Babywearing or carrying has been proven to offer many great benefits to you and your baby. However, there are concerns as to whether or not it is bad for your baby's hip development and if it can result in hip dysplasia.
If the correct method of babywearing is followed and the correct choice of carrier is used, then hip dysplasia or dislocation is unlikely to occur.
Here is an in-depth look at what hip dysplasia is, the right way to wear your baby and tips for choosing the right carrier.
What is hip dysplasia?
The hip joint is made up of a ball and socket; the femoral head of the thigh bone (femur) is the ball and the acetabulum of the pelvis is the socket. Loose ligaments around the joint can allow for misalignment of varying degrees to occur.
The hip joint is classified as displaced when the ball and socket do not fit together in their 'normal' position. Babies can be born with hip dysplasia, or it can develop as a result of incorrect positioning; such as from incorrect baby wearing or swaddling.
Image used with kind permission from healthyhipsaustralia.org
In order to avoid hip dysplasia while babywearing, it is key to know what the causes and signs are so that you are fully informed on how carry or wear your baby correctly.
According to International Hip Dysplasia Institute (IHDI), the risk is highest in the first few months after birth when babyies' joints are stretching out naturally. If babies are placed in carriers that force the legs into a straight position, the ball could dislocate out of the socket.
IHDI describes hip dysplasia as a ‘silent condition’ because babies do not show any signs of pain and end up still learning to walk. It is also hard to tell if your baby had hip dysplasia in the womb or if the condition occurred after birth.
Signs of hip dysplasia may include:
- Asymmetrical skin creases on baby's bottom.
- Audible hip clicks or pops during a hip examination (though popping sounds can be normal).
- Limited range of motion when spreading hips.
- Exaggerated waddling limp or leg length discrepancy while learning to walk.
Treatment is optimised when diagnosis occurs within the first 3 months of life. If hip dysplasia treatment is delayed until after the age of two, it could lead to pain or waddling. If not treated at all, osteoarthritis, arthritis, and other hip deformities can occur in young adulthood.
Image used with kind permission from healthyhipsaustralia.org
Diagnosing Hip Dysplasia
According to the NHS your baby's hips should be checked by a paediatrician within 72 hours of birth. The doctor will move the baby’s hip joints to assess if there are any problems. This examination does not cause any discomfort to your baby.
If you are concerned that your baby may have hip dysplasia, your Paediatrician can examine them again. If they suspect an issue, they will suggest an ultrasound scan. Other factors that could warrant this scan include:
- A family history of hip problems.
- The baby’s birth position. If the baby was born in the breech position, hip dysplasia is more likely to occur.
- Twins or multiples. This could also increase the risk of hip dysplasia.
Sometimes the baby's hips will stabilise on its own before the scan can be conducted but they should still be checked to make sure.
Can Hip Dysplasia be treated?
According to the Mayo Clinic, hip dysplasia treatment depends on the baby’s age and the extent of the problem. Babies are usually treated with the Pavlik harness, which is a soft brace that holds the ball portion of the joint firmly in its socket for several months.
If the baby is older than 6 months, the doctor may use a full body cast to move the hips into their proper position. Sometimes surgery is needed to fit the joint together properly.
The correct hip-healthy carry position
According to the International Hip Dysplasia Institute (IHDI), the healthiest position for a baby to be carried in a baby carrier is for the hips to be spread naturally apart to either side of the parents’ body, with the thighs supported and the hips and knees bent. The hips should be able to move freely and your baby's legs should not be straight and forced together. The knees should be higher than the baby's bottom.
The M position: Thighs spread around the mother’s torso and the hips bent so the knees are slightly higher than the buttocks with the thighs supported.
Image used with kind permission from International Hip Dysplasia Institute
This position has been called the M-position, jockey position, straddle position, spread-squat position or frog position.
Any baby carrier that forces the baby’s legs together and in a straight position for long periods of time could cause hip dysplasia. Baby carriers should secure baby in the seated position with thighs and legs spread across the parent’s body to keep the hips stable.
For the first four months of the baby's life, it is recommended to use a carrier or wrap that secures the baby in the M-position facing you.
