Midwife and Clinical Negligence Lawyer Nikki Khan explains how your baby is checked for Hip Dysplasia, what to do if you think it has been missed, and how to prevent it developing later on.
What is Hip Dysplasia?
Hip Dysplasia (also known as Developmental Dysplasia of the Hip or DDH) is when the femoral head (ball) is outside of the Acetabulum (hip socket), rather than behaving like a normal ball-in-socket joint.
The condition can affect babies from birth or can develop in childhood.
How do babies get DDH?*
- Research from the International Hip Dysplasia Institute shows that DDH is slightly more prevalent among girls.
- Babies born breech are more likely to suffer DDH.
- Babies may have a genetic predisposition to the condition.
- An incorrect seating and/or sleeping position can lead to DDH in childhood in those children pre-disposed to the condition.
- More prevalent in mums who have had a reduced amniotic fluid volume in utero.
- Babies born weighing >5kg are deemed to be at risk.
How common is DDH?
Hip Dysplasia affects 2-3 in every 1000 (approximately 2171 infants in the UK) of all infants, according to the International Hip Dysplasia Institute.
What are the signs?
- A doctor may notice a ‘clunk’ or ‘clicky’ hip in a standard newborn check up.
- You may notice resistance when changing his nappy.
- The skin folds between the legs and the body may not be equal on both sides.
- You may notice he’s slightly dragging his leg while crawling.
- One leg might be shorter than the other.
What are the effects of DDH?
Nikki says, “Although our aim is not to worry parents, if not caught and treated correctly, there is a very real possibility of a limp, constant and/or debilitating pain, complicated treatment and impaired mobility later in life.”
Is there a definitive test?
During a regular newborn check up, a doctor will carry out a Barlow’s Test, where he will bend the baby’s knees and turn the thighs outwards, a bit like opening a book. If the doctor notices a ‘clunk’ or ‘clicky’ hip he will refer you to an orthopedic surgeon.
An orthopedic surgeon will carry out an ultrasound scan, which will definitively determine whether Hip Dysplasia is apparent. If your family has a history of the problem, you will usually be offered an ultrasound scan at 6 weeks.
If you haven’t been referred, but are concerned, talk to your GP.
What are the treatment options?
The earlier DDH is identified, the simpler and more effective the treatment is. If DDH is identified, an Orthopedic Specialist will usually start treatment before your baby is 3 months of age.
A ‘clicky’ hip can be normal at a young age and disappear by the 6 week check. However, if it doesn’t, or the condition is diagnosed later on, the common non-surgical medical intervention for DDH in young infants is to use an orthopedic device (such as the Pavlik’s harness), which keeps legs in the spread squat position.
A Pavlik’s harness will keep your baby’s legs spread apart with his knees pulled up, a little higher than the hip joint. This is known to promote the healthy development of the hip joint. In some instances, this will need to be left on for 6 weeks.
If undiagnosed, Hip Dysplasia can result in intrusive surgery similar to that of a hip replacement.
How can Hip Dysplasia be prevented?
You can reduce the risk of DDH, which is unrelated to genetics or birth, through a baby’s sitting position.
- When your baby is sitting, aim for the ‘M’ or ‘frog’ position, to mimic the foetal position in the womb.
- Choose a wide car seat so that his legs aren’t forced together.
- Don’t over-swaddle, so that a baby’s legs are tightly closed.
- Opt for a baby carrier that keeps his legs in-line or above his hips, rather than hanging loose. This ensures that the forces on the hip joint are minimal because the legs are fully supported and the hip is in a more natural, stable position.
*This list is not exhaustive. Please consult your GP or midwife if you are concerned.
Nikki has been working with Ergobaby on a campaign called “Is Your Baby Sitting Comfortably?”, which was launched to help inform parents about Hip Dysplasia, and empower mums and dads to look out for key symptoms and reduce any potential contributing factors. Find about more about the campaign here.