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Hip Dysplasia - 'Clicky Hips' in Babies

Updated on February 16, 2015

My Daughter in a Pavlik Harness

Baby hip ultrasound

What is Hip Dysplasia?

Hip dysplasia is commonly known as clicky hips or dislocation of the hips. This means the hip socket is too shallow for the ball joint to stay in place.

Hip dysplasia is checked after every birth by a paediatrician or midwife and again at their 6 week check up, they move the hips into their body and then to their sides looking out for a clunk which can be felt not heard.

If it is in the family you will be referred to a hip ultrasound, which they send a letter for an appointment within the next few weeks - they wait a few weeks as a baby born with hip dysplasia may not have it when they go for the scan and that the hip joints have corrected themselves.


Shallow Hip Joint

Cast

Treatment - Pavlik Harness

This is a harness that is fitted by a physicians and it looks like frog legs, this is to hold the ball into the socket to embed it into a normal hip joint.

How long for?

If detected at birth they will have an ultrasound and the harness will be fitted when they are about 6 weeks, the process takes about 12 weeks but could be more or less depending on how long it takes for their bones to develop into the right shape for the ball and socket joint

The hip bone is mouldable at this point, so that's why they use this treatment as it holds their legs into the right position before the bone hardens.

Implication of not treating it:

If it's not treated as soon as possible, it could lead to your child having to wear a splint, which is like a big nappy to separate the legs into a frog position, a cast may be needed or even worse - surgery, which no one wants for their children, so it's best to stick it out and keep it on as it is known that many parents take it off due to finding it hard to hold their baby properly and wanting to bath them.

Appointments:

Once the harness is one, your next appointment will be in two weeks where they checked via ultrasound to see if the harness has the hips in the right position, the harness will be changed and most of the time you will be able to give your baby a quick wash in the hard to reach areas when the harness is one and a little cuddle without it on.

After that your next appointment would be in 2 weeks this is for a harness change, maybe even a bigger size and once again a wash and cuddle.

After 2 weeks you will go back for an ultrasound to see how the hips are progressing, like me my daughter was allowed it off for the day but was to keep it on at night for that extra bit of support, but if the hips still aren't quite right the consultant will advise it stay on and a harness change will be given, the same routine continues until the hips are fully developed into the right place and the harness support is no longer needed.


Different Types of Treatment

1-6 months - Pavlik Harness

A small fabric contraption that allows the hips to be securely in the place of the socket

6-18 months - Closed Reduction

Doctor manipulates the hip joint, moving the ball back into the hip socket whilst they are under local anesthetic.

18 months-6 years - Open Reduction or Bone Surgery

A small incision into the groin in line with the hip is made, this allows the joint to be cleared so they are aligned correctly - They cut out a piece of bone to fit around the ball joint, held together with pins.

6 years and Older -

Reduction is rarely recommended in older children with completely dislocated hips because the bone changes are permanent by this age. Hip dysplasia with partially displaced hips can still be treated in older children and adolescents. This can delay the onset of arthritis in many cases. - See more at: http://hipdysplasia.org/developmental-dysplasia-of-the-hip/planning-treatment-for-children/#sthash.0s09O7yU.dpuf

Sling - Do and Don't

Developmental Hip Dysplasia

Causing hip dysplasia:

Yes, Hip dysplasia can also be caused, if the hips remain in a particular position for long periods of time, this can cause the hips to become shallow and maybe ending up with the condition. Using a sling or swaddle can cause it too, as it keeps the legs together causing the hip joint to become shallow and mould the hips into the opposite of what the harness does, if this occurs then it will be detected later which means the child would most definitely be in a cast instead of a harness, even later and surgery will be discussed.

Daily life in a harness

Travel:

Carriers and slings are great for travelling with your baby due to it maintaining the frog legged position that's needed for your baby's hip development. Using a buggy is ok, the wider it is, the better it is due to the extra room needed for her separation in their legs. Car seats are a nightmare in my opinion due to the sides are quite narrow, so use with caution for short periods of time, if unsure speak to your health care professional.

Bathing - well not bathing:

The harness stays on 24/7 until the consultant says different, this means they can't get a bath, so a bowl of warm water, soap of your choice and a flannel, lean them over the bowl and wash their hair like you would normally and use the flannel to wash the hip area, under arms, behind knees, ears, hands, feet and torso as they can get a bit smelly, plus they appreciate feeling clean.

Clothing:

Clothing a baby with a harness on can be a nightmare, this is due to the amount of leg room they need. A good idea is to place them in clothes a couple of sizes bigger, for girls dress' is a good option and for boys loose fitting dungerees are a good choice. Just remember that the harness isn't on for particularly long so they should be able to wear their cute outfits once its off.


Symptom of Hip Dysplasia

What caused it? How do I know if my child has it?

Symptoms:

  • Deep unequal crease in the thigh
  • When changing their nappy, one leg doesn't go out as fully as the other
  • Will crawl dragging one leg
  • Legs will be unequal length
  • Limp if one leg is affected or waddle if both are affected
  • When walking your child may walk on their toes on the affected side
  • If your parent, brother or sister has a child born with hip dysplasia

It is not entirely clear as to how they get it but some aspects can increase the likelihood, such as:

  • Having a close family member with hip dysplasia
  • A baby born in the breach position, in breach position until 36 weeks or in a multiple birth
  • If it is your first birth
  • If there is a deficiency of the amniotic fluid
  • If your baby has mild foot abnormality or tortorticollis - a tightness of the muscles in the neck

How it is applied

  1. The harness is led flat and the baby is placed on top of it
  2. The arms are put in each arm space and the velco straps are fastened to the right length, giving the baby enough room to move their arms freely
  3. The legs are put in the foot 'socks' which stops their legs straightening, the velcro straps running along the legs are fastened with the legs at 90 degrees
  4. The two leg straps on each leg are fastened with room for their leg and one adult finger
  5. The physician makes any alterations to make sure the hips will be securely placed in the right position
  6. You will then be told that the straps that are horizontal are the ones you can open, to clean their skin, but the ones the open vertically are the ones that have your babys hip securely in place and must not be changed. Tape may be used to keep it more secure
  7. Finally the chest strap is to hold the arm straps in place, this accommodates the baby's torso and 4 adult fingers to allow a full stomach or a big cry, this can also be opened to clean baby or give baby massage to

How to apply a pavlik harness

My Daughter Wearing 9-12 Month Trousers Over the Pavlik Harness

Personal Experience

After having two daughters, both with hip dysplasia, it has become routine with visits to the hospital and trying to dress them in pretty outfits whilst having to put trousers of 9-12 months on to accommodate the space between their legs. My first daughter was out of it within 6 weeks and 2 weeks for nights only, my second daughter still has hers on at the moment. I missed the snuggles in bed in the morning and wrapping her up as they have to lay on their back to maintain the position of the harness. My two year old started walking at 13 months, crawled at 10 months, she rolled over and can now run. Everything went back to normal and she continued with a normal development within the right age gaps.

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