Infant Deaths and Injuries Associated with Wearable Blankets, Swaddle Wraps, and Swaddling

ObjectiveTo assess risks involved in using wearable blankets, swaddle wraps, and swaddling.Study designThis was a retrospective review of incidents reported to the Consumer Product Safety Commission between 2004 and 2012.ResultsA total of 36 incidents involving wearable blankets and swaddle wraps were reviewed, including 10 deaths, 2 injuries, and 12 incidents without injury. The median age at death was 3.5 months; 80% of the deaths were attributed to positional asphyxia related to prone sleeping, and 70% involved additional risk factors, usually soft bedding. Two injuries involved tooth extraction from the zipper. The 12 incidents without injury reported concern for strangulation/suffocation when the swaddle wrap became wrapped around the face/neck, and a potential choking hazard when the zipper detached. All 12 incidents involving swaddling in ordinary blankets resulted in death. The median age at death was 2 months; 58% of deaths were attributed to positional asphyxia related to prone sleeping, and 92% involved additional risk factors, most commonly soft bedding.ConclusionReports of sudden unexpected death in swaddled infants are rare. Risks can be reduced by placing infants supine and discontinuing swaddling as soon as an infant's earliest attempts to roll are observed. Risks can be further reduced by removing soft bedding and bumper pads from the sleep environment. When using commercial swaddle wraps, fasteners must be securely attached.