Friday, October 28, 2011

Swaddling Safely: Reducing Risk for Hip Dysplasia

By Jennifer Goldbronn, MAS, RD

Swaddling can be an effective tool for helping newborns to rest because they have so little control over their sometimes flailing arms and legs. However, a possible adverse effect of swaddling that has gained attention recently (though it has been known for centuries) is the increased risk for the development of hip dysplasia related to swaddling with the baby's hips and legs extended. Today we’ll explain what hip dysplasia is and how it is related to swaddling, and share tips for hip-healthy swaddling.

What is Hip Dysplasia?

Hip dysplasia is simply looseness or instability of the hip joint, which in its severe form results in hip dislocation. About 1 in 20 infants are born with some hip instability, though most (about 90%) are mild and resolve over time with normal development. Tight swaddling of the legs, however, is one factor that can interfere with the hips developing normally.

How are Hip Dysplasia and Swaddling Related?

Young babies’ hip and knee joints naturally flex into the fetal position (curled with legs and arms pulled toward the body) from their time spent developing in the womb. After birth, normal development of these joints will allow their legs to straighten over time. However, when a baby’s legs are not free to bend and flex, there is an increased risk of abnormal development of the hips. This is where tight swaddling of the legs can impact hip health. A 2007 review showed that the incidence of hip dysplasia is highly associated with “traditional” swaddling techniques that force extension of the hip and knee. (van Sleuwen 2007) Studies show that cultures using cradleboards, which force the hips and knees into full extension, have higher incidences of hip dysplasia.

Recommendations for “Hip-Healthy Swaddling”

Here are a few tips for swaddling that promote healthy joint development (based on American Academy of Pediatrics (AAP) and The International Hip Dysplasia Institute (IHDI) recommendations). When swaddling your baby:

• Do not straighten your baby's legs or bring them close together

• Make sure the blanket is loose around your baby’s hips and legs; your baby’s legs should be able to bend up (flex knees) and out

• Always make sure your baby is placed on his back to sleep and that there are no loose blankets near him

Keep in mind that other parents and caregivers who swaddle their young infants may not have information about safe swaddling techniques. Please pass this on! For more information about healthy swaddling and hip dysplasia explore the resources below.

References and Resources

The International Hip Dysplasia Institute Web site:,

The American Academy of Orthopaedic Surgeons Web site:

Van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TWJ, L'Hoir MP. Swaddling: A Systematic Review. Pediatrics. 2007;120: e1097-e1106.


  1. Wow, this is new to me, I will definitely keep it in mind for my next baby. Thanks for sharing

  2. Wondering what your thoughts are concerning cloth diapering and hip development? I notice that my baby has less flexibility with her cloth diaper on and make sure to have several blocks of time per day to be diaper free (helps her skin breathe as well). She immediately draws her knees to her belly once the diaper is off.

    I enjoy your blog! Thanks! Martha in VT