What does “Hip Healthy” mean?

There are a *LOT* of misconceptions right now about carriers hurting baby’s hips. It’s a lot to take in and understand, so let’s break down what the research shows. Then, let’s talk about what that actually means for your baby and what you should look for in a carrier. (The TLDR version is at the bottom.)

I could just say “Olives and Applesauce only makes ergonomic carriers” (because we think they are more comfortable for the person wearing) and be done with it. But what I have learned over years of working with parents makes this too important of a topic to ignore.

Stick with me here, I’m about to throw some numbers at you... (All research for this post comes from the Hip Dysplasia Institute and PubMed, and will be linked at the bottom. Read it. Think about it. Talk to your pediatrician. And make the conclusion that is best for your baby.)

“Baby carriers cause hip dysplasia!” Most of us have heard this recently. What was an unfounded attack on narrow based carriers, has become an attack on all babywearing and a lot of scared parents who are just doing their best. It is time to end the hysteria and take a look at what is really going on. We have *zero* research that shows that baby wearing causes hip dysplasia. Literally nothing. The HDI doesn’t say that and I am honestly not positive where this statement originated. But having been in the babywearing community for the last decade, it comes up often. What we know is that wearing children in an ergonomic carrier (this means a carrier that supports the child’s thighs and keeps knees above bottom in an “M” shape) can help heal and strengthen loose hips. In the US today, approximately 15 out of every 100 babies (15%) will be born with loose hips. 2-3 out of every 1,000 (.2-.3%) babies born will need intervention from a pediatric specialist. (1) Since we don’t have any research that looks specifically at the effects of babywearing in today’s carriers on newborn hip health, we have to take the research we do have and apply it as best as possible.

Looking back at cultures that have been wearing for generations we can see trends in DDH (developmental dysplasia of the hip) and compare that to the style of wearing they use. DDH rates range from .06/1000 births in Africa to 76.1/1000 births in Native Americans. (2) Keeping in mind that we are lumping the entire continent of Africa together here and all Indigenous tribes together, over a large time frame that saw huge shifts in wearing, diapering, and cultural practices. Take a look at the graph showing “DDH in indigenous people” on reference 2 and you will see a drastic difference between tribes in different areas, despite similar wearing practices. So these averages don’t give us the whole picture. We are left making generalizations. Many indigenous cultures wear using Cradleboards, or similar styles with legs kept straight in a swaddled fashion. Many African cultures wear using short woven cloths with legs held out. One of the issues here is, we don’t know if the higher instances of DDH in communities that keep baby’s legs straight are due to the carrier style they use, other environmental or cultural impacts, or genetic traits. And we *DO* know that genetics play a role in DDH diagnoses.(2)

One thing we have seen for sure (and I think this is where most of the concern comes from), is that some cases of DDH can go undetected during routine newborn screenings. Although the study (looking at hip replacement in adults under 40), does say it that could be a reporting issue, a newborn screening sensitivity issue, or a separate degenerative issue.(3) Other countries implemented additional ultrasound screening and were able to catch some of these missed DDH cases. (4)

Ok, you made it! Kind of confusing, huh? There is a lot of “hmmm” and “maybe its connected” going on, and some “did they consider...”. But mostly a whole lot of no definitive answers except we *aren’t* hurting healthy hips in any baby carrier. 

So what is “hip healthy” positioning? “Hip healthy” is a phrase coined by HDI. I don’t love it because it insinuates that something is “hip unhealthy” and that’s not true. We know that keeping baby’s knees above their bottom helps to strengthen and heal loose hips. (You can read about the optimal degrees of abduction and flexion on the HDI page (reference 5)). This will be an important position for any child that is diagnosed with DDH or high-risk and awaiting further testing. Your child’s provider will discuss what they are and are not comfortable with as far as babywearing, diapering, etc. This doesn’t mean that hips not supported in this manner causes hip issues in the 85% of children with healthy hips. All of this really boils down to an “on the safe side” sort of thing.

The truth of the matter is finding a safety tested ergonomic carrier brand can be expensive. Shaming someone for using a narrow based carrier (NBC, aka, non-ergonomic carrier, or a “crotch dangler” but don’t actually use that term), is common. Often times that NBC is the only option available to that parent. As long as these carriers have passed all safety and compliance testing, they are fine to use. They don’t deserve to be shamed for doing their best! There is nothing wrong with their carrier or them wearing their child in it. They are good parents caring and loving on their baby. The. End. They are perfectly capable of looking at the research, like anyone else, and deciding if the benefits of wearing in a safety tested carrier are worth it being ergonomic or not. If you find yourself with a narrow based carrier and wish it was ergonomic, google “narrow based carrier scarf hack” for a great, and simple way to offer more support. But remember, it’s *perfectly* fine to use the carrier as is.

I have also worked with children with extreme reflux, genetic differences, or casting that makes an ergonomic seat impossible for them (whether they physically can’t move to that position or it causes them extreme pain). While this is not the norm and most likely not something a new parent needs to worry about, these families do deserve to have a carrier that fits their needs. And a NBC is sometimes the answer to that need.

What sort of things should we look for in a carrier then? (This is the *real* concern. Our focus is in the wrong place!)

Number one- its safety testing. Any carrier legally sold within the US must undergo ASTM and CPSC testing. This checks things like lead levels, flammability, warning labels, weight limits, etc. It’s how you know that your carrier can withstand years of love, spit up, and abuse without failing. Not all carriers sold at all retailers (I’m looking at you Amazon!) are actually safety tested. So verify with the manufacturer if needed. Keep in mind there are *NO* other safety certifications that are valid or hold any true meaning (including what you see on HDI). Most of these do nothing but buy into fear mongering or are marketing gimics.

Number two- know your ABC’s of safety. You know the carrier you have is safe. So we move on to how to use it correctly.
A: Airway- the carrier should support your child to maintain an open airway at all times. You should be able to see a 2 finger gap between your baby’s chin and chest at all times, and no fabric should cover baby’s face.
B: Body Positioning- the carrier should keep baby close enough to kiss and support your child’s spine in a snug manner. For a newborn, their spine should form a sort of “c” shape. Supporting the back snuggly maintains the two finger gap and therefore an open airway. If the carrier is too loose, the child will slump down (this can close their airway). If the carrier is too tight, it will force the spine to flatten. Be sure to check your carrier’s manual to maintain the correct leg positioning for that carrier.
C: Comfort! You and your little one should always be comfortable while wearing. A few small tweaks to a carrier can make a world of difference here. Check the manufacture’s website for additional how-to videos or reach out for a fit check.

So lets break my rambling down a bit....

  • carriers do not cause hip issues
  • an ergonomic (keeping knees above bottom) carrier can help a child with pre-existing hip issues (but talk to your child’s PT about using a carrier first)
  • there is nothing wrong with a narrow based carrier as long as your child has passed their DDH screening
  • focus on finding a safety tested carrier by a company you can trust
  • review the ABC’s every time you wear your child

Now, go enjoy your little (or not so little one) and happy wearing!!! 

The research:

  1. https://hipdysplasia.org/developmental-dysplasia-of-the-hip/faq/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063216/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235283/
  4. https://pubmed.ncbi.nlm.nih.gov/24488847/
  5. https://hipdysplasia.org/developmental-dysplasia-of-the-hip/baby-wearing/#_ENREF_2


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