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Developmental dysplasia of the hip (DDH) is the name for a range of conditions of a child's hip. It can affect one or both hip joints.
With subluxation or dislocation, the hip socket is often too shallow, more like a saucer than the deep cup that it should be.
The exact cause of DDH is not known. A number of risk factors can raise your child's chances of having DDH, including a family history of DDH and your baby's position in the womb and at birth.
Having DDH does not cause pain. A baby with DDH may have:
A child who is walking may:
Usually, DDH is diagnosed during your newborn's physical exam. If your baby is older, DDH may be diagnosed during a well-baby checkup. But it may be harder to diagnose the condition in a baby older than 1 to 3 months, because the only outward sign may be less mobility or flexibility in the movement of the affected hip joint(s).
Most children born with looseness (laxity) of the hips won't have problems and won't need treatment. If treatment is needed, the doctor will move your baby's upper thighbone into the hip socket and keep it in place while the hip joint grows. A splint, called a Pavlik harness, is most often used to keep the joint in place in babies younger than 6 months. A hard cast, known as a spica cast, is used for older babies. Other forms of treatment, such as surgery or a brace, also may be needed.
It's important to treat DDH early. Children with untreated DDH may develop lasting hip problems. Don't try to treat DDH on your own, such as by diapering a baby with 3 or 4 diapers at a time or by trying to put your baby's legs in certain positions. These methods don't work well and may cause the joint to develop abnormally.
Learning about developmental dysplasia of the hip (DDH):
Living with DDH:
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|Hip Dysplasia: Caring for Your Child in a Body (Spica) Cast|
The signs of developmental dysplasia of the hip (DDH) vary depending on whether one or both hips are affected.
Having DDH does not cause pain. A newborn or infant with DDH may have:
In rare cases, DDH develops in the first few weeks or months after birth and signs may not be seen until your child starts to walk. Then your child may:
Children with untreated DDH may develop lasting deformities in their hips. Untreated DDH can also lead to hip joint degeneration, which is a sort of early "wearing out" of the socket. When the degeneration occurs in the cartilage that protects and cushions joints, it is known as osteoarthritis. Eventually the bones, which had been separated by the cartilage, rub against each other. This rubbing damages tissue and bone, and it causes pain.
Developmental dysplasia of the hip (DDH) is usually diagnosed by a physical exam. A medical history and other tests also may be useful in diagnosing DDH.
All babies are examined for DDH at birth. Newborns who have risk factors for DDH, such as having foot, knee, or leg deformities, are examined very closely for the condition.
Your child's hips are also examined during regular well-child checkups. But a baby with DDH who is older than 1 to 3 months may have fewer visible signs, making it more difficult to detect. These babies may have only slightly less mobility or flexibility of the affected hip joint(s).
An orthopedic surgeon or a pediatric orthopedist usually confirms a diagnosis of and provides treatment for DDH. Your doctor will refer you to one of these specialists if he or she suspects your child has DDH.
Tests that show images of the hip joint are often done to help diagnose DDH if results from physical exams are unclear. These tests are also used to monitor treatments for DDH.
Imaging tests used to diagnose and monitor DDH include:
Treatment for developmental dysplasia of the hip (DDH) focuses on moving your child's upper thighbone (femur) into its normal position and keeping it in place while the joint grows. The hip socket will not form and grow properly if the ball at the top of the thighbone (femoral head) does not fit snugly in the joint.
Treatment for DDH usually includes one of the following:
If your child has had successful treatment for DDH, he or she will likely not have any further hip problems. But have your child examined regularly to make sure his or her hips continue to grow and develop normally.
The longer an unstable, dislocatable, or dislocated hip persists, the more likely it is to cause long-term problems that are hard to treat. For this reason, it is important to diagnose and treat DDH early.
Follow-up medical checkups are very important for monitoring the effectiveness of treatment and preventing complications. For example, damage sometimes occurs to the blood supply of the femoral head from treatment. If not detected and treated early, this damage can lead to the destruction of bone cells (avascular osteonecrosis). The bone may then grow abnormally, become deformed, and later develop osteoarthritis.
Basic home treatment for developmental dysplasia of the hip (DDH) focuses on interacting with your child and keeping him or her comfortable.
If your baby or child is wearing a harness, brace, or cast:
Other home treatment depends on the precise medical intervention used.
Do not remove the harness and do not adjust the straps for the first 3 to 4 weeks of treatment unless your doctor tells you to. The harness holds the joint in the correct position for normal development. Removing the harness may cause the thighbone to move out of position.
Give your child a sponge bath while he or she is in the harness. Later in your child's treatment, the harness may be removed for short periods of time, such as for bathing or for cleaning the harness.
You can put your child's clothing on under the straps to prevent skin irritation. You can also pad the shoulder straps if needed.
If your child's cast is made of plaster, it may need time to dry after it is first put on. Your child will likely be in a semi-sitting position and may need you to help him or her move. Turn your child at least every 2 hours for the first 24 to 48 hours to prevent uneven drying of the cast. You can use a fan to help the cast dry more quickly, but don't use heat. When you tap the cast and hear a hollow sound, it is dry.
While your child is in a spica cast:
DDH is a growth and development problem that is beyond your control. Remind yourself that you did not do anything to cause this condition. Know that it takes time to manage the frequently shifting emotions that are common when your child is diagnosed with DDH. Find a doctor with whom you feel comfortable talking about any concerns you may have.
Caring for a child who has DDH can be stressful. Take time to care for yourself to reduce stress and to stay healthy. When you have the energy to function well, you are able to provide the best care for your child. For more information, see the topic Stress Management.
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This website is sponsored by the Nemours Foundation. It has a wide range of information about children's health—from allergies and diseases to normal growth and development (birth to adolescence). This website offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly emails about your area of interest.
Other Works Consulted
- American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Developmental dysplasia of the hip. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 1050–1055. Rosemont, IL: American Academy of Orthopaedic Surgeons.
- Delahay JN, Lauerman WC (2010). Children’s orthopedics. In SM Wiesel, JN Delahay, eds., Essentials of Orthopedic Surgery, 4th ed., pp. 173–251. New York: Springer.
- Podeszwa DA (2011). Developmental dysplasia of the hip. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 852–856. New York: McGraw-Hill.
- Polousky JD (2011). Developmental dysplasia of the hip joint section of Orthopedics. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 779–780. New York: McGraw-Hill.
- Sankar WN, et al. (2011). The hip. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 2355–2365. Philadelphia: Saunders.
- Shah SA, Stankovits LM (2006). Developmental dysplasia of the hip section of The hip. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1018–1021. Philadelphia: Saunders Elsevier.
- U.S. Preventive Services Task Force (2006). Screening for developmental dysplasia of the hip. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspshipd.htm.
- White KK, Goldberg MJ (2012). Common neonatal orthopedic ailments. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 1351–1361. Philadelphia: Elsevier Saunders.
|Primary Medical Reviewer||Susan C. Kim, MD - Pediatrics|
|Specialist Medical Reviewer||John Pope, MD - Pediatrics|
|Last Revised||March 12, 2012|
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