Baby Legs Spread

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Baby Legs Spread



7th February, 2010 /
Baby Wrap Tips /

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Home > Baby Wrap Tips > Newborn Wrapping: Newborn Legs In or Legs Out
Wondering whether to wrap your newborn legs in or legs out?
The real question of legs in/legs out is how best to support YOUR newborn in a comfortable and ergonomic way.
Optimum newborn positioning includes:
You should wrap around baby in a position that your newborn’s legs are naturally inclined to rest in. You will find that baby will tuck knees up, not spread too far apart.
Usually you can wrap around your newborn baby with legs out while maintaining this natural position.
Baby does not need to be able to spread legs wide or straddle your torso. In fact, newborn legs are so tiny that the length of thigh from bottom to knee fits in front of a mama’s tummy with only a slight spread.
Wrapping a newborn with legs out is often more comfortable for baby.
And with newborn legs out, you can view baby’s feet to monitor circulation.
In the photos below you can see that Annabelle’s legs do not have to stretch around my waist or spread wide across my torso–she’s 6 weeks old in these pictures, and I’m wearing her low in the second picture because she’s been nursing in the front wrap cross carry.
Newborn legs don’t have to straddle your waist!
Before 2010, it was most common (among US and European babywearers) to wrap a newborn baby with legs in – inside the wrap – in what was referred to as “froggy leg” position.
Because of this, there are a lot of older photos, videos, and resources that show this style of legs-in newborn babywearing.
There’s nothing wrong with wrapping a newborn with legs in the wrap – as long as you are doing safe positioning.
So make sure baby’s knees are not spread too wide.
Make sure baby’s weight is not on baby’s feet.
Make sure baby’s feet are comfortably flexed.
Sometimes newborns are very accustomed to being curled up. And if that is what your baby’s body seems to want to do, go with it!
Here’s an example of a newborn who was not uncurled enough to wrap with legs out, but whose little feet did stick out:
In conclusion, do what works best for you and your baby in terms of leg position. Newborn legs in or legs out, either way is fine.
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All What to Expect content that addresses health or safety is medically reviewed by a team of vetted health professionals. Our Medical Review Board includes OB/GYNs, pediatricians, infectious disease specialists, doulas, lactation counselors, endocrinologists, fertility specialists and more. 
Hip dysplasia is a fairly common condition in babies that can happen from improper uses of a swaddle or baby carrier. Here's what you need to know about hip dysplasia in babies.
What to Expect the First Year , 3rd edition, Heidi Murkoff. WhatToExpect.com , Breech Birth: What It Means for You , September 2018. WhatToExpect.com , How to Swaddle a Baby , June 2020. WhatToExpect.com , When to Stop Swaddling a Newborn Baby , June 2020. WhatToExpect.com , Shawn Johnson East Worries About Hip Dysplasia After Using Her Baby Carrier . February 2020. American Academy of Family Physicians, Hip Problems in Infants , May 2020.  American Academy of Pediatrics, Sprains & Strains , November 2015. American Academy of Pediatrics, Visiting the Pediatrician: The First Year , November 2015. American Academy of Pediatrics, Swaddling: Is It Safe? , August 2020. American Journal of Orthopedics, Developmental Dysplasia of the Hip in Infants with Congenital Muscular Torticollis , September 2008. Boston Children’s Hospital, Hip Dysplasia in Babies , 2020. Gillette Children’s Hospital, Developmental Dysplasia of the Hip (DDH) , 2020. Hospital for Specialty Surgery, Developmental Dysplasia of the Hip , October 2016. International Hip Dysplasia Institute, Developmental Dysplasia of the Hip , 2020. International Hip Dysplasia Institute, FAQ Child Hip Dysplasia , 2020. Pathways.org , Frequently Asked Questions About Infant Equipment , 2020. American Academy of Pediatrics, Pediatrics , Developmental Dysplasia of the Hip , January 2019. American Academy of Pediatrics, Pediatrics , Evaluation and Referral for Developmental Dysplasia of the Hip in Infants , December 2016. Stanford Children’s Health, Developmental Dysplasia of the Hip in Children , 2020. National Library of Medicine, Developmental Dysplasia of the Hip , March 2019. American Academy of Orthopaedic Surgeons, Developmental Dislocation (Dysplasia) of the Hip (DDH) , January 2018. American Academy of Orthopaedic Surgeons, Appropriate Use Criteria for the Management of Developmental Dysplasia of the Hip in Infants Up to Six Months of Age , March 2018. American Academy of Pediatrics, Head Tilt (Torticollis) , August 2020. Children’s Hospital of Philadelphia, Metatarsus Adductus , 2020. KidsHealth From Nemours, Developmental Dysplasia of the Hip , October 2019. Mayo Clinic, Hip Dysplasia , March 2020. National Institutes of Health, National Library of Medicine, Developmental Dysplasia of the Hip: What Has Changed in the Last 20 Years?, December 2015. National Institutes of Health, National Library of Medicine, Oligohydramnios: Should It Be Considered a Risk Factor for Developmental Dysplasia of the Hip? , September 2019. Pediatric Orthopaedic Society of North America, Developmental Dysplasia of the Hip (DDH) , 2020.
