It is hard to know what the right thing is to do for your baby when it comes to swaddling. One book says one thing and is contradicted by the next. Here I want to explore the facts so that you can decide for yourself what is best for you and your baby.
There are a range of views from midwives, nursery nurses and doctors on swaddling. The practice is believed to go back as far as the ancient Greeks and Romans. It is thought that it gives the baby a feeling of security like being in the womb, as well as promoting sleep and managing colic. The trend for swaddling has meant that demand for swaddling clothes has increased by about 60% in recent years.
The main reason that swaddling has hit the headlines is an article written in a British paediatric journal. The author, Professor Nicholas Clarke, is an orthopaedic surgeon from Southampton University Hospital and wrote that tight swaddling forces the hips of a baby into a straightened position and that this can led to a condition called developmental dysplasia of the hip (DDH).
A diagram of the ball and socket joint of the hip:
A diagram to show the stress and strain put on the joint when the leg is straightened:
DDH occurs when the bones of the hip joint are not aligned correctly. This prevents the hip from developing correctly and can lead to poor function of the hip later on. There are well known risk factors that contribute to DDH including a breech presentation or a family history of DDH. All babies born breech or with a family history of DDH are routinely scanned using an ultra sound machine at 6 weeks of age. 20% of babies are born with mild DDH which resolves by itself, but the hips are vulnerable and might progress into severe DDH if not managed properly. Swaddling puts these already weakened joins under pressure and might interfere with the body’s ability to repair itself.
"In order to allow for healthy hip development, legs should be able to bend up and out at the hips. This position allows for natural development of the hip joints,” Says Professor Clarke. "The baby's legs should not be tightly wrapped in extension and pressed together."
Professor Clarke also noted that an education programme in Japan against swaddling saw the prevalence of hip dislocation halve.
Andreas Roposch, an orthopaedic surgeon from Great Ormond Street Hospital, agreed with Professor Clarke that there was evidence to show that tight swaddling could affect the hips’ development. "Swaddling should not be employed in my view, as there is no health benefit but a risk for adverse consequences of the growing and often immature hips."
Alastair Sutcliffe, a paediatrician from University College London Hospital, also added that in countries like Nigeria where the women carry their babies with their legs splayed around their waist the rate of hip dysplasia was “virtually unseen”. It goes without saying that papooses that support the legs in a splayed position are therefore thought to be more beneficial than those that leave the legs dangling unsupported.
The International Hip Dysplasia Institute said for infants hips to be properly positioned they must be allowed to maintain the foetal posture during the first six months of life.
The Royal College of Midwives has given advice not to swaddle your baby. Their spokesperson said: “We advise parents to avoid swaddling, but it is also crucial that we take into account each mother’s cultural background and provide individualised advice to ensure she knows how to keep her baby safe, able to move and not get overheated”.
The Lullaby Charity (formerly FSID) points out there are other risks from swaddling your baby such as overheating. They add that you must not put your baby on their stomach whilst swaddled. If you do swaddle your baby, their advice is to use a thin material and not to cover your baby’s head at any point.
So, where does that leave us? I think that Alastair Sutcliffe, a paediatrician, sums it up well:"I would advise that if a baby needs to be wrapped up to get off to sleep that parents do this in a sympathetic and loose manner, and not tight especially around the baby’s hips.”