Hip dysplasia in babies: signs, symptoms and treatment
Why does hip dysplasia happen in young babies, are 'clicky hips' a symptom, and what's the treatment?
In a nutshell: Developmental dysplasia of the hip (DDH), also known as congenital hip dysplasia (CHD), which is commonly called just 'hip dysplasia', is detected either at the 6 to 8-week baby check or, in certain situations, at an ultrasound scan.
The hip is what is known as a 'ball and socket' joint, but in DDH it doesn't form correctly. The 'ball' at the top of the thigh bone, the femur, normally fits in the 'socket' of the hip.
In DDH the socket is too shallow, so the ball doesn't fit into place firmly. If the ball of the femur slips out of the joint, it causes the hip to dislocate.
About 1 baby in 1,000 need treatment for DDH. It can affect one or both hips, and is more common on the left than the right. It is more common in girls than boys, in babies born from the breech position and in first-born children.
Treatment is required because if it DDH isn't treated it can lead to long-term complications such as a limp, hip pain and joint problems such as osteoarthritis.
When and how is hip dysplasia diagnosed?
According to the NHS, your baby's hips will be checked within 72 hours of birth as part of their newborn examination. Your baby's hips will be 'moved around' to see how they work.
If the doctor or midwife thinks your baby's hips are unstable, they will be offered an ultrasound scan before they're 2 weeks old.
You will also be offered an ultrasound before your baby is 6 weeks old to detect hip dysplasia if:
- DDH runs in your family
- Your babies are part of a multiple pregnancy
- Your baby was breech for the last month of pregnancy
- Your baby was born born in a breech position
Diagnosing hip dysplasia later if it's been missed
If DDH isn't picked up early on, or if hip problems develop later, you may notice that one leg drags behind when crawling, one leg seems longer than the other or there's a limp.
Treatment after a child is 1 year is more complicated: they may need numerous operations, and the hip may not be completely corrected. This is why early detection wherever possible is vital.
Hip dysplasia in babies: what are the symptoms?
According to the International Hip Dysplasia Institute, the key symptoms of DDH are:
Clicky hip: Your baby having 'clicky hips' doesn't necessarily mean they'll have hip dysplasia but it could be a sign that they do. Some babies with regular hips will have 'clicky hips', so hip dysplasia can only be confirmed with an ultrasound or x-ray.
Asymmetry: If your baby's buttocks have more creases on one side than the other this could suggest hip dysplasia: but alone it isn't a sign of hip dysplasia and, again, your baby would need an ultrasound scan or x-ray to confirm the diagnosis.
This baby’s gluteal creases are even (the green lines). But this baby’s thigh creases are uneven (the yellow lines). The left thigh is smooth but the right thigh presents with two creases.
Limited movement: You might notice that it's not easy for your baby to open their hips when you're putting their nappy on – this could also be a symptom of hip dysplasia.
What happens if hip dysplasia goes untreated?
If it's not treated early, then symptoms of hip dysplasia in older children and adolescents could include:
'Swayback': Once a child has started to walk, the most common symptom of hip dysplasia is a painful limp or discrepancy in leg lengths.
Pain: While hip dysplasia does't usually cause pain in babies and younger children, it's one of the most common symptoms in teenagers.
How do you hold a baby with hip dysplasia?
The key thing when you're holding a baby with hip dysplasia is to try to keep their hips apart, avoid holding them in a position where you push their hips together and support your baby under the small of their back when you lift them up.
How do you swaddle a baby with hip dysplasia?
You can't prevent DDH but it is important to swaddle or wrap your baby healthily, which allows them to bend their hips up and not be held fully extended.
If your baby is diagnosed with hip dysplasia, then you should be very careful how you swaddle them – if you do so at all.
The same is true about a sling: they need to be able to bring their hips up and not have their legs and knees extended and held in a straight position
A 2013 orthopaedic perspective carried out by Professor NMP Clarke at Southampton University cites evidence from around the world that suggests there could be a link between hip dysplasia and swaddling 1. For example:
- In Japan, a programme aimed at grandmothers, to stop them swaddling their grandchildren, reduced hip dislocation from 1.1–3.5% to 0.2% 2
- In Australia, hip dysplasia cases have tripled: there has been no change to how it is screened and some experts have suggested the increase is due to a resurgence in swaddling 3
The International Hip Dypsplasia Institute gives the following advice to make sure you swaddle your baby safely:
- If you're using a square cloth, fold back one corner creating a straight edge.
- Place the baby on the cloth so that the top of the fabric is at shoulder level. If you’re using a rectangular cloth, make sure the baby’s shoulders are placed at the top of the long side.
- Bring your baby’s left arm down and wrap the cloth over their arm and chest. Tuck under the right side of the baby.
- Bring your baby's right arm down and wrap the cloth over the baby’s arm and chest.
- Tuck the cloth under the left side of the baby.
The weight of the baby will hold the cloth firmly in place.
- Finally, twist or fold the bottom end of the cloth and tuck behind the baby, ensuring that both legs are bent up and out.
What is the treatment for hip dysplasia – and what is a Pavlik harness?
If your baby is diagnosed with hip dysplasia, treatment will usually take the form of a Pavlik harness. It is a sort of splint or harness, made of fabric, that holds your baby's hips in the correct position.
The harness may be adjusted over a period of time, but should be worn constantly, including at night. You will be taught how to change a nappy with the harness on, and how to clean the harness if it becomes dirty without removing it.
You shouldn't remove the harness until your paediatrician or orthopaedic surgeon advises you to do so. Generally, it is removed for short periods at a time initially.
When the harness is off, encourage your baby to kick about by themselves – when they're being given a bath, for example. Don't worry about them moving their legs, let them move as much as they want, but don't push or pull your baby's legs.
What if the Pavlik harness doesn't correct my baby's hip dysplasia?
Pavlik harness is successful in 75% to 85% of cases, according to the International Hip Dysplasia Institute.
If the harness doesn't help, or if your baby's DDH isn't diagnosed until after 6 months of age (at which point the harness won't work), then you may be advised that surgery is the best option. Your baby may then need to wear a cast for about 6 weeks.
Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy's, King's and St Thomas's medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.
Pics: Thanks to the International Hip Dysplasia Institute for graphics
References
1. Swaddling and hip dysplasia: an orthopaedic perspective, Professor NMP Clarke, MP 817, University Hospital Southampton. DOI: 10.1136/archdischild-2013-304143
2. Recent advances in the prevention, early diagnosis, and treatment of congenital dislocation of the hip in Japan, Clin Orthop Relat Res. 1984 Apr; Yamamuro T et al. DOI:10.1097/00003086-198404000-00005
3. Is swaddling damaging our babies' hips? ,N Williams et al. Med J Aust. 2012 Sep 3. DOI: 10.5694/mja12.10652
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Authors
Dr Philippa Kaye is a GP, media doctor and author with a particular interest in women's, children's and sexual health. She has written multiple books including The Science of Menopause, Breasts: An Owner's Guide and Doctors Get Cancer Too, her memoir of being 39 years old, a busy doctor and mother when she was diagnosed with bowel cancer.