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Your baby's developing hips will eventually make it possible for her to crawl, walk, climb, run and even dance.
That's why your pediatrician moves your baby’s legs around during well-baby visits and looks for any signs of hip instability or hip dysplasia — a relatively common condition that could affect your baby’s motor development and lead to other health problems down the road.      
Like many other conditions, early diagnosis, and treatment lead to better outcomes. Here’s what you need to know about hip dysplasia, including the signs to watch for, causes, and treatment options.
Hip dysplasia is a musculoskeletal condition that occurs when the hip bone does not develop properly and the top of the femur doesn't fit into it like a ball and socket. In an infant, this leaves the hip joint loose and prone to injury, and can lead to other health problems.
Why? Well unlike an adult’s hip socket made of hard bone, an infant’s hip socket is mostly soft, pliable cartilage.
Hip dysplasia is often referred to as Developmental Dysplasia of the Hip (DDH). Like many other conditions, hip dysplasia has a wide range of severity, from mild (loose joints) to severe (complete dislocation).
Fortunately, the condition does not cause any pain. An estimated 1 in every 100 babies is treated for hip dysplasia in some form. And rarely, 1 or 2 babies out of 1,000 are born with completely dislocated hips.  
Hip dysplasia in babies is often discovered at or soon after birth during routine wellness exams.
It can be hard to detect because it is, like many others, a “silent” condition. It won’t cause your little one to cry in pain and doesn’t typically prevent babies from learning to walk.
There are some outward signs of hip dysplasia to take note of and bring up with your pediatrician, however, including the following:
Hip popping noises. We tend to think of cracking joints as something common in adults, but hip clicks or pops in an infant can sometimes suggest hip dysplasia. Listen up! Many parents and providers say there is a distinct sound when a baby’s hips are dislocated.
Trouble diapering . Many parents of babies with hip dysplasia have difficulty putting diapers on them because their hips have a limited range of motion and can’t fully spread. Talk with your pediatrician if you have concerns. 
Asymmetrical buttock creases. (Yes, you read that correctly). If you notice something seems off on your baby’s tush, bring it up to your pediatrician. An ultrasound or X-ray will need to be done to determine whether the hips are normal or not.
Limps. If both hips are dislocated, you may notice what’s called a “swayback” after baby starts walking . In other words, it may look like your child has a painless and exaggerated limp. One leg may also appear longer than the other, causing the limp. All toddlers tend to walk a little funny at first, so this sign can be a bit harder to pinpoint.
The exact cause (s) of hip dysplasia are not known, but there are some risk factors:
Breech positioning in utero. Breech babies are more susceptible to hip dysplasia. Other conditions related to positioning in utero — including oligohydramnios , metatarsus adductus (a congenital foot deformity that causes the forefoot to turn inward) and congenital torticollis — are also thought to potentially cause it or increase the risk. The American Academy of Pediatrics recommends ultrasound DDH screening for all female breech babies.
Family history. Tell your doctor if you, another child, or a relative has hip problems. This increases the chance of your baby having hip dysplasia.
Baby's sex. Between 75 and 80 percent of babies with hip dysplasia are girls. Doctors have attributed this to pregnancy hormones. Relaxin, a pregnancy hormone that loosens ligaments and relaxes muscles, is said to be more responsive in female babies.  
Being firstborn. Six out of 10 cases of hip dysplasia occur in firstborn children, according to the International Hip Dysplasia Institute. This is said to be because a mother’s womb is tighter during her first pregnancy, which can sometimes restrict fetal movement.
Prolonged abnormal positioning after birth, including incorrect swaddling and baby carrier use. Babies with caregivers who practice “tight swaddling” — straightening the baby’s legs and tightly wrapping them so the legs can’t move — have a higher rate of hip dysplasia. While there are plenty of benefits to swaddling babies , the hips should be able to flex within any swaddle and the legs should be able to move and bend freely. In addition, doctors have seen an increase in the number of babies who develop the condition months after birth due to the length of time spent in baby carriers , car seats and other products.
Newborns are usually screened for hip dysplasia shortly after delivery and by their pediatrician at each wellness exam until they are 1 year old. But the best method for physically examining the hips for the condition is still up for debate by some experts.
