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Discussion Starter · #1 ·
We just had our evaluation at early steps and the OT noticed how I was wearing my DS in my maya (tummy to tummy). In this position, at 8 weeks, his little feeties are kinda scrunched up and in the sling so his inner legs are against my tummy and his legs are open. She mentioned not overextending him because of the low tone and loose joints associated with Ds. I asked my ped if it was possible that having him in this position could cause hip displasia and he said absolutely not. I'm wondering if wearing my boy in tummy to tummy will hinder his walking when the time comes? Do I have to wear him to the side with legs together? Is that the only position? Also, the sling is probably the only option if that is true or maybe my sleepy wrap? According to this OT, our ergo would definitaly be out, as that spreads the legs even wider - and on the back, even more so. Will someone please tell me that I don't have to worry about this and it will not effect his walking and I can wear my baby just like I wore his big sister? Lorianne
 

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I would ask a PT or an orthopedist if you can.

Generally when there is hip displasia they spread the legs apart to encourage the hips into the sockets. I don't know that the position he is in is good for him (I am not there nor am I an expert) but putting his legs close together is probably not healthier for him either.
 

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Well, the quick answer is no, you probably can't wear him like you wore his sister. But that's not bad, just different.

Hip dysplasia is not typically caused by wearing your baby under normal conditions. Dysplasia is caused by either congenital abnormalities or is developmental. We're not going to worry about congenital, because I don't think it's very common in kids with DS. Developmentally, though, it is a bit more common. And I'll explain why.

First, technical stuff: dysplasia: dys (abnormal)+ plas/o (formation) + ia (condition)

(hey, when you shell out $100's for these medical books, you look for opportunities to put them to further use!
)

The hip socket is fairly shallow and still cartilaginous at birth. As a child begins to stand and put pressure on the hips, the head of the femur pushes in and deepens that socket, forming a normal, stable joint. If it doesn't deepen enough to securely contain the head of the femur, then you have dysplasia. So, weight bearing is the important component in forming a good deep socket. Unfortunately, because of low tone, a lot of our kids are very late weight bearers and late walkers. This sets the stage for potential hip dysplasia.

So now, totally different but somewhat related subject:
Wearing your baby can actually benefit him in by creating resistance against his legs. Having the legs dangle or in excessive abduction can be harmful if hip abnormalities already exist, (*and, btw, would be treated completely differently too) but won't CAUSE abnormalities. However, it also won't help him at all. There was a thread a while back about the benefits of babywearing kids with DS and I think it got kind of confusing, and that may have been my fault. It's not going to do anything for the sockets, but it can help build tone.

Once more: outside of physical abnormalities, dysplasia can be avoided by deepening the hip sockets by weight bearing.

Now, as for how you are wearing your baby...
The way you described does seem to be overextending a bit but once again, it's not dysplasia you're worried about, it's simply the overextension. As your son develops, you want to create some boundaries for that extension. Basically, teach him to please not do those wonderful and weird things that are very easy for him but are going to creep you out! It may not seem important now but later the habit of overextension will inhibit things like rolling, sitting up and crawling.

Ask your early interventionist about any books or videos they may could give or loan you. The short video "Down Syndrome: The First 18 Months" is a good one and it shows some examples how overextension can hinder development.

When you wear your son, just try to not abduct his legs too much. (abduct means away from midline while adduct means towards midline)
Yes, he's little and he's sleeping so it seems like not a big deal but again, you want to discourage excessive abduction.

Some people who know me are laughing right now because they are thinking of the hundreds of photos I have of my daughter in some positions you would never think possible.


Anyway.....

I want to try to sum up so I don't sound like I am contradicting myself.
-Assuming low tone is the only issue, you don't want to overextend hip joints because you want to discourage overextension by providing good positioning and resistance that can help build tone.
-Dysplasia is only a concern if he is not doing some good age-appropriate weight bearing.

Talk to your OT about it, I am sure they will have better suggestions and hopefully much better explanations than I have. And if I am wrong, please let me know! I am keenly interested in the topic, and hope to turn it into a research project one day, and it's one of the reasons I went into occupational therapy (yeah, I know, it seems more PT territory but there is overlap)

BTW, I wore my DD in a moby when she was tiny. I could carry her tummy to tummy by putting her in the fetal position, I guess best describes it. Lower legs crossed, knees together and brought up against her. It's the same way I carried her in front carry in the sling, but the sling didn't bind her quite as tightly. Again, we're talking little... when she got older then this was no longer good positioning for her.

