FR, et al. 2016. Swaddling and the risk of sudden infant death syndrome: A Meta-analysis. Pediatrics;137(6):e20153275.
  2. Richardson, H. L., A. M. Walker, R. S. Horne. 2010. Influence of swaddling experience on spontaneous arousal patterns and autonomic control in sleeping infants. J Pediatrics 157:85-91.
  3. Contemporary Pediatrics. 2004. Guide for parents: Swaddling 101
  4. Van Sleuwen, B. E., A. C. Engelberts, M. M. Boere-Boonekamp, W. Kuis, T. W. J. Schulpen, M. P. L’Hoir. 2007. Swaddling: A systematic review. Pediatrics 120:e1097-e1106.
  5. Mahan, S. T., Kasser J. R. 2008. Does swaddling influence developmental dysplasia of the Hip? Pediatrics 121:177-78.
  6. Franco, P., N. Seret, J. N. Van Hees, S. Scaillet, J. Groswasser, A. Kahn. 2005. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics 115:1307-11.