A growing and developing fetus is naturally and comfortably swaddled in her mother’s womb, bathed in warmth and cushioned from the outside world. Once delivered, a newborn baby discovers it’s cold and bright and loud out here, and it makes sense for parents to use an easy and convenient method for simulating that comfortable and soothing prenatal environment: swaddling.
Professor N.M.P. Clarke provides some perspective:
Historically infant swaddling was almost a universal practice. It involved binding or bundling babies in blankets with the arms restrained and the lower limbs extended. It remains common in the Middle East and in some ethnic groups with or without a board or cradle. There has been a recent resurgence of swaddling because of its perceived palliative effect on excessive crying, colic and promoting sleep. Approximately 90% of infants in North America are swaddled in the first few months of life.
A recent systemic review concluded that in general swaddled infants do arouse less and sleep longer. Preterm infants showed improved neuromuscular development.
However, studies so far fail to show that swaddling improves the excessive crying of colicky babies.
And then there is the concern that swaddling young infants prevents the proper development of their hips, leading to a condition called developmental dysplasia of the hip (DDH). Newborns who are born from a breech position (legs first) or who have a family history of DDH are more likely to be born with this hip problem, which can lead to chronic arthritis, hip pain, limp, and disability as the child gets older.
The standard protocol is to obtain an ultrasound of the hips in these babies at six weeks of age, followed by close observation. Infants with demonstrated DDH are treated by wearing a special soft-cloth brace (Pavlik harness), which keeps the hips in a flexed and spread-out position, until the abnormalities seen on ultrasound have resolved. Swaddling these infants who are at risk for DDH in the traditional way keeps the hips in an improper position (legs extended and drawn together), increasing their risk. Professor Clarke sounds the alarm:
‘Safe swaddling’ with appropriate devices should be promoted because it is recognised that traditional swaddling is a risk factor for DDH. 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. The babies’ legs should not be tightly wrapped in extension and pressed together. Commercial products for swaddling should have a loose pouch or sack for the babies’ legs and feet, allowing plenty of hip movement and hip flexion and abduction.
It is now essential that midwives, neonatologists and paediatricians provide the correct advice in relation to healthy swaddling practices.
There’s more information about hip dysplasia and proper swaddling techniques from the International Hip Dysplasia Institute, including the excellent video below: