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The Secret To Hip Healthy Swaddling

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hip healthy swaddle

Is swaddling a safe to calm babies and help them sleep, or could there be a downside to it? Some daycares are now discontinuing the practice due to growing evidence that incorrect swaddling may cause hip dysplasia. (source)

While there is evidence to support the idea that swaddled babies sleep better and cry less, a study conducted at the University of Southampton found that some wrapping techniques may interfere with proper hip development. Dr. Anthony Scaduto, chief of pediatric orthopedics at the Orthopedic Institute for Children at the University of California, has also “noticed that an increasing percentage of the patients referred to him because of suspected hip dysplasia have been swaddled.” (source)

What NOT To DO

According Dr. Charles T. Price, director of the International Hip Dysplasia Institute, incorrect swaddling techniques are nothing new:

“Studies from Japan, Turkey, and from American Indians have shown that tight swaddling in the papoose position can cause hip dysplasia and can even cause babies hips to dislocate.” (source)

According to Dr. Price, looseness “of the hips is the most common abnormality in newborn infants, so proper swaddling is important to keep the hips healthy. ” (source)

Is Swaddling Safe Even When Done Correctly?

In this article, lactation consultant Nancy Mohrbacher suggests that we need to rethink swaddling completely. She explains that, according to several studies, newborns who are swaddled have a weaker suckling reflex, lose more weight, and are colder than babies who receive skin-to-skin care.

So should we ditch the practice completely? I can’t say what is right for anyone else, but with my last baby I practiced near constant skin-to-skin for the first weeks of life, then began swaddling as the startle reflex kicked in. I found that it was helpful in preventing him from waking himself up as he flailed his arms around, and of course I made sure to keep the room cool and use proper technique to keep him safe.

The Secret To Hip Healthy Swaddling

So how do we keep our babies happy and snug while promoting healthy hip development? Here’s a demonstration of proper swaddling technique:

Houdini’s that they are, my kisd usually escaped from a plain blanket swaddle pretty easily. I ended up using this special wrap instead – it’s very easy to swaddle in a hip-healthy way and it works really well!

Also, please note: Most swaddle blanket manufacturers recommend weaning from the swaddle when baby can roll over.

Other Ways To Promote Healthy Hip Development

Baby Carriers

As the International Hip Dysplasia Institute illustrates, certain baby carriers do not support babies hips properly. (photo source) You can find more on the biomechanics of baby wearing here and here.

Which Carrier Should I Use?

There are many good ones out there, but here are the two I personally use and love:

For younger babies, I love the Boba wrap. It comes with instructions for using the “frog position,” which is considered hip friendly.For older babies and toddlers, I love the  Boba Carrier. I’ve also heard fabulous things about the Ergo and many others.

If anyone has another ergonomically correct carrier that they’d like to recommend please do!

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107 Comments

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  4. swaddling while nursing was the only way my daughter was happy for first 3 months, of course your going to get people to say it causes baby to nurse less but that was not true for both of mine

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  15. I think swaddling can give newborns a lot of comfort as it gives them the feeling of being tucked in like in the womb. I don’t swaddle tightly and allow the freedom of movement in my baby’s legs by wrapping loosely around the legs

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  16. All 4 of my kids, and my daycare infants LOVED Swaddling during those first 3 months of life. Nothing done with swaddling…especially when done the right way and baby likes it.

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  19. Michelle Honsky Wallis – According to the study it’s not necessarily how tight the wrap is (though obviously you don’t want to to be too tight), it’s the positioning of the thighs within the swaddle that makes the difference. 🙂

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  25. I swaddled with a Swaddle Me. Both my girls LOVED it!!! They liked having tight arms. DD2 would freak out if her hands touched her face while sleeping. She was actually swaddled till 6 months (only at night). I liked the Swaddle Me because their legs had free range, but the arms were tucked in close

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  31. My boys were much happier being swaddled when they were very young. They slept well at night, I think in part due to swaddling. We stopped when they were able to kick the swaddlers off. We usually only swaddled when they slept.

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  33. I bought lots of wraps to swaddle my LO when he was born only to find out later he absolutely HATED them and preferred to lie on his tummy from birth up until now … 18 months!

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  35. Both of my babies were swaddled a lot during their first three months of life. This is good information, I never really wrapped their legs tight, but I did always have to make sure their arms were firmly wrapped. I don’t understand why anyone would have a general problem with swaddling (not directed at the post, directed at an above comment).

