When you have a baby, the list of things you can become anxious about is endless. Then, just when you think you have things under control, someone will make a comment or ask a question and give you something new to worry about.
For me, one of those questions was, “Won’t those bulky cloth diapers make your baby bow-legged or mess up their hips?”
Fortunately, I don’t automatically believe everything I read or hear, so I did a little delving into the subject, spoke with some medical professionals, and this is what I found out.
Do Cloth Diapers Cause Hip Dysplasia?
No, cloth diapers do not cause hip dysplasia. Neither do cloth diapers make any form of hip dysplasia worse or cause any type of movement or developmental delay. If anything, some people would argue that cloth diapers hold your baby’s legs and hips in a better position than disposables.
What is Hip Dysplasia?
Before we dive in, we'd like to thank the International Hip Dysplasia Institute who have kindly given us permission to use their illustrations.
In simple terms, there is a ball at the top of your thigh bone. The ball sits within a socket in your hip joint and is held in place by ligaments. This is called a ball and socket joint, and it provides a wide range of motion.
Hip dysplasia, also known as developmental dysplasia of the hip, is when the ball at the top of your child’s thigh bone does not sit as it should in their hip joint. This can happen because the ligaments are not tight enough, the socket is too shallow to keep the ball in place, or for many other reasons.
When Does Hip Dysplasia Happen?
A baby can be born with hip dysplasia, or it can occasionally develop over the first year. Sometimes hip dysplasia caused by a shallow socket of the hip joint is missed during childhood and is diagnosed in adolescence or even adulthood.
According to the International Hip Dysplasia Institute, one in ten babies are born with some form of hip dysplasia. This can range from severe hip dysplasia where the hip is entirely out of the socket to lose ligaments, causing a mild wiggling of the hip joint (source.)
Ninety percent of those babies have their hip ligament tighten up without any intervention. The other ten percent, one in ten of all babies, will have hip dysplasia that requires treatment.
How Hips Develop
A baby’s bones are still relatively soft at birth, with many points of the skeleton still being cartilage rather than bone. The hip is one of these areas.
The socket is partially bone and partially cartilage. As a baby grows and moves around, the ball at the top of the thigh moves about in the socket, a process that encourages the bone to form and harden.
If a baby’s hips are held in an incorrect position, for example, by overly tight swaddling with the legs straight, this can reduce the stimulation provided by the ball of the thigh and cause a malformation of the hip joint.
What Causes Hip Dysplasia?
There are several causes of hip dysplasia.
Pre Birth Position
One contributing factor is your baby’s position before birth. That tight curl in the womb puts pressure on the hips. Babies in a normal position are more likely to have hip dysplasia of the left hip, while breach babies are more likely to have hip dysplasia than head-down babies.
Another reason why some babies develop hip dysplasia is a sensitivity to their mother’s hormones. Before birth, a mother’s body produces hormones that cause ligaments to relax more than usual, making it slightly easier for the baby to pass through the birth canal.
What flows through a mother’s body also flows through her baby’s also loosening their little one’s ligaments. This form of looseness is one of the reasons why a baby can get their feet up to their face with such ease.
Some babies with softer ligaments may have a mild hip dysplasia at birth that will then resolve without intervention. The hormones disperse, the ligaments tighten up naturally and hey presto - no more hip dysplasia.
Babies are born with softer bones and less developed joints than adults, and a baby’s hip joint is mostly cartilage rather than bone. This soft, flexible cartilage makes it easier for the thighbone to move about in the joint.
Again, this form of hip dysplasia often resolves without treatment as a baby grows and the bone develops.
Post Birth Positioning
A baby who is swaddled, with their legs straight, is more likely to develop hip dysplasia than a baby who spends time with their hips spread and legs up, bent at the knee, in a frog-like position.
Other Risk Factors
While doctors do not go as far as saying hip dysplasia is inherited, they do believe there is a genetic component.
A baby is up to 12 times more likely to have hip dysplasia if a parent, grandparent, or sibling has also suffered.
- If a child has a sibling with hip dysplasia, they have a 1 in 17 chance of also being diagnosed.
- If a child has a parent who was diagnosed with hip dysplasia, they have a 1 in 8 chance of also being diagnosed.
- If a child has both a sibling and a parent who has experienced hip dysplasia, that child will have a 1 in 3 chance of hip dysplasia themselves.
In addition, for reasons that are not yet understood, girls are up to five times more likely to have hip dysplasia than boys.
Different Types of Hip Dysplasia
Hip dysplasia is broken down into three main types.
