From the time our children are born they undergo many tests. Tests are performed in the hospital when they are born and continue throughout their growing years at their numerous checkups. One test in particular is done on their hips. While it may seem like insignificant stretching and pulling on your child’s legs, it is very important that you pediatrician continues to do this to diagnose developmental dysplasia of the hip (DDH), or congenital dislocation of the hip. This condition is commonly found at birth but not always. Because it is an ongoing process it can’t always be detectable at birth.

The two causes for DDH are both physiologic and mechanical. The physiologic cause has to do with the child’s basic makeup as well as the child’s response to maternal hormones. Mechanically pertains to positional influences in utero. Most children with DDH have looseness in their fibrous bands connecting bones together in joints. This is what sets the child up for hip instability, which in turn allows the hip to slip out of position and become dislocated. Mechanical factors include breech presentation.

Here is the breakdown of statistics for children with DDH:

• It is estimated that 1 in 100 newborn infants have clinically unstable hips.
• Only 1 in every 800 to 1,000 newborn infants experience a true dislocation where the ball of the hip lies outside the socket.
• There is a 9 to 1 female predominance; the baby’s own female hormones aggravate the abnormal looseness of the hip ligaments.
• Of children with DDH, approximately 60% are firstborn.
• 30-50% develops in breech position; 2% to 3% of all babies are born in breech presentations, but about 20% of DDH patients are born in the breech position.

Due to the fact that DDH cannot always be detectable at birth, it is all that much more important that routine checks of your child’s hips are performed at every well baby appointment. From 1 to 6 months true dislocations can develop. Treatment generally consists of wearing a special harness called the Pavlik harness and will have to be worn anywhere from 3 to 4 weeks. The special harness is only 95% effective in dysplastic or subluxated hips and 80% effective in true dislocations. If after proper use of the Pavlik harness doesn’t work, surgery is the next step. Children over the age of 6 months who are found to have DDH generally are not given the harness for treatment and are recommended for surgery.

Every child has their own surprises, including my own. My now 6 month old son had his well baby check up yesterday and was sent off for x-rays of his hips. Now we are just sitting here waiting to hear what the results are so we can move on and over this (what we hope) little bump in the road. There are so many different things that we have to watch for with our children, you just never know what is going to hit you next.

For more detailed information on DDH, please visit: http://www.drhull.com/EncyMaster/H/hip_dysplasia.html