Effect of baby-carrying and swaddling practices on developmental hip dysplasia: a systematic review

Abstract

Objective: To assess the association between different baby-carrying methods and swaddling and the occurrence of developmental dysplasia of the hip (DDH) in children under five years of age, through a systematic review. Study design: Medline (using PubMed), Scopus, and Web of Science were searched from inception to February 9, 2025. Observational studies that included samples of children ≤5 years old and reported the effect of swaddling and/or other baby-carrying methods on DDH were eligible. Two researchers independently assessed the inclusion criteria and evaluated risk of bias. Due to the heterogeneity of study designs and sample characteristics, a narrative synthesis was performed. Results: A total of 16 studies covering 50,377 children were included in this systematic review, ranging from 0 to 24 months of age. 4 of the studies were cross-sectional, 8 cohorts, and 4 were case-control. All reports evaluated swaddling as exposure, and most of the studies defined DDH through the Graf classification. A positive association between swaddling and the occurrence of DDH was observed in most of the included studies. Bilateral and late diagnosis of DDH was also more frequent among swaddled children. However, a sound assessment of the effect of baby-carrying methods and DDH was hampered by the limited number of studies, risk of bias, and lack of control for potential confounders. Conclusion: The present review highlights the relation between swaddling and DDH, and, therefore, this baby-carrying method should be used with caution. Nevertheless, more robust evidence is needed for a proper understanding of these associations. Systematic review registration: PROSPERO on February 8, 2025 (CRD42025644157)