Fact check: Can too many layers of clothing harm your infant?

CLAIM:

Excessive layering of clothes can overheat newborns and cause fever, which may subside once the baby is unwrapped. 

FACT:

Over-layering clothes on infants can cause overheating, dehydration, and increase the risk of Sudden Infant Death Syndrome (SIDS), especially if caps are tight or the baby sleeps in unsafe positions. Experts recommend dressing babies in one layer more than adults, ensuring comfort without sweating.

Winters are a time when parents are extra cautious about protecting their babies from the cold. It is common to see newborns wrapped in multiple layers of clothes, blankets, caps and mittens, often out of fear that exposure to cold air may cause illness. However, a viral video circulating on social media has raised questions about whether excessive layering can actually harm a child’s health. 

In a viral reel posted by Dr Santosh Yadav, a paediatrician, he explains how overdressing can lead to fever in newborns.  In the video, Dr Yadav discusses the case of a 19-day-old baby named Darshiv, who was brought to the hospital with fever. He notes that the baby’s temperature was around 99–100°F and points out that one of the most common reasons for fever in newborns is overdressing. 

According to Dr Yadav, the baby was wrapped in multiple layers, which prevented proper heat loss from the body. He explains that newborns are unable to regulate their body temperature effectively, and excessive covering can trap heat instead. “The most common reason for fever in a newborn baby is overdressing,” he says in the reel. 

He further adds that Darshiv was overheated because of being tightly wrapped. “He is not able to lose heat. He is completely covered,” Dr Yadav explains, stressing that the baby felt warm due to overheating and not because of an infection. 

Dr Yadav advises parents to take a simple step if a newborn develops a mild fever. “Whenever your newborn has a fever, first unwrap the baby. After half an hour, check the temperature again. It will definitely come down,” he says. 

He clarifies that if the baby remains active, feeds well, and the temperature normalises after removing extra layers, it is likely a case of overheating caused by excessive clothing. “If the fever becomes normal after unwrapping, it means it was due to overheating caused by wrapping the baby in too many clothes,” he adds. 

The reel has struck a chord with many and has sparked widespread discussion on safe winter-care practices for newborns and young children.

 Is over-layering clothes on children harmful to their health?

According to a 2020 study conducted on infant babywearing and thermoregulation, researchers examined whether adding extra clothing layers during babywearing affects babies’ body temperature. The study involved nine babies under 12 months of age and their mothers, who participated in short-duration babywearing under controlled indoor conditions. 

The authors explained the context behind the research, noting that while dressing babies in one extra layer than adults is commonly advised, this guidance does not account for babywearing. As stated in the study, “Babies are thermally vulnerable and public health bodies advise dressing them in one extra layer than adults. However, these guidelines do not consider babywearing.” 

To assess this, researchers measured babies’ temperature while they were carried in a sling for 15 minutes in a thermoneutral environment. Babies wore either one light clothing layer or two light layers. The findings showed that babies’ core temperature did not increase during the activity. The study reported that “babies’ tympanic temperature did not change after 15-minute babywearing.” 

However, researchers observed changes in skin temperature. According to the paper, “Local skin temperature increased across all sites tested, and similarly between clothing trials, with the abdomen showing the largest change.” 

The authors clarified that while skin temperatures rose by up to 1°C in some areas, this did not translate into a rise in core body temperature. Summarising their main conclusion, the researchers stated, “We show that 15‐min babywearing increases babies’ skin, but not tympanic, temperature by up to 1.1°C.” 

Importantly, the study also found that caregivers were unable to reliably detect these temperature changes. “Mothers did not perceive any change in babies’ thermal state,” the research noted. The authors cautioned that although short-duration indoor babywearing appeared safe under controlled conditions, prolonged or warmer environments could alter outcomes. They warned that increased insulation, close contact with the caregiver’s body heat, and environmental warmth could together increase the risk of overheating, especially if heat loss is restricted. 

Overall, the study suggests that brief babywearing with light clothing does not raise babies’ core temperature, but it also highlights that skin warming occurs and may become relevant in longer durations or hotter settings, underscoring the need for careful judgment in layering infants.

Another 2021 experimental study examining clothing systems designed for premature infants further highlighted how clothing insulation affects infants’ thermal balance. This research focused on the ergonomics and physiological comfort of protective clothing, particularly three-layer textile assemblies used in sleeping bags for premature babies. 

Using laboratory testing, human skin models, and newborn manikins, the researchers measured air permeability, thermal resistance, thermal insulation, and water vapour resistance of different fabric combinations. The study found that materials containing polyurethane (PU) vapour-permeable membranes provided higher thermal insulation, helping maintain body heat and reduce the risk of hypothermia in premature infants.

At the same time, the authors emphasised that biophysical comfort depends on multiple factors, including material thickness, moisture resistance, and the baby’s individual physiological characteristics. They cautioned that while insulation is necessary to prevent heat loss in premature infants, excessive or inappropriate clothing design can interfere with heat and moisture exchange. 

The researchers concluded that “it is difficult to unequivocally conclude which garment is an ideal solution for a prematurely born child,” stressing that clothing for premature babies must strike a balance between preventing hypothermia without creating excessive thermal load. 

Further insights come from a 2022 narrative review examining the role of heat stress and hyperthermia in Sudden Infant Death Syndrome (SIDS). Reviewing existing literature, the authors found that thermal stress is frequently observed in SIDS cases and may increase risk either directly, through lethal hyperthermia, or indirectly, by disrupting vital physiological functions. 

The review identified excessive clothing and bedding insulation as a primary contributor to hyperthermia, particularly when insulation levels are inappropriate for ambient temperatures. “Hyperthermia mainly results from excessive clothing and bedding insulation,” the review stated. 

The authors explained that thermal stress can impair cardiovascular and respiratory regulation, reducing an infant’s ability to respond to life-threatening events such as apnea or low oxygen levels. They also highlighted the risk of brain overheating, noting the head’s critical role in heat dissipation and autonomic control. The review concluded that although multiple physiological factors contribute to SIDS, excessive thermal insulation is a key, preventable risk factor, highlighting the importance of carefully regulating how infants are dressed, particularly during sleep. 

What doctors recommend

Dr Amit Gupta, Senior Neonatologist and Paediatrician at Motherhood Hospitals, Noida, addressed the common concern about over-layering infants during winter. He emphasised that excessive wrapping is indeed harmful. As he explained, “First time, you should always make sure your child is not over-wrapped.” 

“The layer of clothes you (adults) are wearing, add one additional layer to the baby, and that is okay,” he recommended a simple guideline for parents. Dr Gupta also advised parents to check for signs of over- or under-wrapping. “See at the back, if you notice sweating, the child is over-wrapped. Or if the hands are cold or blue, then the child is under wrapped and may need another layer.” 

He highlighted the risks associated with over-layering, explaining that it can lead to dehydration. “Babies have very little water in their bodies, and repeated sweating can lead to dehydration,” he said.  

He also warned about the dangers of tightly fitting caps and improper sleeping positions, “Sometimes the cap is put on too tightly, which can lead to suffocation. If the baby lies on their stomach or in a twisted position, it can increase the risk of SIDS. You can never fully monitor the child in that situation.” 

Dr Gupta stressed comfort and moderation, “Keep only that much clothing which makes the child comfortable, and he is not sweating. That is important. One layer plus one extra layer is enough. Simple rule of thumb.”