As with any newborn screening , the goal is to prevent diagnosed cases and allow for earlier, less aggressive interventions down the road.
Physical exams aren't 100 percent effective for diagnosing hip dysplasia, so babies with apparent risk factors often need additional testing to confirm it, including:
Ultrasound. This test is recommended for infants 4 months and younger, because the hip is still predominantly cartilage and unable to be seen clearly on other scans.  
X-rays. After around 4 to 6 months of age, X-rays are the preferred method for evaluating and monitoring hip dysplasia.
If a physical exam, an ultrasound or an X-ray confirm a diagnosis, your pediatrician will likely refer you to a pediatric orthopedic specialist for continued care and treatment. 
The treatment for babies with hip dysplasia depends on the factors, including your baby's age and the severity of their condition (i.e. how much the thigh bone is displaced from fitting inside the hipbone socket). For example, some cases of hip dysplasia do correct themselves over the first six months of development, as the femur and pelvis grow, but other cases can take months to years to correct. 
Treatment options may include the following:
These suspender-like harnesses are considered the routine treatment for infants up to 6 months of age with confirmed cases of hip instability or dislocation and are anywhere from 60 to 90 percent effective.
They hold the legs in the “M” or froggy position to help mold the ball into the socket of the hip. Because the harness is typically worn full-time for six weeks, and then part-time for another six weeks, it can make the day-to-day lives of new parenthood significantly more difficult (causing trouble finding baby clothes, changing diapers , keeping the brace clean and so on). Babies rarely seem bothered by the brace, especially if they’ve worn it since birth.
After about six weeks, the doctor will do an ultrasound and look for improvement. If the hips are still dislocated, the harness is worn longer. 
If wearing the harness hasn’t solved the problem, a closed reduction surgery may be considered for babies between 6 and 12 months old. It’s considered minimally invasive (no incisions) but does require your baby to be put under anesthesia for the pediatric orthopedic surgeon to position the hipbone correctly in the socket.
Afterwards, a plaster cast, called a spica, is applied to hold the hips in the “M” position and is worn for a few months. Follow-up tests will determine whether the procedure was successful. 
Babies older than 12 months who don’t have success with the closed reduction surgery are considered candidates for open reduction surgery. (Sometimes babies older than 6 months qualify if the Pavlik harness didn’t improve the condition).
These cases of hip dysplasia are considered severe. While the baby is under anesthesia, the surgeon will make an incision to reposition the hip socket and repair the ligaments. Similar to the closed reduction surgery, a plaster spica cast will then be applied and worn for a few months.
While these treatments can seem extreme — particularly if your baby appears completely healthy — it’s important to keep in mind what can happen down the road if the condition is left untreated.
There is the potential for some long-term problems if hip dysplasia is left untreated or isn't properly diagnosed early on.
Teens may experience hip pain and discomfort, and many young adults go on to develop early hip osteoarthritis. In fact, untreated hip dysplasia is the most common cause of early-onset hip arthritis in young women.
The goal of treating hip dysplasia early in infancy and childhood is to prevent these subsequent impairments and conditions as your child grows into adolescence and adulthood.
Hip dysplasia cannot be prevented, because the exact cause is unknown. However, there are some things you can do to keep your little one’s hip development on track and avoid any existing hip dysplasia from getting worse: 
Practice hip-healthy, safe swaddling. The Pediatric Orthopaedic Society of North America, with the AAP Section on Orthopedics, recommends allowing your baby’s legs to bend up and out within a swaddle. In other words, the swaddle blanket should be loose around her hips so she can move her legs freely. 
Consider sleepsuits. If your baby isn’t a fan of the swaddle or you are working on a transition, sleepsuits can be a great alternative. They keep babies feeling snug and safe, while allowing your infant to move her arms.
Wear baby safely. There is no shortage of options when it comes to babywearing — from simple cloth wraps to specialized baby carriers with padding, pockets and straps. Whichever style of baby carrier or sling you choose, make sure your baby’s hips are spread out in the squat position. This means that baby’s thighs are spread around the parent’s torso and baby's hips are open with his knees are bent at the same height as or higher than his bottom, in an "M" shape like a sitting frog. Always check with your baby’s pediatrician before wearing your baby as some infants lack the muscle strength to keep their airways open in an unsupported position.
Limit time spent in baby carriers, car seats, baby seats and other products. Where does your baby hang out the most during the day? Too much time spent in infant equipment like carriers and seats can not only up his chances of hip dysplasia but also increase the risk of delays in sitting, crawling, walking and even talking. Try to use this kind of baby gear only when necessary, practice tummy time every day and carry baby often and in different positions.
Remember, the vast majority of babies with hip dysplasia do tremendously well with treatment and are able to walk at a typical age. Most are not lim
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