Subluxation is when the ligaments holding the hip together are loose.
If a hip is suxluxable, the ball is still within the socket until the leg is flexed in a particular position. Then it is possible to pop the ball out of the socket.
In full subluxation, the ball rests partly out of the socket.
A low dislocation is when the ball is out of the socket but moves within an area called a false socket.
A high dislocation is when the ball is entirely out of the socket and is, in some ways “adrift,,” moving freely around the area of the hip.
A shallow socket is just how it sounds. Instead of a nice deep hole where the ball can sit, the socket is more like a shallow dish where the top of the ball is in the socket, but the rest of the ball is unsupported.
How is Hip Dysplasia Diagnosed?
Do you know how doctors grab a baby’s legs and twist, turn, and rotate them? That is the basic exam for hip dysplasia. It’s a little more complex than that, of course. The doctor is trained to know how it feels when the hip is sitting correctly in the joint and when it is not.
Doctors will also look for any discrepancy in leg length and assess how symmetrical your baby’s buttocks are. Uneven legs or a lack of symmetry may indicate hip dysplasia.
In addition, the American Academy of Pediatrics recommends an ultrasound exam at some point between six weeks and six months for babies who:
- Were born in a breech position.
- Have an inconclusive physical exam - for example, the doctor cannot feel any classic signs of hip dysplasia but still has concerns that dysplasia may be present.
- Have is a family history of hip dysplasia.
How Is Hip Dysplasia Treated?
Treatment will depend on the severity of the hip dysplasia and the baby’s age at diagnosis.
A newborn’s hip can be pushed back into the socket relatively easily, then a harness is worn for up to 12 weeks while the ligament tightens and the bone of the socket solidifies.
For infants, the process is very similar. However, the hip may not go back into the socket as quickly and easily as for a newborn. Wearing the brace can slowly ease the hip into place before the ligaments tighten and the socket bone sets.
Beyond six months, hip dysplasia may need surgical treatment.
Cloth Diapers and Hip Position
Some people believe that the position of a baby’s legs and hips in cloth diapers is unnatural, uncomfortable, and potentially damaging. They assume that the thinner, less bulky disposable diaper will allow a baby’s legs to lay closer together and subsequently be more healthy.
In reality, the opposite is true.
Straight legs cause the ball and socket to be pulled slightly apart, and the ball does not spend enough time stimulating bone growth in the socket.
When a baby is wearing a cloth diaper, their legs are held in a slightly raised position, higher and further apart than in a disposable diaper. This position can prevent a baby from spending lots of time with the ball further away from the socket.
The more frog-like position of an unswaddled baby in a cloth diaper can encourage good, strong bone growth and healthy socket development.
Cloth Diapers and Hip Dysplasia
Cloth diapers were once used as a treatment for hip dysplasia. Before the development of harnesses and braces, doctors would recommend, for mild cases, that parents put two or even three cloth diapers on their baby to keep their hips in a healthier position.
Other Healthier Options for Hip Dysplasia
There are many things you can do or not do to maintain a healthier hip position for your baby.
Avoid swaddling your baby with their legs straight and together. This is a less healthy position and will cause your baby’s hip to spend less time planted securely in the socket.
Instead you can swaddle your baby in a hip-healthy way.
First, spread your blanket out flat in a diamond position and fold the top corner down.
Lay your baby on the blanket, face up with the back of their neck roughly level with the folded edge.
Straighten their left arm and fold the blanket across their body, tucking the corner in between their right arm and body.
Straighten their right arm and pull the blanket across, tucking the corner between the left arm and body.
Finally take the bottom corner and either fold or twist it and tuck it under one side of your baby.
Make sure there is enough room for your baby to move their legs and for you to fit two fingers between the blanket and their chest.
If you use a baby carrier, avoid forward-facing models or other styles that allow your baby’s legs to dangle straight below them. Instead, chose a carrier that holds your baby in more of a froggy position.
Chose a car seat with as wide a space as possible for your baby’s bum, hips, and legs. A wider seat will let your child bend their legs and flop their knees out sideways, a healthier position.
Cloth Diapers do not Cause Hip Dysplasia
If someone throws out a random, off-the-cuff remark about cloth diapers and how they hold your baby’s hips far apart, don’t worry. In reality, the opposite is likely true. A cloth diaper will keep your child’s legs and hips in a healthier position than disposables.
Do you have any other hints or tips about cloth diapers and hip dysplasia? Perhaps you have a child who has undergone hip dysplasia treatment? What can you share that may help other parents?