Mother and Baby

Hip Dysplasia

Section: Labour & Birth

Checking your baby’s hip health is important from birth to ensure he develops properly and goes on to take his first steps

When your baby is born, one of the first things that the midwife or doctor will check is his hips, as part of a national screening programme called the Newborn Infant Physical Examination (NIPE). ‘This is because some babies may have hips that are not properly in the socket joint or not shaped perfectly, a condition called Developmental Dysplasia of the Hip (DDH) which affects 1-3% of newborns,’ says Deborah Murray from Steps, a charity supporting children with lower limb development problems.

What is hip dysplasia?

The hip joint is called a ball and socket joint. The top of the thighbone is ball-shaped and fits into a socket on the side of the pelvis, which allows the leg to move both up and down and side to side.

Very young babies’ hips are made of soft cartilage, which changes into bone over the first few years. But for the joint to grow, the thighbone needs to be properly fitted inside the socket joint.

‘In DDH, the ball and socket are not fitted snugly together,’ says Deborah. ‘This is sometimes caused because the socket joint is more shallow than usual, which makes the joint less stable and more likely for the socket to slide out, which is known as a dislocatable or subluxatable hip.’

How is hip dysplasia diagnosed?

During your baby’s NIPE check, your doctor or midwife will look at how your baby holds his legs at rest.

‘They’re also checking to see if the legs are the same length and lie in the same position, with natural thigh creases at the groin that are symmetrical,’ says Deborah.

The midwife will then gently manipulate your baby’s legs to see if they are safely in the joints with tests knows as the Ortolani and Barlow tests.

‘Lying on his back, your baby’s legs will be moved gently outwards,’ says Deborah. ‘If she feels (rather than hears) a distinctive “clunk”, there could be an abnormality. A “clicky hip” is normal and nothing to worry about.’

The tests are very gentle and shouldn’t cause any discomfort, although your newborn will probably cry because most babies object to being examined.

What causes hip dysplasia?

Hip problems such as DDH can happen to any baby, but certain factors make the condition more likely.

‘If your baby is born breech, or was in the breech position in the last three months of pregnancy, he could be at a higher risk of DDH,’ says Deborah. ‘A family history of DDH or foot abnormalities could also increase his risk, and it tends to be more common in first pregnancies and in baby girls, although it’s not known why.’

How is hip dysplasia treated?

If your baby’s hip test comes back negative, but you still carry some of the risk factors such as him being in the breech position, your baby will have an ultrasound exam when he’s six weeks old. If the test was positive and there was a clunking sound, your baby will have his ultrasound sooner – at two weeks.

The ultrasound is similar to the one used when you’re pregnant. ‘It helps the doctors obtain an accurate image of the hips to see if they’re well-formed and safely in the right place,’ says Deborah. ‘It can identify abnormalities in the shape of the ball and socket and see if it’s unstable.’

What’s the treatment for hip dysplasia?

Sometimes the ultrasound will show that all is well with the hip socket and no further treatment is needed. ‘But if there is a problem, your baby will probably be treated with a splint, made from webbing, plastic or plaster of Paris,’ says Deborah. ‘This keeps the hips flexed so that the legs are held splayed apart in the best position to encourage normal growth.’

Are there any other symptoms of hip dysplasia?

Hip checks carried out at birth aren’t always 100% effective as they only detect abnormalities at the time of the test, and some problems develop later. ‘That’s why it’s a good idea for parents to be aware of any signs of problems,’ says Deborah. These include:

  • When changing a nappy, one leg does not move outwards as fully as the other.
  • Your child crawls with one leg dragging.
  • There are unequal creases in the buttocks or thighs.
  • The legs are different lengths.
  • Your child has a limp or abnormal waddling walk.

If you notice any of the above, speak to your GP or health visitor.

Can you prevent hip dysplasia?

If your baby has DDH, it’s important to remember that it’s nobody’s fault, and most babies with unstable hips get better without treatment.

Babies hips are always flexed so their thighs against their stomachs, but they should be able to kick them straight out on their own and not be stretched out flat.

‘If you choose to swaddle your baby, make sure the material isn’t restricting his leg movement,’ says Deborah. ‘His legs should be able to move like they did in the womb and the material should be loose enough to allow for this.’ You should also avoid leaving your baby in his car seat for long periods of time, as that can restrict leg movement.

For more baby health advice, visit our clinic section.


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