Before any baby can be discharged from hospital, the Newborn Infant Physical Examination (NIPE) has to be carried out by a paediatrician or midwife and part of the process the hips should be checked thoroughly.
NIPE details can be seen here.
Babies are placed on their backs, the gentle examinations, known as the Ortolani and Barlow Tests, are used to detect a distinctive click or clunk, which is caused by the head of the femur moving in and out of the socket.
Sometimes there will be a click and this can be totally normal with most hips stabilising spontaneously without the need for treatment.
However, if it is believe that a baby’s hip unstable an ultrasound scan to assess what is happening will be carried to decide if medical intervention is needed.
Sometimes, hip problems are not be picked up at birth and this can be for various reasons.
During pregnancy, the body produces pregnancy hormones called ‘relaxin’, which soften and relax the mother’s ligaments, enabling her pelvis to move and make more room for the baby during birth. These hormones can stay in a baby’s blood stream for a few weeks, making it normal for their hips to be ‘stretchier’ and looser shortly after birth. Therefore, any problems may not be detectable until sometime after an initial check-up therefore it is important that all infants (both high and low risk) should have their hips regularly re-examined during the first year of life.
At other times it is unfortunately missed, something we feel very strongly about.
If you think that your child might have DDH the main things to look for are:
- Deep unequal creases in the thigh or bottom
- Stiff hip joint where one leg does not seem to move outwards as fully as the other – it is often possible to notice this when changing your baby’s nappy
- One leg is dragged when crawling
- Legs are of unequal length
- A limp in the leg that is affected
- Abnormal ‘waddling’ walk if both hips are affected
If you are concerned, make an appointment with your GP who can refer you to a Consultant Orthopaedic Surgeon who specialises in treating DDH.
It is important to remember that nearly all babies who are diagnosed with DDH go on to have a healthy, active life, with no disability.
However, the sooner DDH is diagonsed and a treatment plan decided, the better. The main aim of any treatment is to successfully relocate and secure the ball of the femur into the hip socket. By doing this, as a child grows and develops, their hips will follow suit normally.