Post-Natal Positioning through Babywearing: What the Orthopaedic Surgeon Needs to Know

Abstract

Babywearing is the practice of using a swathe of fabric or purpose-built carrier to hold an infant or toddler close the caregiver’s torso, for multiple hours of the day. The child’s legs are often positioned in an “M” shape, with hips and knees flexed and abducted. There is increasing interest in the potential for babywearing to assist in hip development, as the “M” position assumed in most carriers is similar to the position achieved in harnesses/braces used in the treatment of developmental dysplasia of the hip (DDH). The association between low incidence of DDH in babywearing populations (Southern China, Aboriginal people of Western Australia, Central and Southern Africa, Malawi, and the Inuit/Eskimos of the circumpolar north) suggests that babywearing may play a role in optimal hip development, although genetics likely also contributes. Biomechanical studies have demonstrated optimal hip joint reaction forces while in baby carriers, with similar lower-extremity muscle activation as obtained in Pavlik harnesses. Ultrasound studies have shown that infant hips maintain normal ultrasound parameters while in baby carriers. In addition to its potential positive impact on hip development, babywearing stimulates caretaker-infant responsiveness, improves attachment and bonding, promotes language development, decreases infant crying, supports breastfeeding, and allows for caregiver multi-tasking. With improper use or insufficient care, asphyxia, falls/trauma, and baby-carrier purpura are potential complications. Energy expenditure of babywearing is less than arm-carrying, and effects on gait and posture can be minimized with proper positioning. Orthopedic surgeons may support their patient families that wish to babywear, as there are multiple non-orthopedic benefits, few potential complications if performed properly, and a promising potential for this form of post-natal positioning to have a positive impact on hip development. Future research should focus on prospective comparative studies of babywearing versus other post-natal positions and their impact on hip development.