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AAP: SAFE SWADDLING TO PREVENT HIP DISLOCATION

Many parents are probably familiar with the widely recognized “5 S’s” protocol for fussy babies by Los Angeles  pediatrician, Dr. Harvey Karp.  The program in its books and DVD’s is also known by the anticipated results:  “The Happiest Baby on the Block.”   The first “S’–swaddling– the infant  is the subject of this article.   Numbers two through five are beyond this scope of this posting, but are easy to research for those interested.

The practice of swadding young babies has been around for a more years and used by more cultures than one could accurately assess, and in recent years has become increasingly popular in our country.  Perhaps with this increasing inclination in mind,  three organizations dealing with pediatric orthopedics, have mutually developed some guidelines as to how to safely swaddle babies.   The September issue of AAP News features an article by prominent pediatric orthopedists and AAP authorities Dr. Charles Price and Richard W. Schwend, describing risks to babies’ hip development  from improper swaddling, specifically hip dislocation or  dysplasia.  Reviewing studies in which included experience with swaddling methods  native American Indians and Japanese and Turkish parents, as well a benchmark 2007  study and another study by the same “5 S’s” Dr. Harvey Karp, both in the journal Pediatrics,  the authors summarize the safer method of swaddling recommended in the guidelines presented by the three authoritative groups mentioned above.  In brief,  safe swaddling, the infant’s hips should be flexed (not tightly maintined straight), somewhat abducted (separated), and maintained to allow some movement rather than maintaining  rigid tightness.  All of this is to prevent or minimize the risk of the condition of developmental dysplasia of the hip, a potentially serious condition with possible permanent consequences for gait throughout life.  As usual, this is necessarily an inadequately brief discussion given the goal of this article, but hopefully the main points are clear.

And to clarify correct positioning, the Academy presented it’s own parent guide to safe swaddling, written by AAP author,  Trisha Korioth.  Risking a little repetition from what’s already been said,  here is the statement  as presented in AAP News:

 Practice safe swaddling to protect baby’s hips

Many babies take comfort in being swaddled in a blanket.  However, swaddling the wrong way can cause hip dislocation.

 The cozy feeling of a blanket snugly wrapped around the baby’s body resembles the mother’s womb. The American Academy of Pediatrics supports safe swaddling of infants that leaves the hips and legs free to move. Studies have found that straightening and tightly swaddling a baby’s legs can lead to hip dislocation or hip dysplasia, an abnormal formation of the hip joint where the top of the thigh bone is not held firmly in the socket of the hip.

When swaddling a baby, use the following techniques from the International Hip Dysplasia Institute:

  • Swaddle the baby on a square blanket. 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 and tuck it under one side of the baby.
  • Swaddle a baby using the diamond shape technique. 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 of the blanket over the baby and under the right side. Fold or twist the bottom of the blanket loosely and tuck it under one side of the baby.

Legs should be able to bend up and out. When using a commercial swaddling blanket, make sure it is loose around the baby’s hips and legs.

To reduce the chance of sudden infant death syndrome, parents should place babies on their backs to sleep and keep loose bedding and soft objects out of the crib.

© 2011 American Academy of Pediatrics. 

Trisha Korioth, Staff Writer
This information may be freely copied and distributed with proper attribution.