Hip Dysplasia and Cloth Diapers: Expert Answers from Dr. Pablo Castañe

Hip Dysplasia and Cloth Diapers: Expert Answers from Dr. Pablo Castañeda, MD

Topics Discussed in this Article

Cloth Diapers Health

April 24, 2026|Krystal Keller

If you’re exploring cloth diapering your new baby, you’ve probably heard a mix of excitement and a few raised eyebrows from loved ones. Maybe someone mentioned that cloth diapers are “too bulky,” or expressed concern that cloth diapers could delay milestones or even cause hip issues. It’s enough to make any new parent second-guess their choice to use cloth diapers.

The truth is, all of your concerns are valid—and you deserve clear, evidence-based answers. In this article, we’re walking through the facts about cloth diapering and hip health, with insight from a trusted medical expert, Dr. Pablo Castañeda, MD, Medical Director of the International Hip Dysplasia Institute, so you can feel confident you’re making the best decision for your baby.

When it comes to your baby’s development, hip health might not be the first thing on your mind—but it plays a big role in long-term mobility and comfort. We interviewed Dr. Castañeda, to break down what hip dysplasia is, how it’s treated, and how everyday choices (like diapering) fit into the picture.

Answering Common Questions About Hip Health:

Q: What is hip dysplasia?

A: Hip dysplasia refers to abnormal development of the hip joint, typically, the ball (femoral head) is not well seated within the socket (acetabulum). In infants, the joint is still forming, and positioning plays a role in how the socket develops around the femoral head.

Because a baby’s hips are still developing after birth, positioning matters more than many parents realize. In babies, this joint is still soft and developing after birth. That means the way your baby’s hips are positioned day-to-day actually helps shape how the socket forms around the ball. When the hips are able to rest in a natural, bent and spread position, the joint is better supported as it grows. When they’re forced into a straight or restricted position, it can make proper development more difficult.

Learn more about Hip Dysplasia »

Q: How common is hip dysplasia and who is at risk??

A: This depends on how you define it and how you look for it but in a general sense it happens in roughly 1 in 100 infants, though the milder forms are common, the most severe type (dislocation) is about 1 in 1000. Importantly, factors include breech positioning, family history, being female, and tight swaddling.

Q: Are there signs to look for?

A: Often, there are no obvious signs. Subtle findings can include asymmetry in leg position, limited hip motion, or uneven skin folds, but most cases are only detected on screening.

Hip dysplasia can be difficult to spot at home because many babies don’t show obvious signs. Still, there are a few subtle things parents can watch for. You might notice your baby’s legs don’t move the same way on both sides, one hip seems less flexible during diaper changes, or the skin folds on their thighs or bottom look uneven. These signs can be easy to miss—and in many cases, there are no visible clues at all—which is why routine checkups and screenings with your pediatrician are so important for catching any concerns early.

Q: How is hip dysplasia diagnosed?

A: Through physical examination in infancy and, when indicated, ultrasound in younger infants or X-rays later.

Hip dysplasia is usually first checked during routine exams in infancy, where your pediatrician gently moves your baby’s hips to feel for stability and proper motion. If there’s any concern, imaging may be recommended to get a closer look. In younger babies, this is typically done with an ultrasound, which is safe and painless. As babies get older and their bones develop further, X-rays may be used instead. These tools help providers clearly see how the hip joint is forming and decide if any treatment is needed.

Q: What happens if it’s untreated and can it correct itself?

A: Untreated hip dysplasia can lead to abnormal hip development, pain, limp, and early arthritis. Mild forms may improve, but unstable or dislocated hips generally require treatment.

The good news is that early intervention for hip dysplasia is highly effective and can help support healthy, long-term joint development.

Q: Do parenting choices cause hip dysplasia?

A: Positioning matters. Practices that force the hips into extension and adduction (legs straight and together) like tight swaddling can increase risk. Everyday care that allows free, natural positioning is protective.

Hip-Healthy Positioning: Quick Do’s & Don’ts

Do:

Let your baby’s hips rest in a natural, bent and spread (“frog-like”) position
Choose swaddles and carriers that allow leg movement
Give baby plenty of time to kick and move freely

Don’t:

Force your baby’s legs straight and tightly together
Use tight swaddling around the hips and legs
Choose products that restrict natural hip positioning

Small adjustments in everyday care can go a long way in supporting healthy hip development.

Learn more about the causes of Hip Dysplasia »

Q: What does treatment look like?

A: Most commonly a dynamic brace in early infancy (like a Pavlik harness). In more severe or later cases, bracing, casting, or surgery may be required.

In many cases, babies are fitted with a soft, flexible brace called a Pavlik harness. This harness gently holds your baby’s hips in a healthy position—knees bent and legs spread—so the joint can develop properly over time. You may have seen one before; it looks like a set of soft straps that go around the baby’s shoulders and legs, allowing movement while still keeping the hips supported. In more severe cases, or when dysplasia is diagnosed later, treatment may involve more structured bracing, a cast, or in some cases, surgery to help correct the position of the hip.

Cloth Diapering and Hip Health: What Parents Need to Know

There’s a lot of conflicting information out there about diapers and hip development, which can leave parents feeling unsure about what’s best. To help provide clarity, we asked Dr. Castañeda some common questions specifically about cloth diapering, based on the real concerns we hear from parents like you.

Q: Do cloth diapers increase the risk of hip dysplasia?

A: No: there is no evidence that cloth diapers increase the risk of hip dysplasia.

Q: Is diaper bulk harmful?

A: No. Additional bulk is not harmful. The key issue is not bulk, but whether the hips are allowed to rest in a natural, flexed, and abducted position.

What matters most for healthy hip development isn’t the type of diaper you use, but how your baby’s hips are positioned. As long as your baby’s legs can move freely and rest in a natural, bent and slightly spread position, cloth diapers are a safe and supportive option.

Q: Could diaper bulk be beneficial for hip development?

A: Yes, a slightly wider position is consistent with healthy hip development. Neither [cloth diapers or disposable diapers are] inherently better or worse. What matters is that the baby’s hips are not restricted and can move freely.

A slightly wider leg position supports how a baby’s hips are designed to develop. When a baby’s legs are gently spread apart and bent, it helps keep the hip joint in an ideal position for healthy growth. This natural “frog-like” posture allows the ball of the hip to sit securely in the socket.

This is also why cloth diapers can be a great fit for growing babies. The natural bulk of a cloth diaper can help encourage that wider, more supported position while still allowing plenty of freedom for movement. As long as your baby can kick, wiggle, and move comfortably, that extra bulk is working with their development, not against it.

Q: Can you use cloth diapers with a harness?

A: Yes, most cloth diaper styles can be used with a harness, but families should ensure the diaper does not interfere with the brace positioning. Comfort and fit are key. Families should follow their treating physician’s guidance, especially when a brace is in use.