Baby Hip Health

The Parents’ Guide

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Steps Baby Hip Health - A guide to hip development – The Parents’ Guide2

If you are worried about the results ofyour baby’s examination, being ableto contact someone who knows whatyou are going through can be a greathelp. Our family contact service canput you in touch with others whohave shared a similar experience.

Our online chat forum is anotherfantastic resource of helpful tips andpractical advice written by parentswho are coping with a child with a hip problem. You can share your problems and solutions to everyday challenges.

No matter how big or small yourconcern our helpline team areavailable to offer an expert ear andsupport in complete confidence.Telephone 01925 750271 or emailinfo@steps-charity.org.uk

Most children can be treated simplyand successfully and go on to leadhealthy active lives with no long termproblems. Some babies do haverather more complicated problemsand treatment may be more difficult.

Support when you need it

This booklet is for all parents. It explains why a baby’s hips are checked at birth, what the tests are and what happens if a problem is found. It also tells you how to keep your child’s hips healthy.

Introduction

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The hip joint is called a ball andsocket joint. The top of the thighbone is ball- shaped and fits into asocket on the side of the pelvis. Thisallows the leg to move both up anddown and side to side.

For the hip joint to grow normallythe ball shaped head of the thigh

bone needs to be inside the cupshaped socket. It is held in placeby ligaments, muscles and a jointcapsule. Very young babies’ hips aremade of soft cartilage which changesinto bone over the first few years. Forthe joint to grow properly the ball and socket have to be held firmly in the right place.

How does a baby’s hip grow?

All babies’ hips are checked at birthand at 6-8 weeks as part of a nationalscreening programme called theNewborn Infant Physical Examination(NIPE). This is because some babiesmay have hips that are not properlyin joint or not shaped perfectly, acondition called DevelopmentalDysplasia of the Hip (DDH). Somebabies seem to be more at risk ofdeveloping DDH than others.

Studies have shown that developmental dysplasia of the hip (DDH) requiring some form of medical intervention affects 1-3% of newborns. However, a long term UK study stated that as many as 6% of babies are born with some form of hip instability. At a current UK annual birth rate of around 700,000, this could equate to more than 40,000 babies.

Why are babies’ hips checked at birth?

Introduction

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In DDH the ball and socket do notfit snugly together: there are varyingdegrees of severity.

If the ball (femoral head) is notheld safely in place, the socket(acetabulum) may be more shallowthan usual; this is called acetabulardysplasia. Sometimes this makes thejoint less stable and the ball may slidein and out of the socket, this is calleda dislocatable or subluxatable hip. Ifthe ball loses contact with the socketand stays outside the joint it is calleda dislocated hip.

These are all forms of DDH. One orboth hips may be affected. About 1or 2 in every 1,000 babies has a hipproblem that requires treatment.Many more babies will haveimmature hips that will get better bythemselves.

What is DDH?

Disclocation Hip

Subluxation Hip

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During the examination, thehealthcare professional will note howyour baby holds his or her legs at rest. They will check to see if the legs are the same length, lie in a similar position and whether the natural thigh creases at the groin aresymmetrical.

The baby’s hips are gentlymanipulated to see if they are safelyin joint by tests known as the Ortolaniand Barlow tests.

The baby is laid on his or her backand the hips are moved gentlyoutwards. A distinctive ‘clunk’ (which is felt but not heard) suggests apossible abnormality and the jointmay be classed as unstable. Itmay be caused by the head of thethigh bone moving in and out of

the socket. ‘Clicky’ sounds are notusually important: a ‘clicky hip’ can be entirely normal.

When the test shows a potentialproblem it is called a positive test,while a test that reveals no problemis called a negative test. The healthprofessional ask questions to find outif there are special risk factors that are associated with DDH.

How are the hips checked?

DDH can happen to any baby butsome factors make the conditionmore likely. The two most importantrisk factors are:

• A baby born by breech or who was in the breech position in the last three months of pregnancy.

• A close family history of DDH or hip problems that came on in early

childhood. DDH is more common in first pregnancies and in baby girls and is more common in babies who have mild foot abnormalities or tightness in the neck. Usually, however, there is no identified risk factor and it is not known why a baby has the condition.

What are these risk factors?

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The manipulation is very gentle and shouldnot cause discomfort, but most babies objectto being examined, however gently. It canhelp to calm your baby by giving a breast orbottle feed before the examination.

Do these tests cause mybaby any discomfort?

Your baby’s hips will have anultrasound examination within 6weeks:

• If there is a history of early childhood hip problems in your family or

• If your baby was in the breech position:

• At or after 36 weeks of pregnancy even if the baby turned round and was then delivered head first.

• Born before 36 weeks in a breech position.

• In a multiple birth, if any of the babies is in either of the groups above, every baby should have an ultrasound examination.

My baby’s hip test is negative, but mybaby has one of the risk factors

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An ultrasound will be carried outwithin two weeks if the examinationis abnormal. A more senior or

experienced clinician may alsoexamine your baby’s hips.

My baby’s hip test is positive, whathappens next?

This is a harmless procedure verysimilar to the ultrasound used inpregnancy. It helps the doctors toobtain an accurate image of the hipsto see if they are well-formed andsafely in the right place.

