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Dangers of Swaddling and Hip Dysplasia

Author: Neil Fearn  Bullet  Dated: 09/04/2013

Talking on a recent Radio 4’s flagship Today programme in March, Paediatric Orthopaedic Surgeon Professor Nicholas Clarke considered the effect of swaddling among the children he sees in his busy clinic at Southampton General Hospital.

Swaddling is an old fashioned practice, which has made something of a comeback in recent years - some midwives and health visitors recommend it as a way of soothing a distressed child, and it has become a popular method for calming children with colic.

Swaddling is where the baby is swaddled with blankets with their legs straight and the arms restrained so that it's comfortable and quiet. The problem is that the hips need to be apart, the legs need to be apart for the hips to develop particularly in the first 6 months and straightening a baby's legs and holding them together, which is what happens when they are swaddled, can hinder the development of a healthy hip joint leading to hip dysplasia and arthritis later in life.

As a result of the resurgence of swaddling doctors are seeing a shocking increase in hip dysplasia in their screening clinics.

Professor Clarke explains that hip dysplasia is under-development of the joint. It's a spectrum of abnormality - at one end you've got the tricky hip which you see in general practice and screening and at the other end you've got babies who have got dislocated hips and then you've got children who are untreated walk into the clinic at the age of 2 with a dislocated hip. The thing is it's multi-factorial but if you don't allow the hip to develop normally and you assault it with these different positions, that are not physiological (such as swaddling), you will not encourage normal hip development.

Historical data reinforces Professor Clarke’s comments about the downside of swaddling. The North American Indians used to swaddle their babies for transport issues and they had a very high incidence of congenital dysplasia. The Laplanders used to swaddle their babies because they were cold and they used to put them on boards and there was a huge incidence of hip dysplasia. And in the 1980s in Japan all the babies were swaddled for comfort and warmth and they realised that there was a very high incidence of hip dysplasia and they started a campaign where they educated grandmothers to tell their daughters not to swaddle their babies and the incidence went down by something like 10% - a huge number of cases that did not need treatment subsequently.

At least one in a hundred children in the UK will develop some degree of hip dysplasia and it accounts for a third of all hip replacements done in adults under the age of 60 as late dysplasia is associated with premature osteoarthritis.

If caught early the hips can be repositioned and encouraged to develop normally by putting the baby in a special harness. But if missed or picked up late more extreme measures are required and the outlook is nowhere near as good. It may mean unnecessary, extensive and invasive operative treatment. It may also lead to a total hip replacement, years earlier than otherwise needed.

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