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A (short) guide to Developmental Dysplasia of the Hip


Our daughter Penny was diagnosed with Developmental Dysplasia of the Hip {DDH} when she was one day old.  Following our experience I became passionate about not only raising awareness of DDH but to also help and support other families by sharing our experience and stories of other families.  I hope that this guest post can offer a small insight into what DDH is, what signs and symptoms to look out for, how the condition can be treated and where to find support.

What is DDH?

“In the simplest terms, Developmental Dysplasia of the Hip is where the ball and socket of the hip joint fail to develop correctly.”  {Natalie Trice | Cast Life: A Parent’s Guide to DDH1}

What causes DDH2

DDH is a birth defect which can be caused by both genetic and environmental factors.

Risk factors include:

  • family history of DDH
  • position of the baby in the uterus, especially with breech presentations
  • associations with other orthopaedic problems

Symptoms of DDH in Infants2

DDH is commonly picked up during a baby’s Newborn Infant Physical Examination. Symptoms may include:

  • legs differing in length
  • one leg turned out
  • deep or uneven folds in the skin of the thigh or buttocks
  • a wider space between the legs than normal

Symptoms of DDH in Toddlers

Symptoms in older children may include3:

  • one leg appears shorter than the other
  • an extra deep crease is present on the inside of the thigh
  • one of the hip joints moves differently from the other and the knee may appear to face outwards
  • when a baby’s nappy is changed one leg does not seem to move outwards as fully as the other one
  • the child crawls with one leg dragging
  • the child stands and walks with one foot on tiptoes with the heel up off the floor
  • the child walks with a limp (or waddling gait if both hips are affected)

Diagnosis

If picked up early, DDH is commonly successfully treated with the use of a Pavlik Harness.  This is worn 24/7 over a number of weeks or months and, if successful, the hips are excepted to develop normally with no long-term problems.  A late diagnosis is likely to require more prolonged treatment with sometimes multiple surgeries and time spent in a cast plus rehabilitation.  Left untreated in childhood severe problems can develop in adulthood, sometimes resulting in joint replacement. 

Early diagnosis is vital since surgery and long-term effects can usually be avoided if DDH is identified and treated at birth. 

DDH is usually diagnosed by:

Treatment2

The aim of treatment is to put the femoral head back into the socket of the hip so that the hip can develop normally.

Treatment of DDH depends upon:

  • your baby's gestational age, overall health, and medical history
  • the extent of the condition
  • your baby's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Treatment may include4:

  • use of a Pavlik Harness, a soft brace used in babies up to 6 months old to hold the hip in place and allow normal development of the hip
  • hip abduction brace
  • reduction surgery followed by a cast
  • osteotomy surgery followed by a cast
  • total hip replacement

Penny’s Story

During her Newborn Infant Physical Examination the paediatrician discovered one of Penny’s hips could be easily dislocated, stating she had a “clicky hip”.  I remember thinking ok, that doesn’t sound so bad {as I continued to potter around my hospital bay post C-section}. “She will probably have to wear a harness for 6 months to a year”.  What?!  I felt like I’d been kicked in the stomach.  I couldn’t take in what she was telling me. 

After she left I did what any normal person would do. I googled clicky hips. The words Developmental Dysplasia of the Hip {DDH} flooded my phone screen along with pictures of babies and young children in harnesses and plaster casts. I stared in disbelief and shock.  How could this be happening? What does this mean for Penny? Will she need operations? Will she be able to develop normally? Will she be able to walk? I sat alone {with P] and silently wept. A sense of loss flooded me. Would she miss out on things? I just couldn’t make sense of it in my mind. 

An appointment with a specialist was made for the next day.  He confirmed both hips could be dislocated and at two days old Penny was fitted with a Pavlik Harness

Fast forward to nearly a year on and Penny is a happy, healthy baby.  She has been discharged from the Orthopaedic Specialist Consultant and is even starting to walk! 

Read Penny’s full story here and more about DDH and other real life stories at a Life Twintastic here

Support for DDH

Diagnosis and treatment of DDH can be a deeply traumatic and lonely experience.  DDH is not a life-threatening condition but it is a serious condition which can lead to years of invasive treatment.  I personally was completely unprepared for Penny’s diagnosis and desperately needed information and support. I came across DDH UK Charitable Trust and Hip Dysplasia Support Group on Facebook and then DDH UK and have never looked back.  The sense of support, understanding and solidarity from other parents or sufferers of DDH is overwhelming. 

About me

Hi I’m Ellie, mum of three, wannabe perfect housewife, to-do list checker and mental health advocate with dreams of a healthy style, unburnt cookies and mini adventures.  I started my blog a {life} twintastic to share my honest account of my life and things I’ve learnt along the way as I navigate the challenges {and blessings} of motherhood {including life with twins and Penny’s diagnosis of Developmental Dysplasia of the Hips and various food allergies}, being a working mum and healthy {aka yummy} mummy whilst also trying to keep my sanity and have a giggle along the way. 

References

1 Cast Life: A Parent’s Guide to DDH by Natalie Trice

2 www.stanfordchildrens.org

3 Emma and 3

4The Parents’ Guide to Hip Dysplasia by Betsy Miller


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