Ok, I know this is plenty long enough but I also wanted to say congratulations on your newest family member and please stick around to share all your wonderful stories, anxious and proud moments and just any thoughts you have!
 

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Discussion Starter · #5 ·
Thank you for your detailed reply. I understand that not being able to wear him the same as my DD is not bad just different......but it still makes me sad. Although I have a lot of that going on recently(sadness, that is). I understand everything you are saying about over extending so let's talk positions. I'm trying to understand the position you recommended but it sounds a little uncomfy? I'll have to try it out tomorrow. Technically it wouldn't be tummy to tummy though, if I'm reading it correctly? More like my tummy to his knees and shins? So keeping his feet in, (even when he's big enough for them to dangle out) is better? Also, is it ok to have him in his current fav position for short periods of time during the day? Like how long? As you can see I'm a pretty detailed person myself so I really do appreciate your info! We are seeing an OT for the first time on Friday the 24th, I'm really looking forward to starting his therapy. Thank you for your support. Lorianne
 

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Discussion Starter · #8 ·
Thanks, I did check out that site and there seemed to be some conflicting information? Maybe I just wasn't clear on what I was reading though? I started using slings with my DD b/c I didn't want her 'hanging from the crotch'. This seems to be the position recommeded with a wrap (like moby style) as it does not over extend the hips - but then my DS would be hanging from the crotch so isn't that not good for the spine? I checked out the K'tan and I'm not sure what the difference is between that and my current wrap? I'm sure there is some difference but it looks the same from what I can tell from the site. I'm confused by the mama's that used a mei tei or ergo (which I have also and would love to use again if I can) but it seems to me that those are the carriers that overextend the hips the most - especially on the back as the legs have to go across a broader area. I'm not a PT or OT, just an experienced babywearing mama - although not experienced with Ds so that's why I'm here - asking all these questions and trying to just use some common sense, but I know sometimes it's not that simple. Just want to do the best for my boy......
 

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Here is an article on how swaddling affects tone. It's nothing we don't already know, really but it's interesting anyway.

And here is another that explains fairly well the difference between low tone and low strength.

I would recommend first of all, RELAXING! Your baby is still new. Enjoy him! Don't take on too much worry, for you don't need to do everything and know everything right now.
Now, having said that, I felt the same way you did so I am going to feed you everything I've got anyway.


Ask lots of questions of your OT and PT and any other T's when you get them. That's what they are there for, to teach you. Because basically, you are going to be primary therapist to your son. Videotape therapy sessions every so often if you want to so you can reference it and also so you can see progress because sometimes we don't remember exactly what they weren't doing a month ago, you know.

Get some of these. There is also a Fine Motor Skills for-- and an Early Communication Skills for children with Down syndrome that will be useful later. I got mine free from the resource center at Children's hospital.

I don't want to see you obsess over how to best wear your son, when there are so many other great things to obsess over! But seriously, there are better things to focus on right now like just enjoying your child! There are going to be times that make you sad, yes, but really any child will do that to you.
The Ktan was suggested I think because it combines the benefits of a sling but can go over both shoulders, making it more comfy to wear. Am I remembering right?
Approaching 30 pounds, Charlotte is heavy and cumbersome to wear in the sling, but I can't give it up because it just pops on and off -- I can literally get it on and her in it in the same time it takes most people to just get their kid in/out of the carseat. And now that she's bigger, it's definitely the best because it gives the resistance around the hips (we only do hip hold now) but also forces her to maintain some balance and use trunk control. That's very important at this stage.

Ahh, I remember, the Ktan can be too hot in the summer months depending on where you live. But if that's not an issue, then use it. If you are going to let legs dangle at all just sure make the part that goes under the crotch as narrow as possible, so as to not overly abduct the thighs. That goes for any jumpers or walker things you may want to use too -- when he's ready for that. For those, tie a ribbon around the crotch, cinching it up. But remember that you still won't want to leave them in this position for longer than about 15 minutes at a time.

It would be soooo helpful if I could directly post pictures here, I dont have time to upload to a webalbum right now.

Sorry if this is all convoluted... I have someone pulling on my pants legs begging to be included in whatever is so fun up on the table....
 
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