Improper wrapping or swaddling increases the risk of DDH?

Introduction -

Wrapping or swaddling a newborn can help the baby to feel more secure and comfortable. This may assist the baby to settle and establish regular sleep patterns. However, improper wrapping or swaddling baby tightly with legs straight can hinder the normal growth and development of the child’s hips. So improper wrapping or swaddling can result in DDH.

Van Sleuwen BE, et al, in a systematic review of swaddling noted that developmental dysplasia of the hip is more prevalent when the legs are bound so they are not free to move. Similarly, Yamamuro et al noted a decrease in the incidence of DDH from 1.5-3.5% to 0.2%, following the implementation of the national programs to eliminate swaddling with hips and knees in an extended position.

In contrast, cultures that carry their children in the straddle or jokey position, have very low rates of hip dislocation compared to cultures that wrap their children tightly with the legs together and extended.

In the mother’s womb, babies generally lie with their hips in an outward position. This position helps the hip joint to develop normally. In some babies, the ligaments around the hip joint are loose, which in most gets corrected during the first few months of life. So, incorrect swaddling or wrapping can have an effect on the growing hip joint and cause the hip to become unstable and dislocate.

That’s why all parents and caregivers need to know how to wrap a baby correctly to minimize the chance of hip dysplasia. So, safe wrapping or swaddling is most important during the first three months of life.

Safe wrapping or swaddling -

Any safe wrapping or swaddling methods like diamond method, square method or using a pouch can be followed. But it is recommended to leave enough rooms for legs to move freely.

International Hip Dysplasia Institute and POSNA, has issued the following statement. “It is the recommendation that the infant hips should be positioned in slight flexion and abduction during swaddling. The knees should also be maintained in slight flexion. Additional free movement in the direction of hip flexion and abduction may have some benefit. Avoidance of forced or sustained passive hip extension and adduction in the first few months of life is essential for proper hip development.”

To conclude, when wrapping or swaddling, “Always remember to leave the baby's legs free to move”.