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  40. My daughter was born breech and also born with hip dysplasia. So coming from a mom who has single handedly dealt with hip issues with our child from day one, I can’t stress it enough how very serious this issue is. One thing you should all know is that a child suffering from hip dysplasia is a silent sufferer. It may not cause them pain that you can be aware of. It will be how they suffer down the road from improper development of the hips. I could sit all day and tell you all things you are not aware of and how these chairs, swaddles, bouncy seats etc will affect the development of their body but I would prefer it for you to research it yourself. I did lottssssss of research and we have been to lots of orthopedic appointments with her doctor at DuPont Hospital for children. I’ve asked hundreds of questions and between all that, medical treatment of a pavlik harness, her amazing doctor and tons of dedication to being very cautious of her hip placement we have come to a road of healthy & happy hip development. Please mamas do your research and educate yourselves for your child’s sake.

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  45. I guess because I educated myself first before I swaddled I assume everyone does. One style blanket I found had Velcro in the right places so that wouldn’t be an issue period. One person above mentioned placing her baby on their belly for sleep , your not supposed to do that , or use regular blankets. The world of rules has made safe sleep very confusing and scary! You get to know your baby, find what’s comfortable for everyone and do the best you can 🙂

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  46. Swaddling doesn’t have to interfere with nursing or skin to skin. My babies were only swaddled to sleep. Sometimes they slept in a stretchy wrap, but the other times they were swaddled. Then after they woke up I’d de-swaddle, change their diaper, then nurse. Just because a mother swaddles doesn’t mean she’s doing it 24/7. Don’t villianize it because of what you read from some expert…

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    • all my children slept best on their tummies – they are in their late 20’s and early 30’s now; i still love to sleep on my belly – people do have preferences even as newborns; my grand children sleep on their bellies as well, they rolled themselves into that position; besides the Australian SIDS study showed (yes some refute that one, i know) that it is bacterial gasses, mainly from older mattresses (and possibly from all the flame retardants used on mattresses); some studied the use of fabric softeners and SIDS…. so just tummy sleep as a cause of SIDS is not convincing – to me at least;

      Swaddling always makes me feel like we imprison the little ones! even in the womb there is ample room for arm movement, babies sucking their thumbs inutero – swaddling feels way too confining to me, but some babies love it, so swaddle them!
      In view of the hip dysplasia – with the introduction of disposable diapers and not spreading the legs as far as cloth diapers used to is another point to consider.

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  50. Interesting! I will be changing my practice for sure. I like to Swaddle babies in the NICU and nursery for the benefits but will consider one of the two other options if a sleep sack is not available.

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  52. Our oldest son was born with hip displasia. Thankfully they caught it early but he did have wear a Pavlik harness for a few months and will have regular check ups until he is fully grown.

    It’s definitely worth researching how to keep those hips in proper position!

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  53. Raluca Donciu – I don’t think it really has to be an either/or thing. My 8 week old nurses unswaddled all day long, but I swaddle him at night. He doesn’t wake all that often throughout the night, so the percentage of time he nurses while swaddled is very low.

    As for skin-to-skin, there are virtually no photos of me from the first month of his life because I place the utmost value on touch and was basically never dressed in a way I’d be comfortable having photographed. However, as he transitioned out of the newborn stage and became more prone to waking himself up via the startle reflex I found that swaddling was helpful. It was with my previous two as well.

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  64. This is why it’s imperative to get babies checked by a Chiropractor!!! These problems can turn into deadly subluxations but if found early, your child will live a very beautiful, healthy life.

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  66. I’m glad you talk about this because swaddling is very popular but not without risks. However, the proper development of the hips is not the only concern. There is controversy about how the swaddling is experienced by the baby, some say it gives him a feeling like in the womb, others say it is extremely stressful so the baby shuts down in order to survive. I cannot say who is right, it is true that many parents see their baby sleeping deeper and longer when swaddled. And exactly here lies the other risk: baby’s are not designed to sleep long and/or deep (or alone for that matter)! A light and interrupted sleep is a protection against SIDS, the interruptions are necessary to get fed (breastmilk digests easily and quickly, the brain needs nutrients constantly in order to develop properly). A swaddled baby can not help himself when he gets too hot or cold, he can not give the necessary cues to show he needs food (or something else), either because he can not move or because he is sleeping to deeply.
    So my case against swaddling: higher risk of SIDS, risk of hip dyplasia an risk of missing feeding cues.
    I am not against swaddling altogheter, but keep the bigger picture in mind!

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    • Thank you for your comment, Janine! I have looked into each of these issues individually and here are my thoughts.

      I don’t bathe my babies right after birth, but when I do I’ve noticed that they splay their arms out and look very stressed when we get in. I know that I am interpreting their feelings and that there’s a possibility I could be wrong, but it is my sense that they are frightened by the sense of limitless space. As soon as I scoot them over to where they can touch the side of the tub they relax in my arms. I’ve seem this with them over an over, and so I interpret their tendency to relax in snug spaces as a feeling of peacefulness.

