Developmental Dysplasia of the Hip in Infants

As a new parent, navigating the world of infant health screenings can feel overwhelming. Among the various checks your baby will receive, one that deserves particular attention is screening for Developmental Dysplasia of the Hip (DDH). This condition, while potentially serious, is highly manageable when detected early. This blog will explain what DDH is, why early screening is vital, and how proactive care can ensure your child’s healthy development. What is Developmental Dysplasia of the Hip (DDH)? Developmental Dysplasia of the Hip refers to a spectrum of conditions where a baby’s hip joint does not form properly. In a healthy hip, the rounded top of the thigh bone (femoral head) fits snugly into the hip socket (acetabulum). In DDH, this socket may be too shallow, or the ligaments may be loose, allowing the femoral head to slip partially or completely out of place. This can range from mild instability to a complete dislocation. DDH is not always present at birth; it can “develop” during the first year of life, hence the term “developmental.” It is one of the most common congenital conditions, affecting approximately 1 to 3 of every 1,000 babies. Girls, first-born children, babies born in the breech position, and those with a family history are at a higher risk. Why is Early Screening for Hip Dysplasia So Crucial? The first few months of a baby’s life are a period of rapid growth and development. This is a critical window for the hip joint. Cartilage is still soft and moldable, making non-surgical correction not only possible but highly effective. Prevents Long-Term Complications: Undiagnosed and untreated DDH can lead to significant problems as a child grows. These include a limp, leg length discrepancy, hip pain, and early-onset arthritis, often requiring major surgery in adolescence or adulthood. Enables Simpler, Non-Surgical Treatment: When detected early (within the first 6 months), DDH can often be treated with non-invasive methods. The most common is a soft brace, like the Pavlik harness, which holds the baby’s hips in a stable, flexed position, allowing the socket to develop normally around the femoral head. Success rates for harness treatment are excellent when started early. Avoids Complex Surgery: Late diagnosis (after 6-12 months) often means the child will require closed or open surgical procedures under anesthesia, followed by months in a spica cast. These treatments are more invasive, stressful for the family, and have longer recovery times. Promotes Optimal Development: A stable hip joint is foundational for reaching motor milestones like rolling over, sitting, crawling, and walking. Early treatment ensures your child can develop these skills on schedule. Screening typically involves a physical examination where the pediatrician performs specific maneuvers (like the Ortolani and Barlow tests) to check for hip stability. For high-risk infants or those with inconclusive exams, an ultrasound of the hip is the gold standard diagnostic tool before 6 months of age. Expert Care for Your Child’s Orthopedic Health For parents in Thane and Mumbai seeking expert guidance, Dr. Vinod Dubey is a leading pediatric orthopedic surgeon in Mumbai specializing in childhood bone and joint conditions like DDH. FAQs on Hip Dysplasia 1. What are the signs of hip dysplasia in babies? Common signs include uneven thigh or buttock skin folds, limited movement in one hip, a “clicking” or “clunking” hip sound, and, in older infants, a limp or walking on toes on one side. 2. Can hip dysplasia correct itself? Mild instability may resolve on its own in the first few weeks. However, true dysplasia or dislocation will not self-correct and requires medical intervention to ensure proper joint development. 3. How is hip dysplasia treated in infants? The primary treatment for infants under 6 months is a soft positioning brace like a Pavlik harness. For older babies or more severe cases, treatment may involve a closed reduction (manually repositioning the hip) or surgery, followed by a period in a cast. 4. What causes hip dysplasia in infants? The exact cause is often multifactorial, involving genetic predisposition (family history), hormonal factors that loosen joints, and mechanical factors like a breech position in the womb or swaddling with legs straight and tight. 5. When should a baby be screened for hip dysplasia? All newborns should receive a clinical hip exam at birth and at every well-baby check-up until they are walking confidently. High-risk babies often require an ultrasound screening between 4-6 weeks of age.

As a new parent, you notice every little detail about your baby. While most quirks are perfectly normal, some physical signs can indicate a need for closer attention. One such condition is Developmental Dysplasia of the Hip (DDH), a term used to describe a range of hip joint problems where the “ball and socket” joint of the hip doesn’t develop properly. The good news is that with early detection, DDH is highly treatable. Knowing what to look for can make all the difference in your child’s long-term mobility and health. Early signs of DDH every parent should be aware of 1. Uneven Skin Folds One of the most noticeable signs is asymmetry in the skin folds on your baby’s thighs or buttocks. When you lay your baby on their back and straighten their legs, you might see that the folds on one thigh don’t match the other in number or depth. While some asymmetry can be normal, pronounced unevenness should be discussed with your pediatrician. 2. A “Clicking” or “Clunking” Sound You might hear or feel a “clunk” or “click” when moving your baby’s hips. This sound, known as the Ortolani or Barlow sign, occurs when the hip joint is unstable and the femoral head (the “ball”) slips in or out of the socket. It’s crucial to note that a faint click can sometimes be normal, but a distinct clunking sensation warrants a professional evaluation. 3. Limited Range of Motion Does one of your baby’s legs seem less flexible than the other? You might notice it’s harder to spread their legs apart during diaper changes or that one leg consistently falls outward more easily. This limited abduction (moving the leg out to the side) is a classic indicator of a dislocated or dysplastic hip. 4. Leg Length Discrepancy In more advanced cases, one leg may appear noticeably shorter than the other. You can check this by laying your baby on their back and bending their knees, placing their feet flat on the surface. If one knee appears significantly lower than the other, it could signal that the hip on that side is dislocated. 5. Asymmetry When Walking (In Older Infants) For babies who have started to stand or walk, DDH may present as a limp (on one side) or a waddling “duck-like” gait (if both hips are affected). While this is a later sign, it underscores the importance of early detection before walking begins. What Should You Do Next? If you observe any of these signs, don’t panic. The first step is to bring your concerns to your pediatrician. They will perform a physical examination and, if necessary, refer you to a pediatric orthopedic specialist for an ultrasound or X-ray. Don’t wait and wonder. If you have any concerns about your infant’s hip development, seeking expert advice early is the best course of action. Consult Dr. Vinod Dubey, a renowned Pediatric Orthopedic Surgeon in Thane and Mumbai, for a comprehensive evaluation and the most advanced care for Developmental Dysplasia of the Hip. Ensure your child gets the best start for a healthy, active future. Frequently Asked Questions (FAQs) 1. Can DDH correct itself in babies? In some very mild cases of instability in newborns, the hip can stabilize on its own within the first few weeks. However, true dysplasia (shallow socket) or dislocation requires medical treatment and will not correct itself. 2. What are the risk factors for DDH? Key risk factors include being a first-born female, breech position in the womb, a family history of DDH, and swaddling with the legs straight and pressed together. 3. How is DDH diagnosed? Diagnosis typically involves a physical examination by a specialist, followed by an ultrasound (for infants under 6 months) or an X-ray (for older babies) to confirm the hip’s position and development. 4. What is the best way to swaddle a baby to prevent DDH? Always practice “hip-healthy” swaddling. Ensure the blanket is loose around the legs so the baby can bend their knees and hips up and out. The legs should be able to move freely into a “frog-like” position. 5. At what age is DDH typically detected? DDH is often detected during routine newborn and well-baby checkups. The ideal window for the simplest treatment is before 6 months of age, but it can be diagnosed later if signs become apparent when a child starts to walk.