Are you wanting to babywear, but are scared by horror stories of hip dysplasia in infants?
As parents, we want our babies to live perfect lives, without the burden of needing surgeries or medical equipment. But, the reality is that infant hip dysplasia happens, and while it is often preventable, in some cases, it’s unavoidable.
Let’s discuss what baby hip dysplasia is, how to prevent it, and what you can do to treat it if it happens.
What Is Baby Hip Dysplasia?
Hip dysplasia is the underdevelopment of the hip bones. This can lead to clicky or easily-dislocated hip joints and may occur in one or both of a baby’s hips.
The hip is a ball-and-socket joint that develops while the baby is still in utero and continues to develop in early childhood. In a newborn, the hip joint is mostly made up of cartilage, which is replaced by bone throughout the first year of life.
Normally, the ball grows faster than the socket, keeping the ball portion inside of the socket. But, in this condition, the socket is underdeveloped, so the ball cannot be fixed within the socket. As a result, the hip is prone to dislocation and could cause more problems in the future.
The Causes of Infant Hip Dysplasia
The exact causes of infant hip dysplasia are unknown, although it is known that a baby could either be born with the condition or develop it as an infant. Below, however, are a few factors that increase its likelihood.
There are several genetic links to this condition. For example, if one child in a family has had infant hip dysplasia, there’s a one in 17 chance another one will have it (1). Also, if a parent had the condition as an infant, the chances of their children having it increases to one in eight. Girls are more likely than boys to have hip dysplasia.
Its likelihood increases to a one in three chance if a parent had the condition and has already had a child with hip dysplasia.
2. Position in Utero
How a baby sits while they are in utero can also affect whether or not they develop this problem. Some positions can cause pressure on babies’ hips, stretch the ligaments, and make them more likely to develop the condition.
The normal in-utero position puts more strain on the left hip than the right. This is thought to be why the left hip is more often affected. Breech babies, babies with torticollis, and those with foot deformities are also more likely to have this issue.
Some people also believe that hormonal changes toward the end of pregnancy which loosen a mother’s ligaments to facilitate birth can make the baby’s ligaments lax too.
3. Baby Carriers
Baby carriers can cause a baby to develop infant hip dysplasia if they do not hold the baby’s hips in the correct position.
For example, some carriers are narrow at the crotch and allow the baby’s legs to hang down. This strains the baby’s hips and can cause dysplasia. A sling carrier can also cause it if the baby is not positioned correctly.
4. Car Seats
Car seats can contribute to this issue because of the way they hold the baby in position. A narrow car seat does not allow room for the baby’s hips to spread out (2).
Swaddling can be a great tool to comfort your baby and help them rest easy. But swaddling them too tight, until their legs have no room to spread, can increase the risk of this problem.
Preventing Infant Hip Dysplasia
- For a soft-structured carrier or mei tai, use one that is wide at the crotch and allows your baby’s hips and knees to sit at an M shape, with the knees angled slightly above the hip joints. This supports the baby’s legs from the hip to knee joints.
- When placing your baby in a sling, do not place them lying down with their legs tight together. Instead, have them sit up, with their hips spread around you to keep them stable. These methods put less pressure on the joints and make dysplasia less likely.
- Choose a car seat that is wide and allows your baby’s legs to spread apart. A narrow seat prevents the legs from spreading and results in unnecessary pressure on the hip joints.
- When swaddling your baby, make sure not to force your baby’s legs tightly together. Instead, give enough room for their legs to spread apart and bend slightly at the hip.
- There is no need to fear about the swaddle coming undone; you can secure your baby’s arms snugly while the legs have more room. Allowing the baby’s hips to flex open will cause less strain on the joints.
- Finally, if your baby has a predisposition to this condition, either from genetics or an in-utero position, talk to your doctor to see if triple diapering would be a good idea. Using this method involves simultaneously wearing multiple diapers on your baby to keep their hips in a frog-like position. You could also roll up cloth diapers between the baby’s legs to keep the hips at an optimal position.
What Signs Should I Watch For?
It is important to recognize the signs of hip dysplasia and catch them early. This allows treatment to begin right away and your baby can get the care they need. Here are five things to look for.
When you lay your baby on their stomach, do you notice that one buttock crease is higher than the other? This might be a sign of this condition. Usually, an x-ray or ultrasound can diagnose it.
2. Limited Range of Motion
Babies without this problem have flexible hip joints (3) and their legs open up easily while diapering. If you notice your baby’s legs are not able to spread or relax as they should when diapering, contact your doctor.
Hips that snap can be a normal occurrence in babies, but clicking hips can often be a sign of infant hip dysplasia. An x-ray or ultrasound will confirm the diagnosis.
Pain rarely occurs in babies with this condition. However, it can occur in older children or adolescents.
5. Swaying Back
A swaying back exaggerated limp or having one leg longer than the other could all be signs of this problem. An exaggerated limp would signal the condition in just one hip joint, whereas swaying back and limping together can be a sign both hips are affected.
If your baby does develop this issue, don’t be discouraged. Sometimes it can happen, even if you have done everything right, and no one fully understands why. Thankfully, there are several treatment options available.
Treatments might differ based on your baby’s age, activity level, or the severity of the condition. Below we will discuss treatment options based on age, and how these treatments work.
Newborn to Six Months
Braces are often used in newborns because their hips can easily be placed back into the socket and simply need to be held in place until the joint can fully develop. The Pavlik Harness is a common device, as are other abduction harnesses (4).
These devices keep the knees and hips spread apart and bent to help the hip joints develop in the optimal position (5). Usually, the braces are worn full-time for 6 to 12 weeks, although they may be taken off for bathing and diaper changes.
Once the hip joints are stable, babies will wean off of the device, first wearing it part time and then only at night before finally stopping entirely.
Six to Eighteen Months
This age group is a tricky period. Sometimes, the non-surgical methods work to repair this problem, but other times, doctors may need to take more complex measures. It often depends on the doctor and how severe the dysplasia is.
The hip may be placed into the socket under general anesthesia in a process called closed reduction. General anesthesia means the child is put to sleep using gas during the procedure.
After the hip is put into place, a spica cast is used to hold it in position for several months. This procedure is called a closed reduction because you don’t have to make any incisions to set the hip.
Sometimes though, a closed reduction is not enough. In especially severe cases, doctors might recommend an open reduction instead. For babies under one year, doctors often prefer a medial approach, but they are likely to use an anterior approach for children over a year old (6).
This is because the thigh bone often needs to be shortened and then tilted toward the joint to relieve pressure on the hip. The procedure improves joint stability and reduces the likelihood of problems later in life.
Before You Freak Out
Eighteen Months and Older
For children of this age group, a closed reduction can be attempted, but they will need to be in the cast for longer to help the hip grow back normally. Doctors might choose to perform an open reduction instead as the process is quicker and more efficient in many cases.
The most popular treatment for this age group is an open reduction with an anterior approach and bone shortening. Ligament tightening is often done as well.
Six and Up
For this age group, a reduction is rarely done because any bone changes are often permanent. Hip dysplasia can still be treated though, and this helps to delay arthritis in the future.
Keep Moving Forward
No parent wants to face the reality that there is something wrong with their baby, but sometimes things happen despite our best efforts. Infant hip dysplasia is one of those things.
Still, try to do as much as you can to prevent the condition. Make sure to use a proper carrier when babywearing, keep their legs loose when swaddling, and provide a wide car seat.
But, if this condition still happens, the good news is it is usually easily corrected and won’t cause lasting issues if taken care of properly.