Ewald Fettweis is an orthopaedist, internationally acclaimed expert on infant and adult hip development, an author of a publication titled "Hip dysplasia". Dr Fettweis is a propagator of babywearing, he cooperates with a reputable Dresden Babywearing School in Germany (Trageschule Dresden).
When a baby is born, her hips are not mature yet. But there is no need to worry - this is something normal. However there are simple rules that need to be followed while taking care of a baby so that the hips stay healthy.
Ultrasound examination of a newborn's hips is a must! - dr Hans Dieter Matthiessen writes in orthinform 2/2004. To emphasize it explicitly: we once again want to show what can be achieved by having an ultrasound examination at an early stage: early diagnosis and early treatment of the so called congenital hip dislocation help prevent its dreadful results.
Before the early diagnostic methods were developed - made much easier by ultrasound examination introduced by prof. Reinhard Graf in 1970s - among 5 thousand babies that were just about to learn how to walk 4 or 5 has shown symptoms of the problem - they were limping and swaying, they had ducklike walk caused by shortened thigh (femoral part) and extreme lordosis.
At the turn of the 20th century Adolf Lorenz from Austria was a leading orthopaedist specialising in this area (...). In principle, Lorenz was right to think that a newborn has an initial stage of this affliction.
With ultrasound examination this initial stage can be detected. In the meantime, it turned out that there is no such thing as one initial stage, but there are very individual different developmental stages - from very stable acetabulum (hip socket) to slight developmental delay, to poorly developed acetabulum. It also became clear that in most cases it is not the first step that causes the dislocation, but premature straightening of hip joint after birth, within first 12 months of life.
During pregnancy the embryo's legs are bent at 90 degrees angle, as seen by most parents on their unborn baby's ultrasound image. This bend is increasing towards the end of pregnancy until it is not possible to bend the legs further. Previously it was believed that this was the cause of hip dislocation. Today we know that this position is very good for formation of the acetabulum (hip socket).
With the birth the process of straightening up begins, which, at the end of the first 12 months, results in straight posture. Hip joints, first and foremost, have to carry the burden of development of the little human being. If the hip sockets are not strengthened enough, the thighbone ball (femoral head) may slowly move up until it is fully dislocated. Therefore, we have to do as much as possible to support further strengthening of hip sockets after birth.
Birth is not the end of the development process
(...) The skeleton of a newborn is composed mostly of cartilage. For the optimal hip joints development the most favourable position is when the legs are bent.
For example, in countries where babies are carried, usually in a sling, closely clinging to mother's body, there are virtually no hip dislocations. If a baby sits in a sling, her legs are bent at 90 degrees, or more, they are slightly spread out and not stretched. In such position muscles press centrally via thighbone ball on the acetabulum causing hydrostatic pressure in the cartilaginous part of the joint and resulting in ossification. Crawling has a similar effect. It is not that such position is necessary for all babies. Still, all parents should try to strive for this optimum when positioning their babies and, what is more important, they should avoid everything that may give opposite results. Negative influences on baby's body are very often disregarded, although they may damage properly developed hip joints. Double diapering, which was used earlier, is particularly harmful. With this method legs will be straightened and spread. Folded diaper between baby's legs may operate as the rotation axis where the thighbone ball is lifted outside. This is the way a hip dislocation occurs, particularly often in countries where babies are put into and carried in baby swaddling wraps.
Placing baby on the tummy before she can turn on her own (at around 5 or 6 months) is also detrimental to baby's health. In such position baby's legs are straightened. Each premature straightening (flexing), and anything that make active moves difficult, is harmful - also plaster casting, heavy duvets and pillows. Also placing a baby on her side may be dangerous if the baby is not placed with upper leg in straddle position.
When lying in a cot, baby's upper body should be raised slightly. (...) Hip and knee joints should be slightly bent with support of blankets, small pillows or part of a mattress etc. Legs should have freedom of movement. This is why it is better to use thicker rompers or a sleeping bag than a heavy duvet.
A diaper should be put on in such a way that they cause a straddle. Babies from a high risk group - babies with hip dislocation history in the family or those born in breech position, with simultaneously straightened knee joints (approx. 60% of breech position cases) - "wide diapering" is recommended. After putting the first, "regular", diaper on, a second diaper, folded as it is straight from the package, is placed across baby's thighs and then baby is dressed in close fit rompers.
Slings and wraps are perfect
Ideally, babies should be carried in appropriate slings and wraps as often as possible. Newborn's hip joints are designed for a "ride on a hip". Angles of bones in the upper part of the thigh guarantee optimal position of a thighbone ball in the hip socket. There are many reasons for carrying a baby this way, including some psychological aspects. Manufacturers of baby-carrying accessories may be found on the Internet (...).
Everything you need is large enough cotton shawl without harmful admixtures, which stretches both ways - not too much and not too little. When you fold it, a wrap must reach up to the knee pit (popliteal fossa). If you rearrange wrap's edge you will obtain proper stability. It must precisely fit the back of a baby placed in a wrap, and for the youngest ones it must also offer head support. In just a few days a baby will learn how to control her head. The back will not be harmed by carrying, just the opposite - it will support spine development. (...). When babies are older, you can carry them on the back with no problem at all. My three daughters carried all of their twelve children this way.
Link for the publication:
Dr Ewald Fettweis
Schleckheimer Strasse 118
29.08.2000 (idw) Köln University. Babies carried in slings and wraps do not suffer lack of oxygen. This is the outcome of experimental research carried out by Waltraud Steining and Patricia Nitsch at the Köln University Child Clinic. During babywearing oxygen saturation of baby's blood drops on average by one percent. Such drop for children in good health causes no problems. Also premature babies can be carried in such wraps as long as certain conditions are met, as in this group under research there were no differences as compared to other babies.
Babies' reactions do not depend on the carrying method, although in case of premature babies better results were noted when babies were carried in upright position.
At the University Child Clinic other supplementary care methods for premature babies are used. Those include so called kangaroo care - transporting a baby not in an incubator, but placed on mother's chest; also hanging mats are used in incubators.
Link for the publication: Presse-Information 127/2000