Does Swaddling Influence Developmental Dysplasia of the Hip?

There has been a recent trend toward swaddling to help decrease crying and promote uninterrupted sleep in neonates.1 Substantial anecdotal evidence has been supportive of this technique. Most studies have found that swaddling does decrease crying and promote sleep in the very young,2–5 but another study found that it made no difference.6 Swaddling is recognized to be an age-old technique; however, Dr Harvey Karp1 recently increased its popularity in the United States with a popular book and promotion program. As pediatricians increasingly recommend swaddling of neonates to decrease crying and promote sleep, there is concern in both the pediatric and pediatric orthopedic communities that it may influence the rate of developmental dysplasia of the hip (DDH) in this population. DDH is considered to be one of the most common congenital defects.7 There is currently some ongoing debate about whether to screen for hip dysplasia,8–11 because most hip dysplasia present in the first few days of life resolves on its own untreated.7–9 Nonetheless, even those who do not advocate for screening recognize that hip dysplasia can lead to premature degenerative joint disease and chronic pain.9 DDH is considered to be one of the leading causes of early arthritis of the hip.12 Increasing the rate of hip dysplasia in the neonate would … Address correspondence to Susan T. Mahan, MD, MPH, Harvard Medical School, Department of Orthopedics, 300 Longwood Ave, Boston, MA 02115. E-mail: susan.mahan{at}childrens.harvard.edu