Do Cloth Nappies Damage Your Baby's Hips?

Monday, 31 December 2018

A common question I get asked by first time cloth nappy users is: Does the extra bulk of a cloth nappy effect baby’s hip development or motor development? The answer is NO!

Cloth nappies keep a newborn's hips wider apart than disposables, but this is actually the optimum position for a newborn. It's important to understand how babies'/children's hips develop to understand why cloth nappies (and ergonomic baby carriers/slings) help support the natural positioning. The hip ball and socket joint is not fully formed at birth, which is how babies can get their toes in their mouth, and we can't. The joint becomes fixed about 2-3 years of age and are effectively dislocated until then naturally. But the bone that develops to form the roof of the socket and seals in the ball requires contact with the ball to stimulate that growth. This happens fine for most kids, but for those with any degree of hip dysplasia, the two do not sit together enough and the bone doesn't grow. It's nasty enough to treat in babies, but horrible and painful in teens and adults so very important to treat it early.

Hip dysplasia is a developmental condition - you can be born with it or it can develop after birth and leg/hip positioning plays a role in that. By 3 months or so, hip dysplasia is already obvious enough to need treatment fast if not spotted after birth. Hip dysplasia in a moderate to severe case will always need proper treatment, but in mild to moderate cases positioning may be enough to get the hip back on track. The position created by a wide cloth nappy and ergonomically designed sling, is similar to the one created by the Pavlik harness and Spica cast that are used to treat hip dysplasia.  The gentle lift of a bulky cloth nappy in the first three months certainly prevents that child spending lots of time with the ball far from the socket and is why cloth nappies can help support hip problems that the child may already be predisposed to.

This first picture below is with the legs down; the ball of the hip is pulled away from the socket. This in itself is OK for a child without a family history or concern for hip development issues, but potentially a contributor to an identified problem with hip development.  "You can see why it might be a shock for baby to go from that knee to chest position in the womb to the straight leg position below. The straight leg position may look natural to an adult because we obviously need straighten our legs to walk. The thing to really note here is while this might be uncomfortable it will not cause screaming pain and the child may adjust. In the second picture (child shown in a sling) by lifting the legs the ball is pushed against the socket stimulating bone growth. The more time a child spends in this position the faster it grows.” International Hip Dysplasia Institute

Below is an image of a baby  in a Pavlik harness. This keeps baby's legs wider apart so that the hip ball and socket joint are held in a deeper position and can develop properly. This usually helps prevent the need for hip operations later on.


Pavlik Harness

Cloth nappies don’t hold the hips in as wide a position as a hip harness, but the extra width and support cloth nappies provide can sometimes prevent the need for a hip harness at all in children with mild hip dysplasia.

For children with "normal" hip development, cloth nappies prevent that child spending lots of time with the ball far from the socket. The deeper hip position in a cloth nappy in turn encourages socket bone growth and development of the socket joint.  Disposables do not cause hip dysplasia nor worsen it, but bulkier cloth nappies present an opportunity to treat and also to prevent it worsening. In the past, hip dysplasia was treated by putting the child in two bulky terry nappies as that ensured hips were kept apart and turned out (abducted and externally rotated) to achieve the wider leg position. 

One of my customers, Kirstie, has written about her experience with clicky hips.

"We had already decided our son would use cloth nappies before he arrived and we purchased a complete nappy system from Wendy during antenatal. He stared wearing them after the meconium had been passed out his system. In his fifth week he was diagnosed as having a 'clicky hip' and he required a Pavlik harness. We were reassured to learn from the paediatrician that the cloth nappies had been helping to keep his hips in a better position compared to the thinner disposable nappies.

At first it was tricky to weave the nappy's velcro fastenings through and underneath the harness straps, but after a couple of days we were changing nappies fairly expertly. We had a few leakages at first as the harness was keeping his legs wide open but as soon as his thighs bulked up the seal around the legs was tighter and no more accidents.

He is now four months old, and was only in the harness for 7 weeks. We are happy knowing that the cloth nappies are still augmenting his hip joints. We regularly receive positive comments about using cloth nappies, and we are really pleased that we made the decision to use them."

Once baby is also cruising and walking, their bottoms and backs will thank you for choosing cloth. Learning to walk requires a lot of falling too. The impact (especially on hard floors) is softened by the fluffy padding of their nappies. I know i’d certainly prefer to fall over with a thick layer covering my bottom than just thin trousers!


Some happy customers in their harnesses and nappies.

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