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Ever notice your healthcare provider bending your baby’s legs into a froggy position during regular visits? She’s checking for hip dysplasia or “developmental dysplasia of the hip” (DDH), a condition in which one or both of the hip joints are unusually loose. It may sound scary, but about one in six babies has some mild hip joint instability that resolves on its own a few weeks after birth. Two or three babies in 1,000 need treatment, such as wearing a harness or undergoing surgery.
When babies are born, their hip joints are a mixture of bone and soft cartilage, which gradually hardens 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. When the ball and socket don’t fit together properly, that’s hip dysplasia. It can happen around birth, shortly after birth and occasionally into childhood. Left untreated, it can lead to problems with walking or issues such as hip osteoarthritis later in life.
The exact causes of hip dysplasia are unknown, but it’s about 12 times more likely when a parent or sibling also had the condition, and it’s more common in girls. The bum-down position of a breech baby can also make the womb crowded and potentially move the hip joint out of place.
Regardless of risk factors, there are some best practices for maintaining a baby’s hip structure. Correct swaddling is one key consideration. Many parents wrap their babies too tight. “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 hip conditions. Similarly, if you’re using a swaddle-type “sleep sack,” make sure it doesn’t restrict the lower body.
Baby carriers are another issue. The International Hip Dysplasia Institute has a list of recommended carriers on its website. It says the best hold for a baby in a carrier is the M-position, in which baby’s thighs are spread around a parent’s torso and baby’s knees are bent so they are level with or slightly higher than the buttocks, with the thighs supported. Cross-body slings, in which baby’s legs are stretched out across a parent’s torso, or carriers where baby’s legs dangle unsupported, don’t hold the hips in the correct position.
If your healthcare provider notices some hip instability in the first four weeks of your baby’s life, she may opt to wait and see if the hip joint corrects on its own as the cartilage hardens some more. If the joint still isn’t right after four to six 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 eight to 16 weeks, to hold the hips in the right position. These harnesses are pretty common and have straps that go over the shoulders and across the chest, and then attach to booties on each foot. It might be hard to imagine your baby having to wear one, but it’s helpful to remember it’s temporary.
Treatment sometimes 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. Surgery may be needed to correct the way the hip sits or other related problems, and the doctor will usually prescribe a rigid brace or splint to be worn continuously for several months afterward. (It’s another difficult scenario to wrap your head around, but again, there’s an end in sight.)
If you’re wondering whether your little one could have undiagnosed hip dysplasia, watch for an extra roll of chub at the top of one thigh or just under the buttock on one leg; slightly different leg lengths; or difficulty learning to walk or limping.
If you hear a “click,” “snap” or “pop” when your doctor moves your baby’s hips, it’s not necessarily an indication of a problem but could potentially be a sign of hip dislocation. The best thing to do is to ensure children go to their scheduled checkups, says Lynette Wohlgemuth, a paediatric nurse practitioner at Reflections Nurse Specialist Services in Chestermere, Alta. “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 key advice for parents is not to worry too much. “Don’t lose heart if your child is diagnosed with hip dysplasia,” he says, pointing out that 95 percent of the time, it can be treated successfully, especially if diagnosed early.