A surgeon from the UK has made international headlines with his view that swaddling a baby can lead to children developing hip problems. What are the facts behind the media reports and is swaddling really dangerous?
Swaddling, the process of wrapping a baby in sheets or cloth that restrains their arms and lower limbs, is considered a global cultural practice with a long history that is said to help promote calmness by simulating womb-like conditions. In the past few decades the practice had seemed to fall out of favor, but a recent resurgence in the UK has renewed interest in the benefits and possible dangers of swaddling.
One such possible danger was widely reported on this week when several news organizations profiled a paper published in the Archives of Disease in Childhood journal by Professor Nicholas Clarke, a consultant orthopedic surgeon at Southampton University Hospital, in which he details that swaddling could increase cases of hip problems among young children by impeding the hip joint’s development.
“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,” Clarke is quoted as writing. “The babies’ legs should not be tightly wrapped in extension and pressed together.” He adds, “It is now essential that midwives, neonatologists and paediatricians provide the correct advice in relation to healthy swaddling practices.”
This echoes previous comments Clarke has made, including the following to the UK’s Royal College of Midwives (RCM): “While many cases of hip dysplasia are down to genetics or other conditions, swaddling is becoming an increasingly prevalent cause once again and that is extremely frustrating because it is something parents can control.”
It is important to note first and foremost that Clarke is not reporting on any new research, and nor does Clarke specifically provide research he is using for his assertions so assessing his exact claims are difficult. That said, there is a significant body of research to indicate swaddling can be linked to increased rates of hip dysplasia and so Clarke’s warnings do not appear to be scaremongering but rather drawing attention to an important health issue.
The RCM has also released a statement saying, while remaining sensitive to cultural practices, it does not recommend swaddling. Jane Munro, RCM quality and audit development advisor, is quoted as saying “It is an issue that such a seemingly innocuous thing can lead to significant problems for the baby… We advise parents to avoid swaddling, but it is also crucial that we take into account each mother’s cultural background, and to provide individualised advice to ensure that she knows how to keep her baby safe, able to move and not get overheated.”
What is Hip Dysplasia?
Hip dysplasia or developmental dysplasia of the hip is a misalignment of the bones of the hip joint. This leads to the joint not functioning properly and wearing out much faster. As pain is not normally felt in the early stages of hip dysplasia; the problem can be hard to detect until it is in its later stages and often when the damage has already been done. Such damage can lead to to impaired movement, joint pain and mild to pronounced limping.
The Center for Disease Control (CDC) estimates that around one out of every 1,000 babies will develop hip dysplasia, but many cases can go undiagnosed until much later in life, at which point movement will often be impaired and treatment less effective.
Other Potential Health Problems Related to Swaddling
Hip dysplasia is not the only potential drawback of swaddling. Some studies have shown that swaddling, and in particular tight swaddling that covers the baby’s head, can impair a baby’s ability to regulate its own temperature, causing the baby to overheat. There is also evidence to suggest an increased risk of respiratory infections among children who are swaddled. An increase in Sudden Infant Death Syndrome when linked with certain sleeping positions has also been found among swaddled children, though those findings are disputed.
Positives of Swaddling
Research has shown there may be some benefits to swaddling too, including that swaddling may help soothe a distressed baby and promote a relaxed state. The CDC even recommends swaddling in some circumstances, such as when preparing a baby for her vaccinations.
Recommendations for Swaddling
For those parents who do wish to swaddle, doing so loosely and with a mind to making sure the baby has a good range of movement in their hips and knees will guard against harm. Attention should also be paid to ensuring a swaddled baby does not overheat. As such, the baby’s face should never be covered.
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