Baby wearing, swaddling and your baby’s hip health

20th Feb 2020
Ingress Healthcare

By Dr Ilse Lategan (MBBCh, DCH) – Paediatric General Practitioner

The benefits of baby-wearing are endless. Keeping our babies close allows them to feel safe and secure as they adjust to life outside the womb. It reduces crying and fussiness and allows for more learning during the quiet alert stage. Facing her caregiver, a baby can study facial expressions and listen to conversations which enhances cognitive, personal and social development. It improves the caregiver’s responsiveness as they are more able to read and interpret important cues. And ultimately the close physical contact boosts oxytocin production (the hormone of love and connection) which strengthens the bond between parents and their baby.

As baby-wearing gains popularity in western societies, it is important to ensure that this common practice promotes healthy hips. Developmental dysplasia of the hip (DDH) is a condition where the hip joint has not developed normally. The normal hip joint is a ball-and-socket joint where the head of the femur or thigh bone (ball) fits snuggly into the socket of the pelvis and rotates freely. In babies with DDH, the socket is shallow and the ball may slip in and out (partially or completely) of the socket. In South Africa, all babies are screened at birth for DDH but although this condition can be present at birth, it may also develop during the first year of life.

There is marked geographical variation in the incidence of DDH worldwide. Although genetic predisposition (a positive family history of DDH and female sex) and the intra-uterine environment (breech position) play an important role, postnatal extra-uterine environmental factors such as baby-wearing also contribute to the development of DDH. Interestingly, the incidence of DDH in African cultures where babies are carried in a shawl with the hips open, flexed and free to move is very low, about 0.06 per 1000 live births. This is in stark contrast to some Native American Indian cultures where babies are tightly swaddled and carried in cradleboards where the incidence of DDH is 76.1 per 1000 live births.

According to the International Hip Dysplasia Institute, the healthiest position for the hips whilst baby-wearing is the M-carrying position also known as the spread-squat position, the jockey position or the frog position. The hips should be bent and spread naturally apart to the side, with the thighs supported and knees slightly higher than the buttocks or at the level of the buttocks. Similarly, when swaddling allow ample room for hip and knee movement to encourage optimal development of the hip. Try to avoid straightening the legs and pushing them close together.

If a diagnosis of DDH is made, newborns and infants under 6 months are treated with a Pavlik harness for 6 weeks. The increasingly active and crawling child makes treatment with a Pavlik harness more difficult and surgery is often required in children older than 6 months. If you are concerned about your child’s hips and have noticed limited movement at the hip joint or apparent shortening of the thigh, contact your baby’s doctor. They will perform a thorough examination of the hip and possibly request an Xray or ultrasound.

When the proper hip position is maintained while baby-wearing, there may be a substantial benefit for natural hip development. So continue to keep your baby close to experience all the benefits for both yourself and your baby.

Happy parent. Happy baby. Healthy hips.

Book a consultation with Dr Lategan.


1) The International Hip Dysplasia Institute –

2) Nelson Textbook of Paediatrics, Edition 20

3) Developmental Dysplasia of the Hip –

4) Loder, Randall & Skopelja, Elaine. (2011). The Epidemiology and Demographics of Hip Dysplasia. ISRN Orthopaedics. 2011. 10.5402/2011/238607.

5) Storer & Skaggs. (2006). Developmental Dysplasia of the Hip. Am Fam Physician Oct 15;74(8):1310-1316

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