Healthy Hips Australia -

Safe Swaddling Guidelines

Swaddling is not something we just know how to do:

There are many benefits to swaddling during the first months of life; it provides security and comfort, aides in settling and establishing sleep patterns. Research indicates swaddling can increase the risk for developmental dysplasia of the hip (DDH). DDH is a common childhood condition where the hip joint does not fit in the 'normal' position due to abnormal development and/or lack of growth of the joint's ball and socket. More information available here.

To help natural hip development during swaddling:

DO

Position your baby with their hips bent and knees apart; a bit like a frog.

Allow room around the hips for movement.

Wrap the upper body firmly, but not tightly. Consider swaddling the arms only.

Follow SIDS and Kids guidelines – links below.

Stop swaddling once your baby is rolling, back to tummy and onto back again, during playtime, as it may prevent your baby from returning to their back during sleep (around 4-6months of age).

DON'T

Wrap legs tight and straight down / pressed together. At this stage in life, the hip joint can be loosened in the straight-legged position.

Use sleep sacks and pouches that tighten around the thigh.

Methods

Diamond – secure the arms individually. Twist the bottom of the wrap loosely so the legs are free to move within a sack, and tuck under your baby.

Square – secure the arms individually. Fold up the bottom of the wrap loosely over the chest, to create a pouch for free leg movement, then tuck under your baby.

Sleep sack or pouch – select those designed for free leg movement.

See the International Hip Dysplasia Institute video for demonstration;

What Research Has Shown

Hip dysplasia is rare in cultures where infants are carried with their hips spread apart (abducted). There is a ten-fold increase in the incidence in tribes carrying infants on cradle boards with legs held straight and together.

When the Navajo Indians replaced moss for diapers in the1940s, a big decrease in DDH was noted. Even though the cradle board was still in use, the slight spreading of the hips, by the diaper, was thought to influence this.

In 1975, a national program started in Japan to avoid swaddling with the legs straight, saw the incidence of hip dislocation drop from 3.5% to less than 0.2%.

Links

Royal Children's Hospital Video on Safe Wrapping

Victorian Paediatric Orthopaedic Network Safe Wrapping Flyer - Royal Children's Hospital

Red Nose (SIDS & Kids) Safe Sleep Recommendations

Swaddling: IHDI Position Statement

Written: November 2015. Revised April 2017