Medical experts now say that tight swaddling or narrow swaddle suits/sleeping bags are to blame for an increase in incidences of infant hip dysplasia. Hip dysplasia is a common childhood condition that can leave your child needing a series of operations including hip replacements or a life-long limp.
This week was a really special milestone for our family. My daughter Mila was given the all clear for her infant hip dysplasia, after two years with the condition. I really wanted to share some of what we have learnt as well as Mila's story in the hope that I can help raise some awareness of infant hip dysplasia and the risks of swaddling tightly.
The lightweight muslin inbetweenie™ baby sleep sack that we sell online here was designed as a safe alternative for swaddling. It is fully enclosed which keeps little hands and arms covered, controls the startle reflex and allows sufficient hip movement. Take a look around our site for more information.
Infant hip dysplasia, or developmental dysplasia of the hip (DDH), is a common childhood condition which has serious repercussions if it is not detected early; and can leave children needing a series of hip replacements from as young as 13, or a life-long limp.
DDH is where the hip joint of babies and young children doesn't fit in the normal ball and socket position due to abnormal development and/or lack of growth of the hip joint. It can be present at birth or it can develop in the weeks or months after birth. One in 20 newborns have some hip instability and 3-5 per 1000 will need treatment. The risk factors for DDH are: family history, female, first born, heavy birth weight and breech (although Mila had none of these).
Research has shown that tight swaddling can increase the risk of infant hip dysplasia and dislocation, and it is now believed that traditional swaddling along with the popularity of narrow swaddle suits or sleeping bags have caused an increase in the number of cases of hip dysplasia.
2016 research published in the Medical Journal of Australia stated that swaddling was linked to joint development issues, including ‘clicky hip’. The study says, “There is growing concern among the orthopedic fraternity in North America, the UK and Australia that a resurgence in the popularity of swaddling, including the increased use of ‘swaddling cocoons’ places children at risk of late diagnosed DDH.”
When the baby is in the womb their legs are in a fetal position, i.e. legs bent and across each other like a frog. Suddenly straightening the legs to a standing position can loosen the joints and damage the soft cartilage of the socket. In order for swaddling to allow healthy hip joint development, the legs need to have enough movement to bend up and out at the hips (diagram below, on right) . Swaddling a baby which still allows sufficient hip movement is perfectly safe, however swaddling a baby with the hips and knees in an extended position (diagram below, on left) will increase the risk of DDH.
When my son Asher was born nearly five years ago we were encouraged to wrap him as tightly as possible, and when he busted out of our cloth origami wrapping I was delighted to find so many different brands of tiny tight swaddle suits to buy for him. These were like houdini straight jackets which pinned the legs together, I never thought to question the safety of them. I had then saved these for our next child, and had Mila not been diagnosed so quickly with her condition, she would have spent all those many hours sleeping through the day and night with her legs straight down, exacerbating her DDH.
Despite the research, there is still a lack of awareness about DDH, even amongst some health professionals. It is advised that a GP or Paediatrician check babies' hips at all the routine early development checkups from birth until the age of one, however many professionals cease these checks at 6 months, or even miss the check all together. The Australian Paediatric Society is currently working to try and to change the national schedule of early childhood checks to ensure that hip tests are performed beyond 6 months old and up to 1 year, but currently the onus is on the parents to request checks after 6 months.
It's been a journey for us, but as the dysplasia was detected so early we were always confident Mila would recover fully, and hopeful it would simply be a matter of when. For families where the DDH is missed or diagnosed too late, however they face the prospect that their child will require several operations, including the first of numerous hip replacements as young as 13, and may suffer a life-long disability, which would have been avoided if the condition had been diagnosed when their child was very young. My heart really goes out to these families and I cannot imagine the anguish.
We were aligned with a fantastic, cautious Paediatrican who attended Mila's birth, and we can be so thankful we had begun this relationship then, as it was integral in the early detection of MIla's case.
