Babywearing for Healthy Hips

Healthy Hips Week is upon us yet again. This is a wonderful opportunity to talk about how you can enjoy a healthy hips babywearing journey, as well as the things to look out for in a hip healthy baby carrier. A hip dysplasia diagnosis does not mean the end of your babywearing journey, however it may require some adaptation to the baby carrier/s used depending on the treatment methods employed in your child’s individual case.  

 

What is hip dysplasia?

Hip dysplasia is defined as incorrect alignment of the hip joint/s. It may also be referred to by a whole list of other names including^1,2:

• developmental dysplasia of the hip (DDH)
• developmental dislocation of the hip (DDH)
• clicky hips
• congenital hip dysplasia or (CDH)
• infantile hip instability
• hip dislocation
• acetabular dysplasia

According to Healthy Hips Australia¹, hip dysplasia is "the most common musculoskeletal birth anomaly in the world". Australian postnatal screening improvements have recently seen a significant number of cases of DDH diagnosed within weeks or months of birth, but this condition can affect older children and adults as well. Screening is incredibly important as there is often no obvious abnormality or pain in babies and children, with pain often beginning later in life due to uneven wearing of the joint over a long period of time. Current statistics suggest that hip joint instability affects up to 1 in 6 full-term babies at birth¹, with at least 1 in 100 requiring active treatment for DDH².  

   

 Image 1a: a larger baby fitted in a rhino brace (courtesy of Abbie Garratt)
Image 1b: a younger baby fitted in a Pavlik harness (courtesy of Healthy Hips Australia¹). 

What is Healthy Hips Week? 

Healthy Hips Australia runs a week long education and awareness campaign every year to help families learn about hip dysplasia and take steps to ensure early diagnosis. The earlier an unstable hip can be diagnosed, the shorter the treatment process may be, although this can also depend on the severity of the condition.

 

To learn more about diagnosis and treatment of hip dysplasia, please see the reference list at the end of the blog post.

 

What are some of the risk factors for hip dysplasia?

Health professionals use a list of potential risk factors, as well as signs and symptoms, in the screening process to identify babies at greatest risk of DDH, so that recommendations can be made for diagnostic imaging assessment of the hip joint wherever necessary. These risk factors include¹:

• female
• first born
• family history of hip dysplasia
• breech presentation in utero
• neuromuscular or connective tissue disorder associated with DDH
• inappropriate swaddling

Healthy Hips Australia do not specifically name baby carriers as a potential risk factor for hip dysplasia, however they do recommend the use of wide based baby carriers which provide knee-to-knee support with baby’s legs in a Frog Squat position (also known as froggy or ‘M’ position, or Jockey Position), “with legs bent at the knee and [comfortably] turned out at the hip¹”. They also acknowledge that narrow seated support of the legs should be avoided, including but not limited to tight swaddling, narrow based baby carriers, and some car seats, baby seats, walkers and jumpers which either limit freedom of movement in the hips or place unnecessary weight loading on baby’s lower limbs (identified by baby’s legs “dangling” without adequate support).  

 

What effect can babywearing have on your baby's hip health, and especially in a DDH journey?

Babywearing is becoming increasingly popular within western culture, however not all baby carrier options are created equally. Most modern baby carrier brands have taken steps to improve their designs in recent years to provide adjustable support of the entire hip and leg complex, particularly in the first year of life. It is important to avoid horizontal or cradle carry positions as well as extended periods of babywearing in a narrow based baby carrier, whilst minimising unnecessary spinal pressure for baby wherever possible and ensuring adequate neck support (see image 2). 

 

Image 2: graphic adapted from the International Hip Dysplasia Institute³

 

Basics Of Optimal Babywearing

• Baby supported in an upright position with hips comfortably spread at 40-55° and flexed at 90-110°.
  • This position encourages the femoral head (the top of the thigh bone) to press “evenly into the centre of the hip socket”².
• Adjustable width of the supporting fabric in the wrap or baby carrier, to be supportive from knee to knee, particularly in the first 12-18 months of life.
• Adequate and adjustable tightening of the width and height of the wrap or carrier.
• Baby will be most comfortable when the spine is also supported in the natural developmental position appropriate for their age, as defined in image 3. 

Image 3: Comparison of normal developmental changes to the infantile spine, and how it correlates to leg and hip positioning during babywearing.
Graphic adapted from: https://www.closeenoughtokiss.co.uk/newborn-babywearing-positions/ and http://www.babywearingadvice.co.uk/anatomy.htm

 

The International Hip Dysplasia Institute recommends limited use of narrow based baby carriers in favour of more supportive, wide based carriers and wrapping techniques, as demonstrated in image 4 and 5.

