Contemporary form of swaddling recommended to prevent dysplasia in infants

May 2 2012

The following is being released by the American Academy of Orthopaedic Surgeons:

While tight swaddling may provide a newborn infant with a feeling of warmth and security, studies have found that regularly wrapping a child too tightly in a blanket or cloth may lead to an abnormal development of the hip joint, causing the ball of the hip to dislocate from the hip socket. To prevent developmental dysplasia of the hip (DDH), a common condition that if left untreated can cause limping, limb length discrepancy, and eventual pain and arthritis, the Pediatric Orthopaedic Society of North America (POSNA), the American Academy of Pediatrics (AAP), and the International Hip Dysplasia Institute (IHDI) are recommending a more contemporary form of swaddling, that allows ample room for hip and knee movement.

"Many cultures, and a growing number of Americans, practice traditional swaddling – the tight wrapping of infants with their legs together and fully extended," said orthopaedic surgeon Peter M. Waters, MD, president of POSNA. "Unfortunately, this practice places infants at a high risk for dysplasia.  Instead, the infant's arms and torso should be snugly wrapped, while the legs are wrapped loosely, ensuring the legs are bent up and out.  The legs should be free to move, and most importantly, the legs should never be wrapped in a 'straight down' position."

Animal studies have shown that forced hip and knee extension in the neonatal period causes increased tension in the hamstring and hip muscles, which can lead to loose ligaments, instability, and eventually, dislocation of the thighbone from the hip socket.  Approximately one out of every 20 full-term babies has some hip instability, and 2-3 out of every 1,000 infants will require treatment, according to IHDI.

In contrast, cultures that carry their children in the straddle or "jockey" position, with their legs wrapped around a parent or caregiver's back or torso, have very low rates of hip dislocation. 'Hip-healthy swaddling' – where a blanket is more loosely wrapped around the baby's hips and legs – allowing for ample hip, knee and leg movement –  also can provide comfort and security to an infant without the risk for hip dislocation.

The POSNA supports a recent IHDI statement that calls for increased awareness and education on "healthy" swaddling. 

Specifically, IHDI recommends that a swaddled infant be able to bend their legs up and out.  The following techniques are recommended for safely swaddling an infant in a square blanket:

• Option 1: Place the baby's head above the middle of one edge, tuck the right arm down and fold the right side of the blanket over the baby between the left arm and under the left side. Then, tuck the left arm down and fold the left edge of the blanket over the baby and under the right side. Fold or twist the bottom of the blanket up and loosely tuck it under one side of the baby
• Option 2: Fold one corner of a square blanket down and place the baby with its head in the center above the folded corner. Straighten the right arm and fold the right corner of the blanket over the baby between the left arm and under the left side. Then, tuck the left arm down and fold the left corner or twist the bottom of the blanket loosely and tuck it under one side of the baby.

Watch the video to learn about hip-healthy swaddling methods:
https://youtu.be/LLqfRQdUP7k

SOURCE American Academy of Orthopaedic Surgeons