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Tuesday, October 29, 2013

Swaddling Can Lead To Hip Problems If Done Incorrectly

Swaddled Baby (Geoffrey Wiseman/Flickr)

Swaddled Baby (Geoffrey Wiseman/Flickr)

When faced with an unhappy baby, new parents all over the world turn to the practice of swaddling — wrapping the baby up tightly in a blanket to mimic the feeling of being in the womb.

In North America, nine in 10 infants are now swaddled in their first six months after birth.

But a new study out today in the journal Archives of Disease in Childhood warns against swaddling the wrong way, because it can cause hip dysplasia.

Study author Nicholas Clarke, a consultant orthopaedic surgeon at the Southampton University hospital in the U.K., writes:

‘Safe swaddling’ with appropriate devices should be promoted because it is recognised that traditional swaddling is a risk factor for DDH [developmental dysplasia of the hip]. In order to allow for healthy hip development, legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints. The babies’ legs should not be tightly wrapped in extension and pressed together. Commercial products for swaddling should have a loose pouch or sack for the babies’ legs and feet, allowing plenty of hip movement and hip flexion and abduction.

Video: How to correctly swaddle a baby

Guest

  • Nicholas Clarke, a consultant orthopaedic surgeon at the University Hospital Southampton in the UK is author of the article.

Transcript

ROBIN YOUNG, HOST:

Historically, parents around the world have swaddled their babies, bound them in blankets. In the Bible, Jesus was swaddled. It's been done for thousands of years. And more and more parents are doing it now. In North America, nine in 10 infants are now swaddled in their first six months after birth. There are special swaddling products. But a new article out today in the journal Archives of Disease in Childhood seems, seems to be warning against swaddling, which sent several young parents in our office into hysteria.

JEREMY HOBSON, HOST:

Let's bring in Professor Nicholas Clarke. He's an orthopedic surgeon at the Southampton University Hospital in Britain and authored the article. Dr. Clarke, what exactly are you saying about swaddling?

NICHOLAS CLARKE: What I'm saying is, and it's a review of the literature that we've looked at, we found that there was a resurgence in swaddling, and we were concerned that it would, as in the past, cause hip dysplasia. And hip dysplasia is very common, probably one of the most common congenital abnormalities, but if postnatally the hips are not allowed to adopt the physiological position, that's flexed and separated, there is a risk of hip dysplasia developing.

And swaddling has been associated with this in the past. In Japan in the early '80s, they prosecuted an educational program to try and get mothers not to swaddle their children. They reduced the incidence of hip dysplasia from three percent to 0.2 percent.

YOUNG: Well, hold on there because it sounds as if you are saying parents shouldn't swaddle, as you just said they reduced swaddling in Japan. But we understand that you're also saying that there is a better way to swaddle?

CLARKE: There is. So conventional swaddling involves binding the - almost the whole body, certain the lower limbs. But there is a safe swaddling technique. Anything that allows the legs to adopt the separated and flexed position is fine. You don't have to swaddle the lower limbs, and if that's avoided, then that is hip-healthy, safe swaddling.

YOUNG: So let me see if I'm hearing you clearly. You can swaddle the upper body, this is, you know, putting the blanket not too tight but so that the arms are down by the sides, and they're restrained, but allow the lower limbs to be sort of more in a sack that has a little more room.

CLARKE: Correct.

YOUNG: Well, as you know, there are other doctors who are totally against swaddling. We're reading a consultant at the Great Ormond Street Hospital told The Telegraph there in your country that swaddling should not be employed, in my view, as there is no health benefit but a risk for, as you say, this growing and often immature hips.

CLARKE: The fact of the matter is that if you swaddle a baby conventionally, there is a risk to the hips. I mean, the reason that the swaddling is so popular is the perception that it helps both sleep, which it does, but also colic, which it doesn't.

YOUNG: Well, that was going to be my question, because this doctor says there is no health benefit. Parents swear there is. What do you say?

CLARKE: The parents are right because basically it's not a health benefit, but swaddled infants do arouse less and sleep longer. And that's why they are swaddled.

YOUNG: Others are asking in our office, well, wait a second, if swaddling was so bad, wouldn't you see millions of people across the - around the world who had hip dysplasia, far more than we see, because so many countries do swaddle.

CLARKE: But we do. The Navajo Indian used to swaddle, and the incidence of hip dysplasia in the Navajo Indian was about 10 percent. In Norway, hip dysplasia accounted for 20 percent of patients requiring total hip replacement younger than 40, and most of those were women. In Adelaide, they've noted a threefold increase in developmental dysplasia of the hip requiring treatment as an infant, and there's been no changes in any of the demographic factors apart from swaddling.

YOUNG: Professor Nicholas Clarke, a consultant orthopedic surgeon at the Southampton University Hospital in Britain. We'll link you to all the writing today. Professor Clarke, thanks so much.

CLARKE: No, it's a pleasure, thank you.

YOUNG: And parents, we've got a link to a video on how to safely swaddle your baby at hereandnow.org. Of course in return we'd love to see pictures of your safely swaddled babies on Facebook.com/hereandnowradio so we can all go: Aw, so cute. It's HERE AND NOW. Transcript provided by NPR, Copyright NPR.


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  • Anne

    My baby would break out of those example swaddles in 30 seconds! You can have the same effect (room for hip movement) but tie the ends of the swaddle instead of tucking to make it more effective. Here is my baby 2 months in a “super swaddle”. You can google “isis super swaddle” for videos of this technique.

    • Robin Y

      Awwwwwwww!

  • David Tessler

    One issue not touched on directly during the piece is the length of time infants are swaddled. The introduction states that many Americans swaddled I cants for their first six months. That seems like an exceptionally long time, and it is easy to imagine that swaddling for such an extended period could produce a number of I intended consequences. Our understanding from several books and our pediatrician is that swaddling is really a technique to assist newborns transition to life outside the cramped womb. They have no control of their limbs which flail about independent of instruction and startle these tiny creatures. We swaddled all of our kids – it aided dramatically in calming them and helping them to sleep – but only for their first three or four weeks post partum. After that most newborns are well into their transition to the wider world – and motor and neural development is racing along. Swaddling any longer than the newborn period just doesn’t make sense beyond the time babies actually need and benefit from the practice. Onlookers would be horrified by a 2 year old being swaddled, and it is really the same after about 2 months. I would imagine that if swaddling was limited to only the very first weeks, deleterious outcomes like hip dysplasia would not result. Does the research track that additive impact with increasing length of swaddling period?

    • Anne

      2 years old would be extreme but often parents swaddle their babies for sleep until their startle reflex ends (at 4-6 months old) or when they begin to roll over. Until the startle reflex ends many babies will wake themselves from sleep by mistakenly hitting themselves in the face and jerking their limbs–not all babies do this but mine sure did. Once they can roll over it is considered unsafe to swaddle with arms in in case the roll over and get stuck face down and cant use their arms to breath. My baby was swaddled for sleep until 4 months (with her arms out after 3 months). She LOVES it and would smile and put her arms down when we put her on the blanket. No one was ever horrified watching me swaddle my baby even at 4 months, on the contrary people thought she was cute in her little bundle, they may have reacted differently if she was crying or fighting to get out but since she was so happy to be swaddled I only got positive responses. I agree that length of swaddling (not only duration in months but also hours/day) should have an impact and be controlled for, although it is pretty easy to make sure you don’t bind the legs and then it isn’t an issue.

Robin and Jeremy

Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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