I see it in chat groups all the time. Someone posts a proud photo with baby in their narrow based soft-structured carrier (SSC) carrier. Almost immediately the comments blow up. Well wishers warn about Hip Dysplasia and leg deformity. Experts believe that these narrow base carriers, also known as crotch danglers, can contribute to hip dysplasia if a child has the predisposition. Is there any evidence behind these warnings? Can narrow based carriers actually cause Hip Dysplasia? Here’s the DL from the experts.
While the exact cause of Hip Dysplasia?
Otherwise known as Developmental Dysplasia, Hip Dysplasia simply means that the hip is displaced from it’s correct location. How does it originate? The true cause is unknown, but it is thought to be developmental. Thought? The word thought is used because in order to determine if something like babywearing causes hip dysplasia someone would have to run a study and subject one group of babies to something that may contribute to the condition…which is terribly unethical and won’t happen. Hey new Mom! Want to see if doing this causes hip dysplasia in your baby? No. Won’t happen. So, the true cause is unknown but experts can speculate and currently Hip Dysplasia is theorized to occur as a result of the body’s own processes and is typically not caused by something the parents do or did. (1)
The hip joint is a ball and socket joint
The hip joint is a ball and socket joint like the shoulder and held together by a group of muscles, tendons and ligaments. When dysplasia occurs the ball portion does not sit securely into the socket portion and may sit too low, to the front, to the side or backwards.
Make a fist with one hand, and a ‘C’ with the other. Put these two together and you can get a basic idea of how the joint is shaped. The tissue, tendons and ligaments holding this joint together (like the shoulder) create a delicate balance allowing the joint to move in a wide variety of motions. To check this joint for dysplasia, the pediatrician will often move baby’s legs around during a regular visit. I remember seeing this done right after birth and at our first few visits with our pediatrician.
Signs of hip dysplasia
Hip Dysplasia may occur as the result of ligaments, tendons and tissue not being quite tight enough to hold the joint securely together, or may result from a joint that isn’t quite the right shape, or a combination of these factors (1). In most cases, this occurs at birth or within the first year of life and may be symptom-less (1-4), or be accompanied by symptoms including:
- Different leg lenths, one may seem shorter.
- Extra or uneven folds of skin on the inside of the thighs.
- A hip joint that moves differently than the other, may be more or less flexible on one side.
- Walk on the toes of one foot with the heel up off the floor.
- Walk with a limp, waddle or appear to walk like a duck.
- Pain (1-4)
While diagnostically impacting 1 or 2 out of 1,000 babies (1), treatment for Hip Dysplasia may include surgical or non-surgical treatment. The type of care depends on the severity of the dysplasia and a child’s individual factors.Those with hip dysplasia more commonly are:
- females (who have looser ligaments than males, historically known as double-jointedness)
- first-born babies (whose fit in the uterus is tighter than in later babies)
- breech babies (whose constrained position tends to strain the joint’s ligaments)
- children in families where there’s a genetic predisposition for the condition
- Possibly an over-tightening in a swaddle position and or on a papoose board (1-4)
So, back to the question: Does Babywearing Cause Hip Dysplasia?
Specifically, do narrow based carriers or ‘crotch danglers’ cause hip dysplasia? The general answer is Uncertain because, as I mentioned above, it would be unethical to run a study. Can improper leg position, dangling down instead of in the M shape, contribute to hip dysplasia if baby is already has the predisposition? The answer from experts is Yes. Do you want to find out if your carrier will contribute to an underlying predisposition to hip dysplasia in your baby? I hope not. Should you simply use a carrier that positions baby’s legs in the recommended position instead? YES.
Why are narrow based carriers blamed for Hip Dysplasia?
To start, the condition or predisposition for dysplasia would already have to exist. Next, allowing the legs to dangle would make it worse or noticable. This is especially true for younger babies. In a newborn, the hip joint is typically more loose then an infant and dangling the legs may lead to malformation of the joint (1).
How so? Baby is in the fetal position in your womb until birth. The bent leg position is most natural and places the hip in an optimal position for development. In contrast, when hanging down and out straight, the weight from baby’s legs pull down on the hip joint and create stress on the muscles, tendons and ligaments. In addition, it places the ball and socket in the non-recommended position for development. Should your baby be one of the 1/20 full term babies with some instability 1 or 2 out of 1,000 to have full-on Hip Dysplasia, it could possibly make the condition worse or encourage laxity or looseness in the hip joint. (1-4).
“The most unhealthy position for the hips during infancy is when the legs are held in extension with the hips and knees straight and the legs brought together, which is the opposite of the fetal position” (1).
Why do narrow based carriers exist?
I don’t know the answer to this question. There are many excellent carriers out there that place baby’s legs in the optimal position. However, “crotch danglers” are still for sale both new and in BST.
What about forward facing?
The same principles apply. What’s important is the position of the hip, knee and thigh. Wondering about your carrier? If this is a concern of yours, certainly talk to your pediatrician. I personally would not use a narrow based carrier for many other reasons. I personally find them uncomfortable on my back and shoulders, find that baby sways around while I’m moving, and believe that the narrow portion of the carrier that sits in baby’s crotch HAS to be uncomfortable. Think small bicycle seat VS nice wide bicycle seat. Which would you want to sit on for 2 hours?
Local babywearing international chapters are a great resource.
At most babywearing meet ups, you can try carriers and get advice about positioning. As always your local Occupational Therapist is a great resource, but specialties in practice vary so call ahead of time and ask about knowledge about babywearing positioning. The International Hip Dysplasia Institute has a great resource of knowledge and accepts donations to further their research.
So what type of carrier is best? Here are two of my favorites! A quality soft structured carrier like a Lillebaby and a Woven Wrap! Each should support the thigh, bottom and back of your infant or toddler and encourage the “frog” position mentioned by the institute. If baby’s legs are dangling in space…obviously the carrier is not recommended.
Disclosure: This is not a sponsored post, these are my thoughts and information from several references (see below) and opinion. Please check with your pediatrician and Occupational Therapist for your child’s individual needs. This is not meant to diagnose, replace medical advice, treat any condition and is simply food for thought. These are not my images, they are used with permission from the International Hip Dysplasia Institute which is a very well put together and quality resource. Being a visual person myself, I collaged them to give you an at-a-glance idea of positioning for babywearing and hip health and the writing beneath the photos is by Mama Banana’s Adventures.
The information presented above is NOT to replace the advice of your physician and is for informational purposes only. Please speak with your physician or other medical providers prior to engaging in any routine concerning your baby’s hip health. Please follow all manufacturers instructions for baby carriers. This disclosure is done in accordance with the Federal Trade Commission 10 CFR, Part 255 Guides Concerning the use of Endorsements and Testimonials in Advertising. Links enclosed may contain affiliate links. If you have any questions or would like your product or company featured on Mama Banana’s Adventures please contact MamaBananasAdventures@gmail.com