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Swaddle with Care to Protect a Baby’s Tiny Hips

Swaddling Newborn Baby

Infant swaddling is a common practice, as many parents and caregivers believe it can help soothe their baby and improve sleep. It entails wrapping an infant in a light cloth or blanket to provide a kind of cocoon. Although swaddling has been shown to reduce crying and promote sleep, if not done properly, it could harm an infant’s tiny hips.

Wrapping the blanket too tightly puts a baby at risk of developing a condition known as hip dysplasia. Basically, it means the infant’s hip does not grow properly. The condition is often referred to as “developmental dysplasia of the hip” or DDH.

Think of the hip as a “ball-and-socket” joint. In a normal hip, the ball at the top part of the thigh bone fits firmly into the socket, which is part of the pelvis. When a baby develops hip dysplasia, it can range from mild to severe. The ball may be loose in the socket or it may partially come out of the socket. Sometimes it dislocates out of the socket completely. Surprisingly, even with a dislocation, the baby typically does not have pain.

Untreated hip dysplasia can cause serious problems later in life. With the more severe form, which is a complete dislocation of the hip, children could develop an abnormal way of walking, experience hip or back pain and potentially need a hip replacement at an early age. Even those with untreated mild dysplasia may be more likely to develop arthritis and hip pain in their teens or early adulthood, and they may need surgery.

The Correct Way to Swaddle a Baby

Parents and caregivers are advised to take special care when wrapping their bundle of joy. Swaddling should allow ample room for the baby to move his legs, with plenty of space to bend his hips and knees. One safe option is to use a sleep sack that leaves lots of room for the baby’s legs. If using a blanket, we advise parents to keep it loosely folded around the baby’s legs so there’s room for them to bend and move apart.

To ensure that the baby has enough room for breathing, parents should be able to fit two or three of their fingers between the infant’s chest and the blanket or sleep sack.

Babies should be placed on their backs to sleep to reduce the risk of sudden infant death syndrome (SIDS). It’s especially important to avoid positioning a swaddled baby on his stomach or side. The American Academy of Pediatrics advises that parents should not swaddle a baby past two months of age, as babies may start to roll over by 2.5 months.

According to a study on swaddling and the risk of SIDS in the journal Pediatrics, it’s essential for parents to monitor their baby to ensure he remains on his back and does not roll over.

In addition, it’s important for caregivers to make sure that the blanket used to swaddle does not become unwrapped, as this could raise the risk of suffocation.

Swaddling can also increase the chance your baby will overheat, so check on your child to make sure he isn’t getting too hot.

Below is a step-by-step guide on how to correctly swaddle a baby from HSS pediatric physical therapist Jennifer Paszko:

  • First, place the blanket down in the shape of a diamond and fold the top corner down:

  • Place the baby so that the shoulders are at the height of the blanket. Holding the left arm down, wrap the blanket around its right side, then tuck under the right side:

  • Bring the right arm down and blanket across the body and tuck under their left side (make sure they’re able to move hips and knees within the blanket):

  • Twist the bottom part of the blanket and put it underneath their body. You should be able to fit two fingers between the blanket and the baby’s chest:


Dr. Emily Dodwell, pediatric orthopedic surgeon

Dr. Emily Dodwell is a pediatric orthopedic surgeon at Hospital for Special Surgery’s Lerner Children’s Pavilion. She specializes in general pediatric orthopedic surgery, pediatric trauma, cerebral palsy, and limb deformity correction. Dr. Dodwell treats children of all ages and sees patients with a wide variety of problems including fractures, ligament and tendon injuries, and joint dislocations.

Topics: Featured, Pediatrics
The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.