Baby Carriers: How to Prevent Hip Dysplasia in Infants

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Placing infants in carriers, wraps or slings that hold their legs in a tight, straight position for long periods of time can negatively impact their hips, but there’s a lot of conflicting information floating around about the subject.

The International Hip Dysplasia Institute website says that “periodic short-term use of a baby carrier (is) unlikely to have any effect on hip development.”

However, the website also says that carriers, slings, wraps and other methods of carrying an infant that place the infant’s hips in an unhealthy position pose “a potential risk for abnormal hip development.”

“It’s a confusing message,” Dr. Charles Price, director of IHDI, told MedTruth. “We’ve created a lot of alarm that we had not intended.”

Baby Carriers and Hip Problems: What’s a Parent to Do?

It gets even more confusing as you search the Internet.

On the Naturopathic Pediatrics website, Erika Krumbeck, a naturopathic physician, recommends against using narrow baby carriers like the Baby Björn and Infantino brands because she says that they place excessive force on infants’ hip joints.

Price, on the other hand, said that such excessive force hasn’t been demonstrated.

Annika Sander Löfmark, head of communications for Baby Björn, defended the safety of her company’s baby carriers.

Lofmark told MedTruth via email that Baby Bjorn works with medical experts “during the whole product development (process) to ensure that our baby carriers are safe and healthy. We have never received any reports of baby carriers causing hip dysplasia.”

Others, like Madeleine Boot, a Slingababy and Trageschule UK-trained Babywearing Consultant and member of the British Association of Babywearing Instructors, say that the position caregivers place their infants in is much more important than the carrier itself.

“There is theory and conjecture that a narrow base carrier might exacerbate an underlying undiagnosed hip dysplasia or shallow socket, but despite the presence of narrow-based carriers on the market since the 70s, this has not been proven,” Boot told MedTruth via email.

Conflicting Views on Hip Dysplasia

Hip dysplasia, according to the Mayo Clinic, is a condition in which the socket, the upper portion of the joint, doesn’t fully cover the lower “ball” of the upper thigh bone, resulting in a full or partial dislocation. Most individuals are born with the condition, according to Mayo.

On the other hand, according to IHDI, hip dislocation and dysplasia can develop after birth as well.

Hip Dysplasia: A “Silent Condition” That Can Be Missed

One of the problems underlying the conflicting baby carrier messages is that while pediatricians catch about 95% of hip dysplasia in infants, “there are definitely some who slip through the safety net of examination,” Price said.

IDHI describes hip dysplasia as a “silent condition” because babies aren’t in pain and can usually still learn to walk. What we may never know is whether the hip problems went undetected or whether the condition developed after birth.

Signs of hip dysplasia may include: asymmetrical buttock creases, audible hip clicks or pops during a hip examination (though snapping sounds can be normal), limited range of motion when spreading hips, swayback, and exaggerated waddling limp or leg length discrepancy while learning to walk. Parents with questions should consult their doctor.

If hip dysplasia treatment is delayed beyond two years of age, it’s more likely to lead to pain, waddling, and decreased strength. If left completely untreated, osteoarthritis and other hip deformities can occur in young adulthood.

One in 100 infants are treated for hip dysplasia, while one in ten are born with hip instability. Hip instability in infants, for the most part, tends to resolve spontaneously without any dysplasia. Females make up 80% of hip dysplasia cases, and infants are 12 times more likely to have the condition when there is a family history of the condition.

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In the Womb: Congenital Hip Dysplasia

Hip dysplasia is usually caused by naturally loose hips around the time of birth, in combination with mechanical forces such as incorrect positioning — in the womb and/or after birth — that prevent the hip from developing into a normal ball and socket fit. Loose hips in the fetus is often due to pregnant women’s hormones, which help relax ligaments to ease childbirth. The baby’s left hip is more frequently involved, due to normal womb position, which stretches the left hip more than the right.

Prior to birth, babies who aren’t in the fetal position (bent hips and knees) are at high risk for hip dislocation and hip dysplasia, according to IDHI. The worst possible position in the womb for infants’ hips is where the legs are held straight and together, although this type of situation is extremely rare.

Even infants who have been in the fetal position can experience hip misalignment or dislocation because infants’ hip sockets are made mostly of soft, pliable cartilage, as opposed to adults’ hardened bone.

Carrying Baby Properly: Tips for Preventing Non-Congenital (After Birth) Hip Dysplasia

Outside the womb, an infant’s risk of developing hip dysplasia or dislocation is highest during the first few months after birth when an infants’ joints stretch out naturally. Breech babies (born bottom first) may need even more time. Natural stretching that occurs during birth can cause the “ball” of the ball and socket hip joint to be loose. If infants’ hips are forced into a straight, stretched out position, the ball can deform the edges of the socket or slip out of the socket, causing hip dysplasia, according to IHDI.

And that’s where proper and improper baby carrying practices come into play.

“If your kid has healthy hips, it’s not an issue,” Price said, referring to short-term (up to 2 hours) carrying practices. “It’s just that we don’t (always) know if they have healthy hips or not.”

However, carrying an infant improperly — with straight, tight legs — for hours on end daily is “definitely detrimental to hips,” Price said, adding that when the Navajo nation tightly swaddled their infants on papoose boards, they had a 30% incidence of hip dysplasia.

The best position for infants’ hips involves the hips spreading naturally apart, to each side of a baby carrier or caregiver’s body, with hips and knees bent as the thighs are supported. Hips should move freely, as opposed to forcing them together. Here’s a video on proper swaddling.

IDHI encourages caregivers to choose baby carriers that accommodate healthy hip positioning. It has found these products to be “hip healthy.”

“Healthy hip habits are similar to other healthy habits of exercise, proper nutrition and adequate rest. These are goals that we hope to achieve, but we shouldn’t be too hard on ourselves if we don’t achieve them all the time, every day,” Price said.

Healthy and Unhealthy Hip Positioning

According to Price, the natural position for the baby’s hips is the ‘M’ position, and carrying infants inward facing toward the caregiver’s face for six months is best, as opposed to outward-facing away from the caregiver’s face.

As far as placing the baby somewhere in between the “M” shape and straight legs, Price said that researchers don’t know much about the safety of these intermediate positions.

If your baby has risk factors, is really loose-jointed or was in breech position or if the family has risk factors, then there may be good reason to be a little more cautious when carrying, Price said.

NOT RECOMMENDED for longer than 2 hours: Narrow-based Baby Carriers, because thighs are not supported to the knee joint.

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NOT RECOMMENDED for longer than 2 hours:

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BETTER:

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RECOMMENDED:

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Additional Resources from IHDI

By Kimberly Nicoletti

Kimberly Nicoletti is a freelance journalist, editor and writing coach based in the Rocky Mountains of Colorado. She has been published in Natural Health magazine, Fitness Republic, SheKnows.com, Cleveland Plain Dealer, Dallas AM News, Minnesota Magazine, The Denver Post and a variety of regional magazines including Aspen Philanthropist, Aspen Times Weekly, Vail Valley, Vail Health, Mountain Gazette, CO Yoga + Life and Spoke + Blossom. She has been the managing editor of several magazines, most currently in Snowmass, CO. She has a masters in somatic psychology and loves writing about health, people, travel and anything related to living a creative, authentic life.

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