Is your baby at risk for hip dysplasia?

Mild hip joint instability may resolve on its own, while other babies may need treatment. Here’s what you need to know about hip dysplasia.

Photo: iStockphoto

When your healthcare provider bends your baby’s legs into a froggy position during every well-baby appointment, she’s checking for hip dysplasia, a condition where one or both of the hip joints are unusually loose. About one in six babies have some mild hip joint instability that resolves on its own a few weeks after birth, but about two to three babies per 1,000 need treatment, such as a harness or brace to position the hips correctly, and some even need surgery. Here’s what you need to know about hip dysplasia in infants and toddlers.

What is hip dysplasia?
Hip dysplasia is also known as developmental dysplasia of the hip (DDH). When babies are born, their hip joints are a mixture of bone and soft cartilage, gradually hardening to bone over the first few months. When you picture the hip joint, think of the “ball” of the end of the thigh bone, or femur, fitting into the “socket,” or depression in the pelvis. Hip dysplasia refers to a situation where the ball and socket don’t fit together properly. It can happen around birth, after birth and occasionally into childhood. If hip dysplasia isn’t treated, it can lead to problems with walking and can contribute to issues such as hip osteoarthritis later in life.

Causes of hip dysplasia
Doctors and researchers don’t know exactly what causes hip dysplasia, but they have identified some risk factors. Hip dysplasia is about 12 times more likely when a baby’s parent or sibling also has the condition, and it’s more common in girls. The bum-down position of a breech baby often makes the womb crowded and potentially moves the hip joint out of position.

sleeping baby in a swaddleThe truth about swaddlingBest practices for hip health
Tight swaddling of your baby’s whole body, so she’s wrapped like a cigar with the legs and hips held straight, is a no-no. “Hip-healthy swaddling means you swaddle the upper part of the body but leave the blanket over the hips loose,” says Kishore Mulpuri, a Vancouver paediatric orthopaedic surgeon who specializes in paediatric hip conditions, including dysplasia.

According to the International Hip Dysplasia Institute, the best position for a baby in a carrier is the M-position or jockey position, where baby’s thighs are spread around a parent’s torso and baby’s knees are bent so they are slightly higher than the buttocks, or at the level of the buttocks with the thighs supported. Cross-body slings, where baby’s legs are stretched out across a parent’s torso, or carriers where baby’s legs dangle unsupported, don’t position the hips correctly. Car seats and strollers should allow baby to sit with his thighs apart, not pressed together.

Hip dysplasia treatment
Typically, if a healthcare provider finds some evidence of hip instability in the first four weeks, she may adopt a wait-and-see approach to see if the hip joint corrects on its own as the cartilage hardens some more. If the joint still isn’t right at four weeks (or if it’s obviously dislocated at any point) you’ll be referred to an orthopaedic surgeon for an assessment and ultrasound or X-ray.

If the hip joint of a baby younger than six months needs to be corrected, your doctor will likely prescribe a soft fabric Pavlik harness, which your baby wears 24 hours a day for a set period, often for eight to 16 weeks, to hold the hips in the right position. These harnesses are pretty common in Canada and consist of straps that go over the shoulders, across the chest and then attach to booties on each foot.

Hip dysplasia surgery
Occasionally treatment doesn’t work, or the joint instability isn’t discovered during regular well-baby checkups. For children older than six months, hip dysplasia is harder to treat. Sometimes surgery is needed to correct the way the hip sits, or other related problems, and the doctor prescribes a rigid brace or splint to be worn continuously for several months after.

Jenny Ostrom’s* baby daughter had hip dysplasia that caused a dislocated hip. Surgery was needed surgery to put her hip (the femoral head) back in the socket (acetabulum), but it doesn’t correct the hip dysplasia itself.  “When Quinn* was 15 months old, I was concerned that she wasn’t walking yet, and I thought her left leg looked slightly shorter than her right,” says the Thunder Bay, Ont., mom. After the surgery on her left hip muscles, Quinn wore a spica cast, a type of body cast that pretty much covers most of your lower body, with an opening over the diaper area, for three months. Quinn started walking several months after the cast came off. Now two-and-a-half, she still has some catching up to do with motor skills, but she is running, jumping and playing.

If you’re wondering if your little one could have undiagnosed hip dysplasia, watch for an extra roll of chub at the top of the thigh or just under the buttock on one leg; slightly different leg lengths; difficulty learning to walk or limping. But the best thing to do is to ensure children go to their scheduled doctor checks, says Lynette Wohlgemuth, a paediatric nurse practitioner at Reflections Nurse Specialist Services in Chestermere, Alberta. “Because babies don’t show us ‘symptoms’ of hip dysplasia, a hands-on clinical check by their healthcare provider is the most accurate and dependable way a parent can ensure this isn’t missed.”

Mulpuri’s biggest advice for parents: “Don’t lose heart if your child is diagnosed with hip dysplasia. If it’s treated early, 95 percent of the time it will have a really good outcome. Kids diagnosed at age two or three require more complex surgeries but can have a pretty decent outcome too,” he says.

*Names have been changed

Read more:
5 tips for safe babywearing
What you need to know about baby’s first milestones 

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