Can Carrying Our Babies Give Them Healthy Hips?
Can Carrying Our Babies Give Them Healthy Hips? What Every Australian Parent Needs to Know
Updated 2026. Original article written by Dr Nicole Williams, Paediatric Orthopaedic Surgeon, Researcher, and Mum to two young girls
If you've ever wondered whether the way you carry your baby could actually affect their hip development, you're not alone and the answer, according to the science, is yes.
Dr Nicole Williams, a paediatric orthopaedic surgeon, researcher, and mum of two young girls based in South Australia, about one of the most common conditions she treats in her practice: developmental dysplasia of the hip. What she shared may change the way you think about babywearing.
What Is Developmental Dysplasia of the Hip?
"As a paediatric orthopaedic surgeon, one of the most common conditions I treat in babies and young children is developmental dysplasia of the hip — DDH," says Dr Williams. "In this condition, the ball and socket of the hip joint aren't forming perfectly. Some cases are subtle, with only a slight change in the shape of the socket. In other cases, the ball of the hip joint is completely dislocated from the socket."
The consequences of untreated DDH can be significant. Left undetected, children can go on to develop a limp, chronic hip pain, and may ultimately need a total hip replacement for arthritis as a young adult. Around 1 in 150 Australian children will undergo treatment for DDH, making it one of the most common orthopaedic conditions seen in paediatric practice across the country.
Why Late Diagnosis Is a Growing Concern in Australia
Most cases of DDH are picked up during a newborn hip examination in hospital. But Dr Williams says the rates of DDH being diagnosed in babies older than three months have been rising and this is a serious concern.
"Most cases of DDH are detected by examining baby's hips as a newborn," she explains, "but rates of DDH diagnosed in children older than three months of age have been increasing in Australia."
Research confirms the incidence of late-diagnosed DDH in South Australia rose from 0.22 per 1000 live births in the period 1988–2003 to 0.77 per 1000 live births in babies born between 2003 and 2009 and reports from New South Wales and Western Australia confirm this increased incidence is not limited to South Australia but has been observed nationally.
The timing of diagnosis matters enormously. "While treatment started as a newborn usually involves a relatively short period of bracing or splinting," Dr Williams explains, "older babies and walking-age children are much more likely to need surgery, casting, and a much longer period in a brace. Older babies and children are also less likely to have a completely normal hip after treatment."
Lack of awareness regarding local screening guidelines may contribute to the current trend of increased incidence of late-diagnosed DDH across Australia. This is precisely why parent education around hip health including how everyday choices like babywearing can make a difference matters more than ever.
What Cross-Cultural Research Reveals About Carrying Positions
Some of the most compelling evidence supporting hip-healthy babywearing comes from cross-cultural research comparing carrying traditions around the world and the corresponding rates of DDH in those communities.
Dr Williams points to the striking contrast between cultures where babies are traditionally carried in slings with their legs spread around their caregiver, and those where babies have historically been swaddled with legs held straight. "In cultures where the most common way to transport babies is in slings or wraps with their legs spread around mum such as in certain sub-Saharan African communities cases of DDH are rare," she says. "In fact, they were historically so rare they were written up in medical journals as a curiosity."
In sharp contrast, some cultures that used traditional carriers like cradleboards which held babies with their legs straight and pressed together saw DDH rates as high as 1 in 10 children.
Crucially, Dr Williams notes that when these contrasting cultural groups abandon their traditional practices and adopt mainstream approaches like prams, their rates of DDH shift to align with the broader society around them. "A family history of DDH is a strong risk factor," she says, "but genetics cannot completely account for this phenomenon." The evidence points strongly to positioning as a key variable.
How Does Babywearing Support Hip Development?
To understand why carrying position matters, Dr Williams explains a little about how hips develop in the first place.
"A newborn baby's hips are mainly made of cartilage and the socket is quite shallow," she says. "As hips grow, the cartilage is replaced by bone and the socket deepens. This happens rapidly in the first few years of life. During this period of rapid hip development, the hip can be encouraged to develop optimally by ensuring the ball and socket are well-aligned."
This is the same principle, she explains, that underlies the use of a harness or brace to treat DDH in clinical practice. When a baby's thighs are spread apart (abducted), legs are bent at the hips (flexed), and knees are allowed to bend freely, the ball of the hip joint naturally sits most deeply in the socket. This position also aligns the surrounding muscles so that when they contract, they actively help to centre the ball in the socket.
"It makes sense then that wearing baby in a carrier that holds baby's legs in a similar abducted and flexed position — sometimes called the 'M' position — would be the healthiest position to encourage baby's hips to develop nicely," Dr Williams says.
The International Hip Dysplasia Institute (IHDI) supports proper babywearing with the hips in the M-position as a method to encourage healthy hip development.
What the Research on Carriers Specifically Shows
Beyond the cross-cultural evidence, there is now specific research looking at what different types of baby carriers do to hip positioning. Research confirms that hips are more fully seated in the socket with wide-base carriers compared to narrow-base carriers, with the differences in hip position being more noticeable for babies with hip dysplasia.
Based on this evidence, the IHDI advises parents to use wide-base carriers particularly in the first six months as the preferred choice for supporting healthy hip development.
It's also important to address a common misconception. Baby carriers do not cause hip dysplasia when used correctly. In fact, many orthopaedic specialists support babywearing when the carrier promotes healthy hip positioning, and the International Hip Dysplasia Institute recognises carriers that support this positioning as hip healthy.
The key distinction is between a narrow-base carrier where baby's legs dangle straight down with only the crotch supported and a wide-base ergonomic carrier that supports the full thigh from knee to knee and maintains the M position throughout use.
