Swaddling and hip dysplasia

The latest parent-dividing headlines announce loudly that swaddling babies may cause them hip problems, according to a new report. Bad news for parents who have found that swaddling settles and soothes their little ones, and now have to decide whether to carry on and feel guilty, or stop and find some new coping strategy.

There are many different techniques of swaddling, all variants on wrapping the baby firmly in a sheet or blanket. Intuitively it makes some sense that babies should be comforted by warmth and cosiness, and this practice has gone on for hundreds of thousands of years.

The new report is an opinion piece by Professor Nicholas Clark of Southampton University Hospital. While looking at an entirely different subject (the management of colic), a correlation was noticed between swaddling and developmental hip dysplasia (DDH). DDH affects up to 20% of newborn babies, and there appear to be a variety of possible causes, but it is important to note that the babies are born with this condition; it is not caused by swaddling. However, swaddling with the legs straight and close together appears to interfere with the natural process by which this usually resolves itself. Therefore swaddling is associated with abnormal hip development in some cases.

Sleep and safety

As we have said, parents usually swaddle in order to encourage sleep. A 2007 review shows that when babies are swaddled and on their backs, they may sleep very slightly better, and be slightly more likely to resettle if they do wake. Before rushing to wrap up your baby, it may be worth considering whether it is actually healthy for your baby to sleep deeply for long periods of time. ISIS has some helpful articles on how and why babies wake up so frequently, and offers some coping strategies that aim not to interfere with normal development.

The same 2007 review shows a small number of benefits from swaddling, but also a number of risks including an increased risk of SIDS when the baby sleeps on his or her front and is swaddled. The authors note:

As soon as traditional swaddling practices are introduced into a Western society with (centrally) heated houses and highly insulating bedding, one should be aware of the possible adverse effects of these practice.

The Lullaby Trust [pdf] (formerly the Foundation for Sudden Infant Death) does not discourage swaddling, but recommends not to change sleeping practices at around three months, when babies are most at risk of cot death. A somewhat more accessible article on parentingscience.com explains the risk factors for cot death in terms of normal sleep patterns, the main point being that where babies are more easily aroused, they are at lower risk of SIDS.

Dilemma

As usual there is a dilemma for modern parents, who may find it hard to cope with the disrupted and disruptive sleep patterns of a newborn baby. The evidence shows risks and benefits that in effect conflict with each other, and we know that individual circumstances and inclinations often outweigh the evidence anyway. If parents are well-informed they can own their decisions and find strategies that work for them.

More resources

International Hip Dysplasia Institute: hip-healthy swaddling.

NHS Choices: review of the media coverage.

NCT: How do I swaddle my baby?

NCT: Self-regulated sleep and unsettled babies.