Categories: Paediatrics

HIP DYSPLASIA – How can parents help to protect their Child’s Hips

A diagnosis of hip dysplasia is a harrowing time for parents, hip dysplasia occurs when the ball and socket are not in the correct alignment. “This may range from loose ligaments and a slightly loose hip joint all the way to a completely dislocated hip. Babies may be born with hip dysplasia, but some cases develop and worsen after birth, approximately 10 per cent of hip dysplasia cases are the loose or dislocated type that occurs in babies, and the other 90 per cent are shallow sockets without looseness that are found later in life.”

Breech babies, Family’s history, it’s important for parents to be aware of any hip issues that they or their older relatives might have. If an older family member has arthritis in the hips or has had a hip replacement, there is a possibility that they have an underlying hip dysplasia issue that wasn’t discovered as a child, and first-born girls (oddly enough) are more at risk of hip dysplasia than other kids.

A harness or brace is the typical treatment for dysplasia, which will hold the hips in the joint until they grow and develop for a few months. This changes the way you would handle your baby and can be a difficult experience for parents. The good news is that five out of six dysplasia cases are fixed by the brace. However, if it doesn’t do the trick, a cast may be required. For hip dysplasia that continues into the walking age, surgery may be needed to repair the ligaments and socket. Even after treatment care need to be taken to help guide the hips development.

Signs of hip dysplasia can be hard to detect in some infants and can be missed if not checked properly at birth. Mild dysplasia is difficult to detect by examination in children less than 3 months. Completely dislocated hips are also difficult to detect before three months of age. Pain is almost never present until adolescence. Dislocated hips don’t spread apart like normal hips so the parent may notice difficulty with putting on a diaper. Sometimes the hip can clunk in and out of the socket when the thighs are spread to apply a diaper.

One thigh may be shorter than the other if one hip is dislocated and the other is not. Buttocks creases may be uneven when one hip is dislocated. Hip dislocation doesn’t delay walking, but a toddler with dislocated hips will sway side-to-side more than toddlers that don’t have a dislocated hip.

Parents who know their child has the risk factors or think their child has an unusual limp should get their child thoroughly examined by a Pediatric orthopaedic specialist. We urge all caretakers to get their infant’s hips examined at birth and at every well-baby check till walking age. Ultrasound screening should be done at 4-6 weeks for at-risk babies or an x-ray taken at 4-6 months to detect hip dysplasia early.

We get asked regularly by parents what they can do to help their infant!!!

We advocate safe hip techniques throughout the daytime and nighttime. That’s done by allowing the hips and legs to move freely and not constraining them with anything. When the legs are held in a particular position, such as by keeping them straight or close together, the ball of the hip and the socket will not have good contact and over time, this position can prevent the hip from developing normally. This is generally done with unsafe methods of swaddling practised in our country.

Choose infant products wisely. Here are some infant items or practices that can contribute to developmental hip dysplasia, and what you can do to avoid it or modify:

Swaddling can contribute to hip dysplasia because traditional swaddling keeps the legs close together and straight. If you choose to swaddle but would like to prevent hip dysplasia, keep the blanket loose around the legs so that the knees are able to be spread apart and the hips can move freely.

(Figure to show the right way to swaddle)

Baby carriers. There are many different types of baby carriers, and some are safe for the hips and others are not. Be careful when wearing your baby in a carrier. Your baby’s hips should be in a spread squat position. This means their hips are open and their knees are bent at the same height as or higher than their bottom. Their legs should be able to wrap around your torso.

Baby slings. Similarly, some slings keep baby’s legs together and potentially even scrunched, similar to an in-utero position, which does not allow for the hips and knees to be open and move freely.  Always opt for a baby sling that is wrapped in a way that allows for baby’s legs to hang down, opened out, and thighs supported.

Sleep gowns. Like swaddling, some baby sleep gowns are too tight around the legs, keeping them straight and not allowing the hips room to move freely. Choose one that is loose enough for your baby’s knees to spread outward and the hips to move freely.

Noteworthy: Limit time in baby seats that hold their legs in a fixed, closed position.

Talk to your doctor or a specialist if you have any concerns regarding your child’s hips.

Dr. Avi Shah | Consultant Paediatric OrthopaedicsNH SRCC Children’s Hospital, Mumbai

Narayana Health

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