Dr Marinus, South African chiropractor, states that, “The position to worry about most when it comes to either causing hip dysplasia or making it worse, is when the baby’s legs are in full extension (straight legs) and internal rotation (toes of both feet pointed in to face each other – or pigeon-toed). "
In this position the hip joints are put under pressure and the capsule of the hip is stretched. The longer this happens, the weaker the hip capsule becomes and the more likely for the hip socket to start developing poorly. For the hip socket to develop well we need the top of the leg – the head of the femur - to be pushed snugly into the socket to keep it open.”
“The most hip-friendly position in which to carry or wear a baby is in the style of baby facing mom, chest to chest, with hips and knees bent so the legs form a little M, with knees as the tops of the M and the bottom as the dip at the bottom. How do we know this? Because the most widely used intervention for hip dysplasia is the Pavlik harness. This is a harness that holds the baby in a very similar position to the M shape to keep the hip joint snug. Just remember that you need to give the baby some time out of the carrier to have free play time and allow for tummy time, both of which are hugely important for development.”
“Slings, where the baby lies with the side of their body against you are not as hip-healthy as the chest-to-chest carriers. Slings do not promote the ‘knees apart’ positioning that allows hips to grow well. For babies where hip dysplasia may be suspected, we would much rather have them in the chest-to-chest position in a hip healthy carrier,” says Dr Marinus.
Image used with kind permission from IHDI
Once the babies get older and head support is not as crucial, you can start to experiment with different positions such as the outward-facing position. You need to choose a carrier that supports the outward-facing position that enables the baby to be in a seated position with their legs placed to the sides higher than their hips. They also need to be tall enough for their chin to sit above the top of the carrier.
Carriers that allow for babies to be carried on a parent’s back must also support the natural spread position. Your baby should be able to sit independently before you attempt this position.
The manual of the carrier will stipulate the age and weight limits for each stage of carrying.
Carriers that CAN cause hip dysplasia
The unhealthiest position for a baby’s hips is the opposite of the foetal position i.e. when the legs are held straight in extension with the hips and knees stretched out and the legs brought together. The risk to the hips is greater when this unhealthy position is maintained for a long time.
Side slings or cradle slings force a baby’s legs together and extend them. These carriers place the hips in an unhealthy position, especially when used for extended periods of time. Any device that restrains a baby’s legs in an unhealthy position should be considered a potential risk for abnormal hip development, as seen in the image below:
Choosing the best baby carrier to avoid Hip Dysplasia
The best choice of carrier is essential, especially in the first 6 months of your baby's life. If you choose to carry your baby for long periods of time, you need to choose a carrier that promotes hip health. It is also important to know whether different facing positions are safe for your baby’s hips and age, such as outward-facing position or carrying your baby on your back.
According to Dr Mike Marinus, hip dysplasia is “one of the most common musculoskeletal disorders found in babies. It is not ‘one problem’ but rather a spectrum of issues regarding the hip joints. Babies can be born with hip sockets which are not molded correctly because of their position in the womb. Alternatively, they may develop an incorrect shape due to positions the baby has been placed in after birth.”
Image used with kind permission from IHDI
Factors to consider when choosing a baby carrier
There are many carriers on the market, and it is easy to get overwhelmed. Here are some factors to keep in mind when choosing the perfect carrier for your baby:
- Make sure the carrier is approved in accordance with the safety standards for baby carriers.
- Choose a carrier that has been approved by the International Hip Dysplasia Institute
- Check that the textiles used have been tested for harmful substances.
- If possible, take your baby with you when buying a carrier so you can test the safe recommended positions and make sure that you and your baby are both comfortable.
Babies grow fast so you want to make sure that the carrier can support the baby's weight and there is no strain on your back.
Hip-healthy baby wrapping according to IHDI
The baby wrap is one of the most popular forms of carrying your baby in the early months after birth. A baby wrap is a great way to ensure that your baby is secured in the recommended M-Position.
Here is a step-by-step guide to a carry wrap position that secures your baby safely and can prevent hip dysplasia:
Image used with kind permission from IHDI
in conclusion
Baby wearing is safe and will not cause hip dysplasia, as long as the correct method of carrying is applied when wearing your baby, and a hip healthy carrier is used.