Mila's Diagnosis and Treatment:
At her birth check up the Paediatrician detected a potential issue with one of her hips and made a note to keep an eye on this. At her 6 week check up he again detected an issue so we were sent off for an ultrasound. I think we had to make an appointment with our GP to get a referral to go back to the Paediatrician in order to get the results. Already it felt like a lot of appointments to be dragging my little baby around to. The ultrasound confirmed that one of her hips was shallow, so instead of the top bone being shaped like a bowl it was more like a plate.
The Paediatrician reassured us that the treatment when DDH is detected early is quite simple, although quite a nuisance for the parents. Because the mother’s relaxing hormones are still in the baby, a dysplastic hip of a newborn baby often goes back into the socket very easily, so treatment is non invasive.
We were then sent to the Orthotics and Occupational Therapy department at the Sydney Children's Hospital for Mila to be fitted with a semi soft brace called a Pavlik Harness which is worn directly against the skin, with strict instructions that we must not remove it, and meaning her nightly bath time routine would cease to exist. We had to return to Occupational Therapy every 2-3 weeks to have the brace refitted as she grew, and used the chance then to give her a bath in the ward.
It was sad to see my perfect little baby girl having to wear this ugly contraption and to see the chaffing from the brace on her delicate soft skin. Initially I was worried about how hard it would be to care for a pooping vomiting baby that could not be properly cleaned. It was also a challenge to find clothes and sleeping bags that could fit over the top of the brace and her legs bent up and out. (Our inbetweenie™ sleep sack easily fits over a child in either a Pavlik or a Rhino brace.) Positioning her in the car seat was never easy. I also found the regular drives to the hospital stressful with a crying hungry baby and the parking so expensive. It never fails to upset me at how prohibitively expensive parking is for people who need to visit. Luckily she never once seemed distressed by the brace, I guess because she was still so young and immobile.
After 3 months in the Pavlik harness a follow up ultrasound showed her hips were still shallow, so we were sent to a see an Orthopaedic Surgeon at the Prince of Wales (next door to Sydney Children's Hospital) to oversee the end of her treatment. By this point I had found the best unmetered street parking spots and knew a shortcut through the basement of the hospital. Back we went to the Orthotics and OT department where she was then fitted with a Rhino brace - a hard plastic brace that she was to wear 23 hours a day. I much preferred the Rhino brace to the Pavlik harness as we could take it off to change her nappies and give her a bath, and she could wear normal clothes underneath it. After about 6 weeks we moved to night time brace wearing only and finally by the time she was 8 months we were able to finish the treatment.
When Mila was 18 months old we went back to the Surgeon with an x-ray however unfortunately while she had improved, it still showed some signs of dysplasia, but it was hoped that through weight bearing and running around it would form properly. We then returned for a check at her second birthday, which was our appointment this week where we heard the news Mila is completely cured!
While there was never really a concern about Mila's future, it was my first introduction to the heartbreak of having a child who isn't healthy as we saw far less fortunate babies and children in the hospital halls and in the Orthotics and OT waiting room. Some families just have to go through so much.
It's been such a privilege to be working on the design of a baby sleeping bag (pictured below in the double weight muslin) with my lovely friend and business partner Jane, who had a vision for a cosy fully enclosed swaddle which didn't feel like a swaddle, after her experiences with her own children. Our work had already begun on the business and design when Mila was diagnosed with DDH so it was incredibly fulfilling that as we learnt more about the condition we were able to place a heavy focus on ensuring our product would be hip friendly.
There is such a minefield of information to learn before having a baby and in those first years. My advice is to align yourself with a GP or Paediatrician you trust wholeheartedly and to follow your instinct.
Co-owner Girl + Boy
Tips for Parents:
- Allow for the natural frog leg bend of the legs
- Avoid tight swaddling or narrow swaddle suits in the lower half of the body (opt instead for a safe "arms out" sleeping bag or inbetweenie™ sleep sack)
- Avoid narrow based car seats or prams
- Avoid any baby carriers where the legs hang down (opt instead for the Ergo Baby or the Manduca)