Return of 'tight swaddling' causing rise in baby hip problems

ProfClarke

A top children’s surgeon says the return of an “eradicated” practice of tightly wrapping babies in blankets to keep them warm and help them sleep is causing a rise in hip problems.

Professor Nicholas Clarke, a consultant orthopaedic surgeon at Southampton General Hospital, says the unsafe form of swaddling – which had almost completely disappeared by the end of the 1980s – is being increasingly adopted by mothers, with some websites selling tight ‘swaddlers’ claiming they can help tackle colic.

He warned the trend is leading to more cases of hip dysplasia – where the hips are loosened by mothers’ hormones which relax ligaments during birth – as forcibly straightening the legs within the first three to four months of life means babies who would otherwise recover naturally are unable to freely flex and strengthen weakened joints, making surgery essential.

“This form of swaddling used to be very commonly used across the world but, with the help of major educational programmes such as the one used to eliminate the problem in Japan in the 1980s, it was all but eradicated and cases reduced drastically,” said Prof Clarke, who spoke out as part of the STEPS charity’s Baby Hip Health Week 2012.

“Now, I and my colleagues across the UK and in America are witnessing its revival, with swaddlers being advertised on the internet that tightly wrap babies. For the hips, that is exactly what you don’t want to happen.”

Up to 100 babies are screened at Southampton General Hospital’s hip clinic every week – around one in every 20 full-term babies has some level of instability – and swaddling-related incidences are increasing.

Although treatment, which involves fitting a harness to keep the legs bent up day and night for six weeks, is successful in 85% of babies, some will suffer permanent damage.

“While many cases of hip dysplasia are down to genetics or other conditions, swaddling is becoming an increasingly prevalent cause once again and that is extremely frustrating because it is something parents can control, yet only last week a mother brought her baby to my clinic tightly wrapped.”

Although keen not to discourage safe techniques, Prof Clarke, who is also a professor of orthopaedic surgery at the University of Southampton, believes parents are no longer distinguishing between what is right and what presents a danger to their babies.

“I advocate swaddling in the right and safe way, which means ensuring babies are not rigidly wrapped but have enough room to bend their legs – they don’t need to have their legs straightened as there is plenty of time to stretch before they start to walk,” he explained.

“But, and this is worrying the orthopaedic community, it seems to be increasingly fashionable among parents to follow the re-emerging trend of tight swaddling.”

Prof Clarke, who last year revealed one in five children assessed in his clinic for bone problems were suffering from poverty-linked Victorian bone disease rickets due to vitamin D deficiency, is now calling for the relaunch of an awareness campaign to address the problems.

He added: “We need to focus on ensuring the years of hard work and effort made by thousands of clinicians across the world to drive out tight swaddling is not unravelled in a matter of months and that means stepping in immediately.”

Posted on Monday 12 March 2012