      While it is true that very long, uninterrupted periods of sleep can increase the risk of SIDS, surveys seem to indicate that parents who don’t swaddle more often place their babies face down because it helps prevent babies from waking themselves with the startle reflex. This reflex, which fades around the time a baby can roll over, seems to be something that parents almost universally try to minimize when baby is sleeping. Interestingly, when compared with placing baby on their tummies, the practice of swaddling baby and placing them on their backs seems to decrease the risk of SIDS. In my opinion my baby’s sleep patterns while swaddled do not constitute excessively long periods of rest. This may not be true of every baby or every circumstance, but it is what I believe to be true for my little one.

      Regarding them getting too hot or cold, I think parents need to be aware of this and dress baby’s accordingly regardless of whether a baby is swaddled or not. And with respect to feeding cues, it has not been my experience that they are suppressed. My little one gets my attention quite easily when he needs to, night or day. Thanks again for your comment!

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  87. I tend to agree with the first comment and have never swaddled a baby (mine hated it when the doctor tried it anyway – those kids had been trying to get out into the open space for a while!). I tend to lean towards holding my babies a lot and co-sleeping, and swaddling while co-sleeping would be a very bad idea! I think co-sleeping does more to reduce the risk of SIDS than swaddling does, and co-sleeping babies rarely tummy sleep (not that tummy sleeping is actually dangerous in and of itself).

    Anyway, as far as hip dysplasia goes, one really easy way to prevent it that I did not see mentioned is to cloth diaper your baby with a double diaper. Our doctor told my mom to do this with my sister because her hip was dislocated at birth and she has never had a problem. I also recently read that the rampant hip issues among the native Americans from the papoose board virtually disappeared when they began using diapers like the Europeans.

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    • That’s very interesting about the diapers, Beth! I’ll have to look into it more. Regarding tummy sleeping: Though it’s difficult to pin down a definitive reason why, it does seem that the risk of SIDS goes up when baby’s are placed on their tummies.

      I suppose different people have different opinions of what constitutes a “very bad idea” when it comes to bedsharing and swaddling. The AAP thinks bedsharing is a very bad idea period, but many parents who live the practice feel the opposite. I imagine there are many different practices along that continuum and many different opinions about what is in the best interest of the baby.

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  90. Penelope not sure what blanket you’re referring to, I used the Carters blankets; the ones I have to you. I like those because they were stretchy and the perfect size. As far as the hip issues I never wrapped tight around the hips only arms so I never worried about it.

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  94. Clarissa, the article clearly says that you’re not putting a baby by swaddling as long as you’re doing it correctly. Which I’m pretty sure I was not. Makes me sad to know that I was a bad swaddler. 🙁

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  96. Wonderful article thanks; my ten-day old is most happy when swaddled and worn in a basic sling; just a 5m x 40cm length of fabric (woven cotton or a light stretch soft jersey).

    Swaddling takes practice, cheesecloths are good and so are cotton knit jerseys but less good are cotton weaves as he likes to kick and stretch his legs, so some fabric give is great.

    He nurses like a legend and sleeps beautifully when carried or swaddled, I can regulate his temperature, feeds and needs like this, and change carry positions as he needs me to.

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  97. There’s nothing wrong with putting a baby tummy-down to sleep. While I used to believe that SIDS would be reduced by babies sleeping in the same room as the parent (co-sleeping), I now believe after seeing extensive research that vaccines are the cause of SIDS. SIDS tends happen when kids are at the peak of all their vaccines. As for swaddling, I never felt the need to swaddle. Sure, I would wrap a blanket around them to keep them warm, but nothing like a papoose!

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  99. I love the pictures that you have provided to support your evidence. You should only swaddle your child if you are certain that you know how to swaddle correctly.

    I like to call the position in the carrier the “frog leg” position. The pictures you have provided shows why I like to call it this position.

    Thanks for the great post.

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  101. I think every baby is just different. My son was a preemie (32 weeks) and the nurses at the hospital kept swaddling him, and he’d keep getting his arms out. A few weeks later, when he was able to come home, I didn’t worry about swaddling so much just because it didn’t seem to bother him to have his arms moving around.
    Same thing happened with the pacifier. Around 4 months of age, he would get screaming mad if we gave him the pacifier. He was happier just being at the breast. So I think it’s just different for each child.

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  103. Has anyone tried the Zipadee-Zip from Sleeping Baby? My LO loves sleeping in it because he feels the comfort and security of a swaddle but has enough mobility to freely move around.

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