Know the Risk Factors for DDH
While DDH can affect any baby, Dr Williams highlights several factors that increase risk and warrant closer attention:
Higher risk factors include:
- Female sex — girls are diagnosed with DDH approximately four to five times more often than boys
- First-born children — reduced uterine space and tighter maternal ligaments increase risk
- Breech position at or near birth, particularly frank breech
- Family history of DDH — risk increases significantly with an affected first-degree relative
- Reduced amniotic fluid (oligohydramnios), which limits movement in the womb
- Multiple births — twins and triplets face increased risk due to crowding
One in six babies born full-term have some degree of hip instability at birth, and this increases to one in ten when a family history of the condition is present. If your baby has one or more risk factors, Dr Williams recommends discussing hip screening with your GP, paediatrician, or maternal child health nurse and being especially mindful of hip-healthy positioning throughout infancy.
What to Look for in a Hip-Healthy Carrier
Not all baby carriers are equal when it comes to supporting healthy hip development. Dr Williams and the IHDI recommend looking for the following:
Wide-base seat support: The carrier seat should support your baby's thighs fully from knee to knee — not just beneath the bottom. This is what creates the spread-squat M position.
Adjustable seat width: Babies grow quickly. A carrier with an adjustable seat width allows you to maintain correct positioning as your baby grows from newborn through toddlerhood.
No leg dangling: Avoid carriers where baby's legs hang straight down with only the crotch supported. This narrow-base design does not support the M position.
IHDI hip healthy endorsement: Look for the IHDI hip healthy seal — this means orthopaedic specialists have independently verified the carrier supports safe, ergonomic positioning.
Newborn-appropriate design: For babies under four months, choose a carrier specifically designed for newborns, such as the Ergobaby Embrace, which supports the M position from birth without requiring an insert.
All Ergobaby carriers — including the Embrace, Omni Deluxe, Omni Classic, Alta, Lift, and Upsie — carry the IHDI hip healthy endorsement.
A Note on Swaddling
Hip-healthy habits extend beyond the carrier. Swaddling practice matters too. Tight swaddling that holds baby's legs straight and pressed together has been associated with increased risk of DDH. Australian guidelines recommend hip-healthy swaddling that keeps the legs free to bend and spread naturally into the frog-leg position. The Ergobaby Swaddler is also IHDI-endorsed and designed with a healthy hip positioner built in.
Dr Williams' Personal View
As a surgeon who treats the consequences of DDH daily, and as a mother who has worn her own children in carriers, Dr Williams is clear on where she stands.
"As a mum, wearing my girls in a carrier which keeps the legs in the M position is a no-brainer for me," she says. "Who would have thought that something as convenient and enjoyable as having my small person snuggle against me in a carrier might also be giving her hips the best start possible?"
Frequently Asked Questions
What is DDH and how common is it in Australia?
Developmental dysplasia of the hip is a condition where the ball and socket of the hip joint don't form or fit together properly, ranging from mild instability to complete dislocation. Around 1 in 150 Australian children will undergo treatment for DDH, making it one of the most common orthopaedic conditions seen in paediatric practice.
Can a baby carrier cause hip dysplasia?
No. The IHDI clearly states there is no evidence that any type of baby carrier can cause or worsen any case of hip dysplasia. However, narrow-base carriers that allow baby's legs to dangle straight down do not support healthy hip positioning. A wide-base ergonomic carrier actively supports the M position.
What is the M position?
The M position is when your baby's knees sit higher than their bottom, thighs are spread around your torso, and hips are bent at approximately 90 degrees. The IHDI supports proper babywearing with the hips in the M-position as a method to encourage healthy hip development. It is also known as the spread-squat or jockey position.
What are the signs of DDH in babies?
Signs can include uneven leg creases, one leg appearing shorter than the other, limited range of movement in one hip, a clicking or clunking sound from the hip, or a limp once walking begins. Many cases present no obvious signs, which is why newborn screening is critical. If you notice anything unusual, speak to your GP or paediatrician promptly.
Which Ergobaby carriers are IHDI hip healthy endorsed?
All carriers in the Ergobaby range including the Embrace, Omni Deluxe, Omni Breeze, Alta, Lift, and Upsie are endorsed by the International Hip Dysplasia Institute as hip healthy products.
My baby has been diagnosed with DDH — can I still babywear?
In many cases yes, and your orthopaedic specialist may even encourage it. Always check with your treating doctor first, as the answer depends on your baby's specific diagnosis and whether they are currently in a brace or harness. A wide-base ergonomic carrier supporting the M position is generally considered appropriate for babies with mild to moderate DDH who are not in active treatment.
Where can I find more information about DDH in Australia?
Healthy Hips Australia is the leading Australian patient advocacy and education organisation. The International Hip Dysplasia Institute provides comprehensive global resources.
References
- Studer K, Williams N, et al. (2016). "Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions." Medical Journal of Australia 204(6): 240.
- Loder RT, Skopelja EN. (2011). "The epidemiology and demographics of hip dysplasia." ISRN Orthop 2011: 238607.
- Graham SM, et al. (2015). "Back-carrying infants to prevent developmental hip dysplasia and its sequelae: is a new public health initiative needed?" Journal of Paediatric Orthopaedics 35(1): 57–61.
- Smart L, et al. (2024). "Variability in Australian screening guidelines for developmental dysplasia of the hip." Children (Basel) 11(8): 915.
- International Hip Dysplasia Institute. Babywearing Position Statement
Shop all IHDI hip healthy endorsed Ergobaby carriers at ergobaby.com.au
