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29 October 2013
Swaddling revival prompts orthopedic warning

A resurgence in the popularity of traditional swaddling has prompted pediatricians to warn of a rise in developmental hip problems in babies. Professor Nicholas Clarke, of Southampton University Hospital (UK), explained how hip problems are linked to swaddling in the Archives of Disease in Childhood.

Swaddling of infants was an almost universal practice in the past, but it gradually fell out of favor in many parts of the world. Now, however, the technique, which involves the bundling of babies in blankets with their arms restrained and the legs stretched out, has become fashionable again. Much of the attraction of the technique is because of its perceived calming effect, says Clarke.

Around 9 out of 10 infants in North America are now swaddled in the first six months of life, and demand for swaddling clothes soared by 61 percent in the UK between 2010 - 2011.

While evidence suggests that swaddling helps induce sleep and soothes excessive crying, there is also a growing body of evidence showing it is linked to a heightened risk of developmental hip abnormalities.

This, according to Clarke, is because swaddling forces the hips to straighten and shift forward, risking the potential for misalignment, and this in turn is associated with an increased risk of osteoarthritis and hip replacement in middle age.

Around one in five babies is born with a hip abnormality, with factors such as a breech birth or a family history, recognized as risk factors. But mechanical factors after birth also have a role, says Clarke. While many of these cases resolve spontaneously, swaddling may delay this.

Clarke advises that swaddling can be safe provided that it doesn't prevent the baby's legs from bending up and out at the hips, because this position allows for natural development of the hip joints. The babies' legs must not be tightly wrapped and pressed together, he warns. "Any commercial swaddling products should include a loose pouch or sack for the babies' legs and feet, allowing for plenty of hip movement."

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Source: British Medical Journal

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