It can identify abnormalities of theshape of the ball and socket and

see if the ball is unstable - whetherit displaces out of the socket. Theseproblems are not always felt when the hips are tested by hand. On the other hand, the ultrasound test may be normal when the physical examination suggested there might be a problem.

What is an ultrasound examination?

Adminstering Ultrasound

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A problem has been identified with thedevelopment of my baby’s hips.What happens next?Depending on the results of the tests yourbaby will be treated or monitored. He / she willbe referred to an expert clinician, - generally aChildren’s Orthopaedic Surgeon, who can usuallystart treatment before your baby is 3 months old.Some centres start treatment immediately after theultrasound diagnosis.

Most of the minor abnormalitiesseen on ultrasound do not causeany problems with hip developmentwhich means that the test hassuggested a problem which usually

gets better without treatment. It isoften better to wait to see if theseminor abnormalities resolve withouttreatment.

Early diagnosis gives the best chancefor effective treatment. Untreated,developmental dysplasia of the hipbecomes more difficult to treat aschild gets older and there is a risk of

developing osteoarthritis of the hip at a young age. As DDH may cause leg shortening other problems may follow in the spine, knee and ankle.

My child has had a positive diagnosis ofDDH -is treatment necessary?

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A problem has been identified with thedevelopment of my baby’s hips.What happens next?

This varies with the severity of theproblem and the age of the child.Most babies are treated in a splintwhich keeps the hips flexed andabducted, so the legs are heldsplayed apart in the best positionto encourage normal growth. Thesplints can be made from webbing,plastic or Plaster of Paris.

A few children’s hips do not respondto early treatment and some are notdetected until they are older. Theapproach to treatment for this groupis different and a number of treatment options are available.

These often include admission to hospital for special x-rays and a short period of traction, a small operation in the groin area under a general anaesthetic or a more extensive operation to put the ball and socket in place. After these more complex procedures it is normal to putthe child in a plaster of Paris/fibre glass cast known as a hip spica - a full body cast enclosing one or both legs.

Children who need to have theirhips put back into place after infancyneed to be monitored until they arefully grown.

What is the treatment for DDH?

Steps produces information onlooking after babies and children insplints and plasters.

For further information, please callSteps helpline on: 01925 750271 oremail us at: info@steps-charity.org.uk

Pavlik harness

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The hip checks are not 100%accurate. The physical examinationonly detects hip instability at thetime of the examination. This meansthat some babies might appearto be OK at the tests but developproblems later. As formal checks finishafter the 6-8 week check, parentsor grandparents are often best atnoticing signs of a hip problem. Doremember that a hip not properly injoint does not hurt in childhood.

If you notice any of these fivesigns you should contact yourhealth professional:

• When changing a nappy one legdoes not seem to move outwards asfully as the other or both legs seemrestricted.

• Your child crawls with one legdragging.

• Deep unequal creases in thebuttocks or thighs.

• Inequality in leg length.

• A limp if one leg is affected orabnormal ‘waddling’ walk if bothhips are affected.

When your baby is undergoingroutine developmental checks do besure to mention any concerns. Healthvisitors and doctors are aware of hipproblems and should check carefullyto be sure early walking is normal.

Can the tests pick up all hip problems?

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When DDH occurs, it is importantto understand that it is not anyone’sfault. Fortunately most babies bornwith unstable hips get better with notreatment.

New mothers make hormones that help ligaments relax during the birth.

These relaxing hormones can stay in a baby’s blood stream for a few weeks making it normal for babies’ hips to be ‘stretchier’ and looser shortly after birth. Babies’ hips are always flexed so their thighs lieagainst their stomachs. They should be allowed to kick them straight on their own and not be stretched out.It is important to leave the hips free

to move and not tightly strapped down with the legs straight out and pressed together. Let your baby hold his or her hips bent up as they werein the womb and allow room forthe legs to move freely. Things thatcould hinder normal hip development are tight swaddling and spending long periods of time in baby seats used for transport. For more information on safe swaddling contact Steps.

Given that some degree of hip instability is not uncommon in newborns, taking care of your baby’s hips is vital for their long term hip health. It is important to leave the hips free to move. Things that could hinder normal hip development are tight swaddling and spending long periods of time in baby seats used for transport. Many parents prefer a specially designed baby ‘sleeping bag’, which allows plenty of room for healthy hip positioning and always take regular comfort breaks when travelling long distances with your baby.

Is there anything I can do to prevent DDH?

Baby sleeping bag photo courtesy of Grobag

We don’t take

walking for

granted...

Steps is the national charity working for all those whose lives are

affected by childhood lower limb conditions

steps-charity.org.ukHelpline: 01925 750271 Email: info@steps-charity.org.uk

Steps Charity Worldwide @Steps_Charity

info@steps-charity.org.uk The National Charity for Lower Limb Conditions Registered Charity No. 1094343

Steps registered charity number 1094343

Company number 4379997

Externally reviewed and republished July 2016

Weblinks:The NHS Newborn and Infant Physical Examination Programme (NIPE):www.newbornphysical.screening.nhs.ukInternational Hip Dysplasia Institute information on how to swaddle your baby:www.hipdysplasia.org/default.aspx

Acknowledgements: We would like to thank the parents and healthprofessionals who have reviewed this leaflet.

‘How hip dysplasia works’ image courtesy of ‘How stuff works’‘Hip examination’ image courtesy of NIPE

We don’t take walking for granted

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2005 Patient Information Award