Volume 197 - Issue 5
Is swaddling damaging our babies’ hips?
Authors: Nicole Williams, Bruce K Foster and Peter J Cundy
Med J Aust 2012; 197 (5): 272. || doi: 10.5694/mja12.10652
Published online: 3 September 2012
Published online: 3 September 2012
To the Editor: In South Australia, the incidence of developmental dysplasia of the hip (DDH) diagnosed at or after 3 months of age was 0.22 per 1000 live births between 1988 and 2003, corresponding to a rate of 4-5 new cases per year.
Since September 2009, 34 children have been treated at our institution for DDH diagnosed at
3-18 months of age, which equates to an incidence of 0.7 per 1000 live births in SA. ...
To the Editor: In South Australia, the incidence of developmental dysplasia of the hip (DDH) diagnosed at or after 3 months of age was 0.22 per 1000 live births between 1988 and 2003, corresponding to a rate of 4–5 new cases per year.1
Since September 2009, 34 children have been treated at our institution for DDH diagnosed at 3–18 months of age, which equates to an incidence of 0.7 per 1000 live births in SA. This is more than a threefold increase since 2003. There has been no systematic change in screening practices, and the demographics were no different from those studied in the 1988–2003 series.1
Orthopaedic surgeons in Australia and abroad are concerned that a resurgence of the age-old practice of swaddling infants is placing them at risk of late-diagnosed DDH.2,3 Baby health care workers have campaigned since 2003 for the wrapping or swaddling of babies as a means to help them settle.4
However, wrapping babies with their lower limbs in extension is associated with increased rates of DDH. A review of 11 epidemi-ological studies showed a high correlation between DDH and swaddling.4 Commercially available products that mimic a “cocoon” (Box) force the lower limbs to lie in extension with insufficient room for natural hip abduction and flexion. In Japan, the incidence of DDH was 5%–6% when traditional “swathing diapers” were commonly used — these held the newborn’s lower limbs in extension. A Japanese national campaign stopped this practice and encouraged the use of diapers that promoted hip flexion and abduction. DDH rates then dropped to less than 0.4%.5 Of the babies we treated for late-diagnosed DDH, 79% had been swaddled.
The increase in DDH in our population is matched by reports from other Western nations where swaddling has been popularised. Parents and health workers need to be better informed of the risks of swaddling and encouraged to use a “hip safe” position (flexed and abducted).
Competing interests
No relevant disclosures.
References
- Azzopardi T, Van Essen P, Cundy PJ, et al. Late diagnosis of developmental dysplasia of the hip: an analysis of risk factors. J Pediatr Orthop B 2011; 20: 1-7. ref1
- Mahan ST, Kasser JR. Does swaddling influence developmental dysplasia of the hip? Pediatrics 2008; 121: 177-178. 0_i1142883
- Price C. Improper swaddling a risk factor for developmental dysplasia of hip. AAP News 2011; 32: 11. 0_i1142886
- van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, et al. Swaddling: a systematic review. Pediatrics 2007; 120: e1097-e1106. 0_i1142889
- Yamamuro T, Ishida K. Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan. Clin Orthop Relat Res 1984; (184): 34-40. 0_i1142891