Swaddling and SIDS: Why scary headlines got it wrong

The following post is by Joy Victory, who joined HealthNewsReview.org in March as deputy managing editor. She tweets as @thejoyvictory. She also discussed the study on NPR’s Weekend Edition.

Once, while discussing the merits of infant swaddling with a fellow new parent and co-worker, a seasoned dad overheard our conversation and piped up over his cubicle: “Isn’t it great? I still swaddle my kid…and he’s 7!”

Yes, anyone who’s been there knows: Swaddling is nothing short of magical, and many parents rue the day their pediatricians urge them to give up the swaddle.

Given the high interest many of us have (or had) in swaddling, it’s not surprising that a new meta-analysis that takes a look at older research examining any links between swaddling and SIDS, or sudden infant death syndrome, got some play this week in news outlets.

Swaddled babyWhile the analysis had many limitations–which the researchers noted–the overall conclusion was that SIDS risk appears slightly higher in babies who are swaddled, especially babies who are facedown or on their sides, compared to babies sleeping on their backs.

And, they stated, because babies get increasingly adept at rolling over into these riskier positions as they age, swaddling should stop early enough to avoid this danger zone (though it’s by no means a panacea: SIDS still occurred in older, non-swaddled, back-sleeping babies).

‘This headline seemed awfully pat for such a complex subject’

This isn’t a new or novel finding for people who follow newborn health issues, nor do the results affect any current guidelines on infant sleep, though those nuances were missing in the press coverage we read on the study.

This discrepancy also was pointed out to us by HealthNewsReview reader Allison Hawley March. She linked to a Washington Post story and added “Kind of a misleading headline, there.”

That headline: “Swaddling babies is tied to heightened risk of sudden infant death syndrome.”

When so many people only read headlines these days (a fact brought to us also by the WaPo), it’s important to be as accurate as possible, explained March, a currently pregnant mom who works in public health in Minnesota.

“If the research is changing, I’d like to know for our twins when they’re born, but this headline seemed awfully pat for such a complex subject as SIDS,” she told me.

The meta-analysis also was covered by The New York Times, which had a similar headline: “Swaddling May Increase the Risk of SIDS.” Yet, the research can’t tell us whether swaddling “may increase” SIDS because the observational studies that were analyzed can’t prove cause and effect, as CNN notes in “Swaddling and SIDS: About that alarming study …

Headlines that oversimplify or mischaracterize research is something we see often, to the point we recently wrote a blog post to help writers: 5 tips for writing better health headlines.

How did the stories stack up?

The Times told us “over all, swaddling increased the risk for SIDS by about one-third,” while the Post said “swaddled babies placed on their side or stomach were twice as likely to have died from SIDS as were babies in those sleep positions who had not been swaddled.”

I found those statements not just over-simplified and incomplete, but irresponsible. What did the actual numbers look like? We’re not told. Those numbers are important: If the overall SIDS risk is very tiny to start with, does this increased risk really add up to anything meaningful?

As Times reader BL commented on the story, “I continue to be amazed by how often pregnancy and infant care risks are not actually provided in numerical form. Parents are surrounded by vague warnings about behaviors whose actual risk they cannot evaluate.”

Jumping to such sweeping conclusions about the research also meant some key limitations were overlooked, even though the researchers themselves took pains to point them out. At issue were limitations like:

  • None of the four studies adequately described what the swaddling techniques were, which The Atlantic noted in “About that Scary Swaddling Study.
  • The four studies took place in several countries across different time periods–and guidelines on what’s safe and what’s not varied in these countries and time periods. (An overly tight swaddle method in one country, for example, could have thrown the numbers off overall.)
  • And, importantly, some crucial factors were not adjusted for, most notably whether babies were sharing a bed with his or her parents–one of the most well-known risk factors for SIDS.

What does this add up to? A meta-analysis that’s not particularly newsworthy, because it doesn’t change what we already know. For example, the findings don’t tell us anything that American Academy of Pediatrics hasn’t already stressed to parents in its well-balanced page on swaddling:

“When done correctly, swaddling can be an effective technique to help calm infants and promote sleep,” but that “Parents should know that there are some risks to swaddling… Swaddling may decrease a baby’s arousal, so that it’s harder for the baby to wake up. … we know that decreased arousal can be a problem and may be one of the main reasons that babies die of SIDS.”

Is there a better way to frame the story?

We think so, either by not covering this research at all or running it with a much more cautious headline–something akin to “Swaddling weakly linked to slight increase in SIDS risk.” And we’d include some more context about that risk high up in the piece: “The analysis further confirms what pediatricians already know about the potential risks of swaddling, especially for babies not sleeping on their backs. The findings don’t affect current recommendations.”

You might think this less scary version would be less “clicky” with readers, but I’m seeing (anecdotal) signs it might win them over, not just among frustrated readers commenting on the news stories, but among my own circle of friends.

Case in point: I first learned of the swaddle study via Facebook, from a frustrated family member who was served up these two stories side-by-side when she went to read The New York Times:











“These two headlines, side by side, pretty much say it all when it comes to media on parenting in 2016,” she posted along with the photo.

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Comments (1)

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Stephen Cox, MD

May 18, 2016 at 1:09 pm

Your info is reassuring except your statement, “We know that decreased arousal can be a problem and may be one of the main reasons babies die of SIDS.” This sounds as alarming as the article.