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Wednesday, October 19, 2011

Post #27 Proper Swaddling of Babies to Prevent Hip Dysplasia

In ten years of pediatrics I have only had a handful of cases of hip dysplasia. Hip dysplasia is when the hip joint (a ball and socket joint) does not develop appropriately and can lead to dislocation and improper development which in turn can lead to mobility issues in the future. Mostly, I have seen this occur in breech babies (legs are in funny positions in the womb), females (hip anatomy makes it have a higher propensity for issues than males), first born babies (the womb is tightest in the first pregnancy leaving less room for the baby and his/her hips), and low amniotic fluid (less room in the womb).

Recent evidence indicates that improper swaddling may contribute to hip dysplasia. Like other parts of the baby, the hip continues to develop and mature even after the baby is born. Proper assessment of the above risk factors and routine physical exams by your pediatrician can catch infants who have hip dysplasia. Parents can do their part in minimizing risks by using proper swaddling techniques which will allow for proper maturation of the hip joints.

The below information is from the International Hip Dysplasia Institute. There is a link embedded in the text that takes you to their web page where 3 different techniques for proper swaddling are demonstrated in a YouTube video. Although the risks with most current swaddling techniques are minimal, this intervention carries no side effects, incurs no costs, and is easy to do - so there is no reason not to try it!

Hip-Healthy Swaddling

Are you swaddling your baby properly?

Improper swaddling may lead to hip dysplasia or developmental dysplasia of the hip. When in the womb the baby's legs are in a fetal position with the legs bent up and across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket.

Many parents find that swaddling can provide comfort for fussy babies, reduce crying, and develop more settled sleep patterns. When babies are swaddled, care should be taken to swaddle properly so the baby is safe and healthy.

There are many ways to swaddle babies by using blankets or commercial products designed for swaddling. In order for swaddling to allow healthy hip development, the legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints.

The baby’s legs should not be tightly wrapped straight down and pressed together. Swaddling infants with the hips and knees in an extended position may increase the risk of hip dysplasia and dislocation.

Instructions on how to swaddle properly

Watch the video at this link to learn three, hip-healthy methods to swaddle your baby:

If you can't view the above video, here is one of the methods described in text:

1. If using a square cloth, fold back one corner creating a straight edge.

2. Place the baby on the cloth so that the top of the fabric is at shoulder level. If using a rectangular cloth, the baby's shoulders will be placed at the top of the long side.

3. Bring the left arm down. Wrap the cloth over the arm and chest. Tuck under the right side of the baby.

4. Bring the right arm down and wrap the cloth over the baby's arm and chest.

5. Tuck the cloth under the left side of the baby. The weight of the baby will hold the cloth firmly in place.

6. Twist or fold the bottom end of the cloth and tuck behind the baby, ensuring that both legs are bent up and out.

It is important to leave room for the hips to move.

What about sleepsacks and commercial products?

Some parents choose to wrap their babies in sleepsacks specifically designed for swaddling, instead of using a simple cloth or blanket. Commercial products for swaddling should have a loose pouch or sack for the baby’s legs and feet, allowing plenty of hip movement. However, even some of these commercial products can confine the legs if they are tightened around the thighs.

It's especially important to allow the hips to spread apart and bend up. In the womb the legs are in a fetal position with the legs bent up across each other. Sudden straightening of the legs to a standing position can loosen the joints and damage the soft cartilage of the socket.

Final Thoughts

When put down to sleep, a swaddled baby should be placed on his or her back, face up.

If the baby can roll onto his or her stomach this may increase the risk of suffocation. Seek the advice of your child’s healthcare provider if swaddling an older or more active baby.


dr_som said...

Thanks for the post. Shared it with a patient of mine.

Randy Wile said...

Hi Dr. Jung. I am a Rice (Sid Rich) guy with a quick non-medical question for you. Is there a time that I can call your office to chat for a moment? Randy Wile

Anonymous said...

I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


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Peter Jung said...

Randy, would love to chat with you. Call my office on Monday 713-467-1741 and leave me your contact info and I will get back to you asap!

Ben said...

Great post! Proper swaddling is definitely an important skill. I've used the Miracle blanket but it seems like it could be a bit tight around the hips. Your advice will be taken into consideration. Thanks for writing it.

Peter Jung said...


I would suggest switching to a different blanket for swaddling purposes that allows for more hip room or perhaps using a different technique with the Miracle blanket to allow for more hip space. Hope that helps!


Katherine Jameson said...

Thank you for this great post! I wanted to ask, what are your thought on the Zipadee-Zip? Personally, I found that the Zipadee-Zip helped my child as it wasn't too loose or too restrictive. However it would be interesting to hear from a professional.

Peter Jung said...

Mrs.Jameson, there is no evidence on how safe or unsafe the Zipadee-Zip product is (that I am aware of). However, after reviewing the product I would be comfortable using it with my own children and it has the added benefit of allowing good movement of the hips.