Hip dysplasia: helping your baby

Deborah's daughter wearing the hip brace.
Deborah's daughter wearing the hip brace. 

So your baby has been diagnosed with hip dysplasia but you're still confused as to what this means for her?* Debbie Clemens of Hip Babes sheds some light on hip dysplasia, what can be done about it and how you can help your child adjust to her treatment.

What is hip dysplasia?
Hip dysplasia or developmental dysplasia of the hip (DDH), the preferred medical term, refers to a range of disorders of hip instability.

DDH is an abnormal development of the hip joint. The ball at the top of the thighbone (called the femoral head) is
not stable within the socket (called the acetabulum). The ligaments of the hip joint, which hold it all together may also be stretched and loose.

Why does my baby have hip dysplasia?
Although the causes of DDH unknown, influencing factors include:
•    abnormal rotation of the developing hip during the first trimester.
•    neuromuscular disease, especially in the second trimester.
•    abnormal mechanical forces e.g. breech presentation.
•    female infants (who are more susceptible to the maternal hormone relaxin).
•    postnatal mechanical forces associated with swaddling.
   
Interestingly, the last point mentioned is thought to be relevant where there are cultural differences. The highest incidence of infant hip dislocation is said to be in cultures such as the Najavo Indians and the Canadian Eskimos, where it is a common practice to tightly swaddle infants or strap them to cradle boards. 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.
   
How will my baby be treated?
If your baby is at high risk, he or she will have an ultrasound performed at about 6 weeks after birth.
   
With early management through splinting (hip bracing) the hip joint can develop as normal and your baby may avoid the need for surgery.
   
In the event that your baby needs to be fitted with a hip brace (usually a Dennis Browne bar or Pavlik Harness in Australia), she may be recommended to wear this device for 23-24 hours a day for a significant number of weeks or months.

If your baby’s hip remains dislocated following a trial of bracing or if hip dislocation is detected in when she is much older, surgery and the use of a hip spica (plaster) may be necessary.

If you’re permitted to give your baby an hour off from brace time, make sure she utilises this to the max: with a bath, play time and maybe a massage.

How can I help my baby?
Hip bracing is used to hold your baby's hips in a position to promote proper growth and development of her hips. The hip brace will hold her legs apart and turn them outwards, in a 'frog-legged' position. This can pose a few challenges for both parent and baby because of the restricted movement. You may find the simplest things such as breastfeeding, nappy changing, swaddling and car travel become quite challenging.

To help your baby adjust to her hip brace or spica cast, try and make sure she is as comfortable as possible. Ask your baby’s specialist about the best way to hold her, position her at bedtime and get them to demonstrate how to put your baby’s brace on and off.

Do make sure she has ample padding between the cuffs of the brace and her skin to avoid any rubbing or friction. The brace should not be too loose or tight. Again, your baby’s orthotist or specialist should show you exactly how the brace should be fitted.

Dress your baby in comfortable, baggy clothes such as baggy grow suits, wide legged baby pants and/or legwarmers. Clothes worn over the brace should not force your baby’s legs together.

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If you have been swaddling your baby at night, you will find the brace prevents you from doing this. It is still possible to swaddle your baby’s top half, if you find that helps her flailing her arms around. You may also find a wide-bottomed sleep sack works well too.

Most importantly, try and imagine how you might feel with this restricted movement and think carefully about what might 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 she utilises this to the max: with a bath, play time and maybe a massage. If you have any concerns or queries, get in touch with your baby’s specialist or maternal health nurse.

DDH can develop over time in any child whether they are at high or low risk so it is important that you get your baby's hips regularly checked during the first year of her life and 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 much later in your baby’s life, it may result in complex surgery. Or if your baby's DDH is undiagnosed and left untreated, it could result in severe hip pain when she is older and encourage early onset of osteoarthritis.
   
References: Conditions caused by defects in physical development. Nursing Care of Infants and Children. 7th edition, Hockenberry, Wong et al. 2003. Paediatric Handbook, 7th edition, Paxton et al, 2003.
American Academy of Pediatrics. Clinical Practice guidelines: Early detection of developmental dysplasia of the hip. Pediatrics 2000
Griffin PP, Robertson WW Jr. Orthopaedics. In: Avery GB, Fletcher MA, MacDonald MG, editors. Neonatology: Pathophysiology and management of the newborn. Philadelphia: Lippincott, Williams & Wilkins, 1999

 * ‘Her’ is used throughout the article due to the higher incidence of DDH cases in female infants. 

Written by Debbie Clemens of www.hipbabes.com.au - the online resource for parents of babies with hip dysplasia. The information included on Hip Babes website is for your information only, and is by no means a substitute for the advice of a qualified medical practitioner.