Developmental Dysplasia of the Hip (DDH)
Discovering that your child has developmental dysplasia of the hip (DDH) can be overwhelming. Our goal is to offer guidance to help you and your child through their DDH journey and provide support along the way.
On this page you will find:
- What is Developmental Dysplasia of the Hip?
- Why Does it Happen?
- How is DDH Detected?
- Treatment of DDH
- Caring for a Child in a Pavlik Harness
- Caring for a Child in a Hip Spica Cast
- How Will DDH Affect My Child?
- Sharing the News
- Support
- Resources
What Is Developmental Dysplasia of the Hip?
It is estimated that around 1 in 10 newborn babies have some hip instability. This means the ball and socket are not held firmly in place because the ligaments are loose. In most babies, these ligaments tighten naturally after birth.
It may be surprising to know that developmental dysplasia of the hip (DDH) is one of the most common hip conditions in children, affecting 1-3% of all newborns according to research published in journals such as the British Medical Journal.
DDH is a condition in which a baby’s hip joint does not develop normally and can affect one or both hips.
In a healthy hip, the ball-shaped part of the end of the thighbone (femur) fits securely inside the hip socket (acetabulum). In DDH, the socket may be too shallow, which means the ball (femoral head) is not held firmly in place.
DDH varies in severity from a mild instability of the hip to a hip that is partly or completely out of the socket.
Babies with hip dysplasia are not usually in pain, and the condition does not prevent them from learning to crawl or walk.
For a guide to baby hip development please download our FREE booklet, Baby Hip Health and DDH, A Parents’ Guide for more detailed information.
Why Does it Happen?
Hip dysplasia can happen to any baby and the exact cause of DDH is not fully understood but it is important to know that it is not anyone’s fault.
There are common risk factors that can increase the chance of a baby having DDH and, in the UK, healthcare professionals use these risk factors to identify newborn babies who may require further assessment.
DDH is more common in girls than boys and it is also more common in first-born babies.
How is DDH Detected?
All babies’ hips are checked at birth and at 6-8 weeks as part of a national screening programme called the Newborn Infant Physical Examination (NIPE). The baby’s hips are gently manipulated to see if they are correctly in joint by tests known as the Ortolani and Barlow Tests.
If the physical examination identifies a potential problem, your baby will be referred for an ultrasound scan of their hips, which will be evaluated by a specialist or expert. The ultrasound results are used for diagnosis as they are more reliable than physical examination.
Even if the physical examination is normal, NHS guidelines recommend that babies with the following risk factors have an ultrasound scan of their hips between four and six weeks of age:
• Breech positioning or presentation (bottom or feet first)
• First-degree family history of early childhood hip problems (seen in baby’s parents or siblings)
Watch our interactive video below to find out more about the ultrasound hip scan process and what to expect.
The physical examination is not 100% accurate as this only detects hip instability at the time of the examination. This means that some babies might appear to be normal at the tests but develop problems later, or that DDH has not been picked up at the initial examination. As routine hip examinations finish after the 6-8 week check, it is helpful for parents to be aware of possible signs of hip problems during the first few years of their child’s life.
Possible signs of DDH include:
• Unequal leg lengths
• Clicking, clunking, or popping of the hip
• When changing a nappy one leg does not seem to move outwards as far as the other, or both legs seem stiff or restricted
• Uneven creases in the buttocks
• In older children: a limp (if one hip is affected) or a waddling walk if both hips are affected
Treatment of DDH
Treatment can vary with the severity of the DDH and the age of the child.
From birth to six months, babies with DDH are usually fitted with a special splint or harness, such as a Pavlik harness. This holds the hips in a safe position, with the legs gently kept apart, to help the hip joint develop normally. The Pavlik harness is a soft harness that can be worn over or under the clothes. Other splints can be more solid, or ‘rigid’. Most babies wear the harness for 6 to 12 weeks, although some may need it for longer and the harness is usually required to be worn all the time, including during sleep.
Regular check-ups and ultrasound scans are necessary to check the fit of the harness and the progress of treatment.
For more information about the Pavlik harness please download A Parents’ Guide to Caring for a Child in a Pavlik Harness.
The Pavlik Harness – what you need to know
If the hips do not improve with early treatment, or the condition is not diagnosed until later, different treatments, including surgery, may be needed.
Initial surgeries may include surgery that releases tight tendons and ligaments (reduction surgery) but sometimes surgery involving the bone (osteotomy) may be required to help improve how the hip and thigh bone interact.
After surgical procedures, your child will be placed in a special plaster or fibreglass cast called a hip spica. This is a hard cast that often has a bar between the legs for stability and is used to hold the hips and legs in position while healing takes place.
For more information about surgery and casting, please download Hip Surgery and Spica Cast Care, a Parent’s Guide. Steps have also produced a downloadable factsheet – Common Types of Hip Osteotomy Surgery in Children.
Caring for a Child in a Pavlik Harness
As your child will be in the Pavlik harness for 24 hours a day, there can be extra challenges and questions when it comes to caring for your child. Our downloadable, A Parents’ Guide to Caring for a Child in a Pavlik Harness aims to provide a useful ‘how to’ when it comes to caring for your child and specifically covers:
- Nappy changes
- Keeping clean and skin care
- Clothing
- Sleeping
- Play time and tummy time
- Feeding
- Car seats and pushchairs
Caring for a Child in a Hip Spica Cast
Caring for a child in a hip spica cast will have specific challenges. Steps downloadable, Hip Surgery and Spica Cast Care, a Parents’ Guide aims to provide useful information when it comes to caring for your child and specifically covers:
- Toileting
- Washing
- Sleeping
- Positioning your child
- Playing
- Clothing
- Diet and meal times
- Childcare and school
- Travel
Steps has compiled a list of items and equipment recommended by other DDH parents that may be useful when caring for a child in a hip spica cast.
The following videos cover caring for the needs of children at different ages.
How Will DDH Affect My Child?
Most children who receive treatment in the first months of life go on to attend school, take part in sports, and live active, healthy lives. Many children who respond well to treatment remain pain-free and have no functional limitations many years later.
However, more research is needed to understand the long-term outcomes into later adulthood as some people who had DDH as a child may experience hip pain in adulthood and may also be more likely to develop joint stiffness, arthritis or need a hip replacement earlier than average, even when treatment in childhood was considered successful. For this reason, maintaining good muscle strength and discussing symptoms or activity-related discomfort with a physiotherapist is important and can help manage symptoms and better prepare for the future.
For more information and advice, Steps have produced a factsheet on Adult Hip Health.
Sharing the News
When and how you tell close family, friends and other relatives about your child’s condition is a very personal decision which will be impacted by how and when the diagnosis occurred, the individual prognosis for your child and the potential treatments available.
There is no right or wrong way or time to share the news, however, being well informed about the condition and having the opportunity to connect with other parents who can understand what you are feeling will likely help.
Once you do share the news, your relatives and friends will probably want to know how they can support you and your child, so take advantage of the experiences being shared by other parents to help you feel equipped to answer these questions.
Support
Steps is here to offer emotional and practical support.
The Steps closed Facebook Group is a friendly and safe way of discussing your worries, sharing tips and finding emotional support. Our Family Contact Service identifies someone else who has been through a similar situation and who’s happy to talk about their experiences, on a one-to-one basis, to offer support.
You can reach out to Steps with your questions, concerns and requests via email info@steps-charity.org.uk or leave a voicemail message on 01925 750271 and one of the team will be in touch.
All our DDH links and related resources can be found below
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