Image 4: Comparison of the leg, hip and spinal positioning achieved in a wide based baby carrier (green) and a narrow base or incorrectly adjusted baby carrier (pink). 
Graphics adapted from the International Hip Dysplasia Institute³

Image 5: The internal bony anatomy achieved in a narrow based baby carrier (pink) compared to a wide based baby carrier (green).
Graphics adapted from the International Hip Dysplasia Institute³

 

Interestingly, it has been suggested that optimal babywearing might have a significant impact on the incidence of hip dysplasia, following a retrospective study on the incidence of diagnosis and treatment for DDH in the southeast African country of Malawi⁴. This study has shown that babies that are worn in an upright Frog Squat position, and primarily in a traditional woven wrap on the caregiver’s back, have a very low risk of being diagnosed with hip dysplasia⁴. This also correlates with a significantly lower incidence of middle aged diagnosis of hip osteoarthritis⁴.  

Disclaimer: It is important to recognise that back carrying is a learned skill, and all babywearing safety guidelines should be met in a modern western society context. Many modern baby carriers may also provide inadequate support for young babies (particularly those under 6 months old) when used in a back carry. Traditional, cultural babywearing techniques are passed down from previous generations during childhood and adolescence, and as such women raised in such cultural groups have had years of experience in wearing children prior to birthing their own babies. This generational knowledge is an important part of traditional babywearing practice. If you are unsure about whether you are ready and equipped to back carry your baby, please reach out and ask a trusted babywearing professional.

 

Image 6: Cloth and Carry owner Alyce Mostert demonstrating a high, supported back carry in a Girasol woven wrap, using a toddler sized weighted demo doll. The toddler's natural spinal curvature is preserved, with knees above bottom. 

TICKS Babywearing Safety

Modern western babywearing education also recognises the importance of the internationally recognised TICKS babywearing safety guidelines, which also encourage hip healthy positioning as seen in the TICKS! Safe Babywearing infographic (image 7). You can also read more about Basic Babywearing Safety Principles here. 

 Image 7: A handy infographic detailing the TICKS babywearing safety guidelines. 

 

Help! My baby has been diagnosed with hip dysplasia and I'm overwhelmed. How do I choose the right carrier? Here's a few top tips for finding the perfect baby carrier for you, and for your baby's precious hips. 

Try before you buy! Visit your local babywearing community meet and/or book an appointment with a babywearing consultant or peer educator.

Always discuss your babywearing concerns with your specialist DDH management team, and if you would like further assistance, book a personalised appointment with a babywearing consultant. Some babywearing consultants will even accompany you to your specialist appointment to help you discuss your babywearing journey with your medical team and prepare a personalised babywearing plan as part of your child’s DDH treatment management.

Do your own research:

• Click here to download the International Hip Dysplasia Institute’s pamphlet on Babywearing and Hip Development.
• Join your local Healthy Hips Australia or Facebook support group.
• Check out your local babywearing community group. 

Don’t purchase a baby carrier solely on the recommendation of someone else’s experience. Your hip dysplasia journey is as individual as your child, and different DDH treatment methods will greatly affect which carrier/s are suitable to your individual circumstances.

According to the International Hip Dysplasia Institute’s Baby Carrier Educational Statement³, it is important to limit time in narrow based baby carriers, for example those that do not support the hips and thighs from knee to knee, and most forward facing positions. Conversely, if you plan to wear your baby in a baby carrier, wrap or sling for extended periods, they recommend using a carrier option that allows for adjustable hip and thigh support in a natural flexed ‘M’ position. This document also states that a woven wrap is the most suitable baby carrier for promoting an optimal babywearing position for hip health.

Did you know: almost all of the baby carriers sold by Cloth and Carry have been recognised by the International Hip Dysplasia Institute (IHDI) as “Hip Healthy Products”. German brands Girasol and Kokadi have not formally applied for Hip Healthy Acknowledgment with IDHI, however both brands produce baby carriers that meet the Infant Carrier Design Considerations for “Hip-Healthy” Designation.

You can see our extensive range of ergonomically designed baby carriers here: 

https://www.clothandcarry.com.au/collections/all-baby-carriers

 

About the author: 
Alyce Mostert is a babywearing consultant and peer educator, a medical sonographer, and a mother of 4. Babywearing has been a huge part of her social life since 2013. She has trained with the Australian Babywearing Association and Babywearing School Australia, and volunteered for Baby Wearers Western Australia Incorporated since 2018. 

 

 

 

 

Links to references and resources:
1. https://www.healthyhipsaustralia.org.au/

2. https://hipdysplasia.org/
3. https://hipdysplasia.org/baby-carriers-other-equipment/
4. https://www.researchgate.net/publication/263292848_Back-carrying_Infants_to_Prevent_Developmental_Hip_Dysplasia_and_its_Sequelae_Is_a_New_Public_Health_Initiative_Needed

 

Please note that photographs depicting traditional African back carrying have not been included in this blog post due to unavailability of suitable permissions from published images available online. I believe that parents and caregivers should be required to give permission to educators for the use of their photographs, and as such, I may update this post with such images in the future, at such time that I can come to an appropriate agreement with the original owner of a suitable traditional babywearing photograph. If you believe you can contribute to this, please contact me: alyce@clothandcarry.com.au