Dr. Charles Price, pediatric orthopedist at the Winnie and Arnold Palmer Hospital for Children and director of the International Hip Dysplasia Institute, has reported a direct connection between incorrect swaddling and hip dysplasia. “Swaddling an infant has many positive effects such calming a crying baby and soothing pain in infants. Unfortunately many parents are taught to swaddle the baby’s entire body to create a tight cocoon, and this restriction of movement in the lower half of the body can lead to post-natal hip dysplasia.”
Hip dysplasia is the most common infant abnormality and results when the top of the femur (leg bone) is not properly located in the hip socket or is loose in the hip socket. The condition is most common in breech birth babies, first born girls and when there is a genetic predisposition (family history). If diagnosed early and with proper care, this condition can usually be reversed. Recently, however, it has been discovered that infants whose hips were normal at birth are developing hip dysplasia in the early months and this may be due to improper swaddling. Improper swaddling has been associated with hip dysplasia in Japan and among native American Indians. The condition often goes undiagnosed and leads to early onset of adult arthritis of the hips with hip replacement at a young age.
Improper “tight” swaddling
Dr. Price offers these hip healthy swaddling tips to help avoid hip dysplasia:
- If using a blanket, wrap firmly around the arms but loosely around the legs so the hips can move freely.
- When swaddling baby, avoid stretching the legs out straight or pressing them together.
- Encourage baby’s hips to be spread and bent as if riding on a horse. (When carrying baby, wrap his legs around your body for proper hip development.)
Also consider using commercial products with a roomy bottom for the legs such as the Halo Sleepsack Swaddle
For additional information, visit www.hipdysplasia.org.
Hip dysplasia in children and adults is sometimes preventable
Hip dysplasia means that the hip ball and socket are not centered, or that the joint ligaments are loose. Hip dysplasia can range from a shallow socket to a completely dislocated hip.
Hip dysplasia is well-known in dogs but most people don’t realize that it is also the most common abnormality in newborn babies. Silent hip dysplasia is also the leading cause of hip arthritis in young women. This condition is also accounts for 10% of all total hip replacements in the USA. Some of this may be preventable with proper positioning of infant hips during the first few months of life.
Straightening the legs and binding them together in a traditional swaddling position increases the risk of hip dysplasia. Swaddling has many benefits for calming and comforting infants, but it’s important to leave plenty of room for the legs to move so the hips are not forced into a straight position.
Hip dysplasia is rare in cultures that carry their babies with the legs spread around the mother’s body. Hip arthritis in adults is also less frequent in these cultures compared to cultures that do not “wear” their babies in the “jockey” position with the legs spread. There may be a connection between this position and the development of stable, well-formed hips.
Infants’ hips are often loose because the mother makes hormones that help the ligaments relax for the birthing process. These hormones affect girls more than boys so hip dysplasia is four times more common in girls than boys. Fortunately, most cases of infantile hip dysplasia become normal as the mother’s hormones leave the baby’s body and the ligaments tighten up. The cause of the adult type of hip dysplasia is unknown, but the socket doesn’t develop normally and remains shallow. During adolescence or later, the hip wears out prematurely and causes an aching pain in the front of the hip or in the groin area.
Hip dysplasia in infants it is painless even when the hip is completely dislocated. The outer edges of a baby’s hip are soft and flexible because they are made of cartilage like the cartilage in your ear. You can bend your ear without any pain and the hip can slip in and out of the socket of a baby without any pain. Pediatricians examine every baby to see if the hips are loose or dislocated. This examination can identify 90% of the cases of hip dysplasia so that treatment with a simple splint or harness can begin early.
Human hips are not ready for walking when we are born and the hips are scrunched up in the womb. The condition is more common when there is a family history, but it is also more common if the baby was crowded in the womb. Breech (bottom first) babies, twins and first-born girls are at higher risk for hip dysplasia than other babies. Infants whose hips were normal at birth may develop hip dysplasia because of improper swaddling with the legs straight out and pressed together in a tight bundle. Watch a video and learn more about hip-healthy swaddling at www.hipdysplasia.org
Treatment for hip dysplasia and hip dislocations in infants uses a Pavlik Harness or other forms of bracing. These harnesses and braces are usually successful before six months when the hip is flexible enough to go back into the socket by positioning. These devices help hold the baby’s hip in the socket until it becomes stable. The International Hip Dysplasia Institute is working with the University of Central Florida, College of Engineering to develop simulation that will help plan the course of treatment in a Pavlik harness. Sometimes the hip is dislocated and won’t go back into the socket. The next line of treatment includes general anesthesia and reduction of the hip into the socket followed by a body cast to hold it there for several months while the child grows. For children older than 18 months or when reduction is not successful, then surgery is needed to put the hip back into the socket.
Adults with hip pain from dysplasia are difficult to diagnose. The average delay in diagnosis is 3.7 years because this is not a familiar condition for many physicians including orthopedic surgeons. If an adult has hip dysplasia, then surgery to correct the shallow socket can relieve pain, allow return to sports, and delay the onset of arthritis by many years. More information can be found through the International Hip Dysplasia Institute.
Any adult with obscure hip pain is encouraged to seek care from an orthopedic surgeon with extensive experience in the diagnosis and treatment of adult hip dysplasia. The Whitney Hip and Musculoskeletal Institute at Orlando Health has a team of highly qualified orthopedic surgeons who manage hip dysplasia. This is the only group in Florida that focuses on hip problems in a coordinated and comprehensive manner from birth to old age.
All illustrations and photos courtesy of the International Hip Dysplasia Institute (IHDI)
References:
Dr. Charles Price
http://www.hipdysplasia.org/About/Medical-Advisory-Board/Charles-Price/default.aspx“For more information about DDH, please visit the website for The International Hip Dysplasia Institute:
http://www.hipdysplasia.org
