What is hip dysplasia?

Detecting infant hip dysplasia early is important to ensure treatment promotes proper growth in your baby. Debbie Clemens looks at the different options available.

Welcoming a newborn into your life can be challenging enough without the stress and worry associated with health problems. For parents who discover their baby has infant hip dysplasia it can be a relief to find out the condition may be successfully treated with careful diagnosis, the right medical advice and appropriate management.

What is infant hip dysplasia?

The medical term used for hip dysplasia is Developmental Dysplasia of the Hip (DDH), which describes abnormal hip development at any time during foetal development, infancy, childhood or later life. Dysplasia means the hip is developing abnormally and the femur (thigh bone) is not held tightly in place within the hip socket as it should be. You may hear your baby's paediatrician or orthopaedic specialist using terms such as " complete dislocation", "partial dislocation" (subluxation) and "instability" - all of which refer to the severity of your baby's hip condition.

The symptoms of DDH are more noticeable in older children due to a waddling gait but are difficult to detect in younger infants. However, the signs are easily picked up by a good medical specialist.

A doctor, midwife or community child health nurse should check your baby's hips soon after birth, on discharge from hospital (or about a week after birth), at around six weeks and at around three months.

The cause of DDH is unknown, but certain factors such as gender, birth order, intra-uterine position, delivery type, joint laxity and postnatal positioning are believed to affect the risk of babies developing DDH. Breech babies and twins are said to be at a higher risk of hip dysplasia. Genes and family history are also thought to play a part in this condition. DDH is much more prevalent in female infants than in males. Approximately one in every 600 girls is affected, compared to just one in 3,000 boys.

Cultural differences

The highest incidence of infant hip dislocation is said to be in cultures such as the Navajo Indians, where it is a common practice to tightly swaddle infants or strap them to cradle boards day and night. In cultures within Africa and the far east, where mothers carry their babies on their backs or hips in a widely-abducted straddle position, the disorder is relatively unknown.

Treating your baby

If hip dysplasia is suspected, your baby's paediatrician will perform a physical examination and then refer you to an ultrasound clinic at around four to six weeks. An ultrasound may confirm a diagnosis of DDH, however not all babies are treated.

If your baby's hip dysplasia is relatively mild, the condition could resolve itself with growth, although frequent monitoring will be required. However, for those babies whose condition requires treatment, a hip brace (splinting) is used to hold their hips in a position intended to promote proper growth and development of the hips. The hip brace keeps the baby's legs apart and turns them outwards, in a "frog-legged" position. The brace maintains the proper position of the femoral head of the hip, allows for "tightening up" of the ligamentous structures and stimulates normal formation of the acetabulum (hip socket).

A number of devices are available for treating your baby to assist this stable positioning. The Dennis Browne Bar and Pavlik Harness are both widely used in Australia and move the hip into a more abducted and reduced position.

In the event that your baby needs to be fitted with a hip brace, it may be recommended that they wear this device for 23 to 24 hours a day for a significant number of weeks or months. If your baby's hip remains dislocated following a period in the hip brace or if hip dislocation is detected when they are older, that is at six to 18 months , surgery and/or the use of the hip spica (plaster cast) may be necessary.

Helping your baby adjust

At first, you will find that the hip brace (or hip spica if this is required), poses a few challenges for yourself and your baby because of the resulting restricted movement. The simplest activities, such as breastfeeding, nappy changing, swaddling and car travel, can be quite a hassle. But be reassured: you will get the hang of them and you'll be surprised at how rapidly your baby can adapt.

When my daughter, Mila, was first fitted with her hip brace, I couldn't believe how quickly she adjusted. I thought she would be unsettled and grumpy, especially at night, but in less than two days she was dealing with it without a fuss. I think it takes the parents much longer to cope with the changes that the hip brace brings.

In order to help your baby adjust to their hip brace, try and make sure they are as comfortable as possible, without making huge changes to their daily routine. Ask your baby's specialist to demonstrate the best way to position them for sleep and how to take the brace on and off.

One mum whose daughter wore the Dennis Browne Bar, a common type of hip brace, says, 'The splint was OK except that it pinched her thighs and needed regular adjustment. She learned to sit in it with some pillows to prop her up and she could also go in the bath, but it was a tight squeeze. It was easier to take her into the shower with us.'

It is important to ensure that there is ample padding between the cuffs of the brace and your baby's skin to avoid any rubbing or friction. Your baby's specialist will regularly monitor the size of the brace needed and show you exactly how the brace should be fitted.

Your baby will be most comfortable in stretchy, baggy clothes such as growsuits, wide-legged baby pants and/or leg warmers. Clothing worn over the brace should not force your baby's legs together.

If you have been swaddling your baby at night, you may need to stop this practice as you will find the brace prevents you from doing this. If your baby flails their arms during sleep, it is still possible to swaddle their top half. Alternatively, you may also find a wide-bottomed sleep sack works well to keep your baby warm.

Most importantly, try and imagine how you might feel with this restricted movement and think carefully about what could make your baby more comfortable. For example, if you need to take a long car journey, stop regularly and give your baby a break from sitting in the car seat. If you're permitted to give your baby an hour off from "brace time", make sure you do so. This could be with a bath, playtime or even a relaxing massage. If you have any concerns or queries, don't hesitate to ask your baby's specialist or maternal health nurse.

Support for parents

The various treatments available for hip dysplasia may seem confronting for parents and seeing what your baby or child will have

to put up with 24 hours a day can be upsetting. On top of that, the support and information available is still severely lacking, as another parent says, ' My husband and I had to get through four months of our firstborn baby girl wearing a Pavlik Harness and a Dennis Browne Bar. We found information was limited and felt quite alone during those months. Strangely enough, there appears to be more websites for hip dysplasia in dogs than in babies!'

The good news is that online support groups and forums are growing so parents don't have to feel alone and can share their experiences among one another.

Regular check-ups

DDH can develop over time in any child so it is vital that you get your baby's hips checked regularly during the first year of their life. This is most likely to be done each time you visit your baby's maternal health nurse. Early detection and treatment of DDH is important, because if the condition is discovered later in your baby's life, it may result in painful and complex surgery. If your baby's DDH is left untreated, it could lead to severe hip pain when they are older and may even encourage the early onset of osteoarthritis. Fortunately, with today's ever increasing awareness of this condition and medical and technological advances, this can be prevented altogether. .

For more information and suitable clothing for babies with a hip brace, such as leg warmers and baggy cotton pants, visit hipbabes.com.au.

RESOURCES

USEFUL CONTACTS

facebook.com Various groups such as Congenital Hip Dysplasia and Hip Babies.

hipbabes.com.au Online tips and clothing store for hip brace babies.

rch.org.au The Royal Children's Hospital kids health fact sheets for the Dennis Browne Bar and Pavlik Harness.

This article is brought to you by My Child Magazine.

My Child is a fantastic parenting, health and lifestyle magazine that helps mums and dads know what to expect during pregnancy and birth, babyhood and the toddler and preschool years. There are great articles, heart-warming stories, personal tales of parents' experiences, and gorgeous fashion, interiors, style and product pages. This is Australia's first truly stylish and informative parenting magazine. Available quarterly. You can also visit our friendly forum or subscribe at www.mychildmagazine.com.au.

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