'Clicky hips' is quite a sweet sounding phrase to describe a condition with potentially serious effects. A campaign, Is Your Baby Sitting Comfortably, is aiming to heighten awareness and help parents to spot the telltale signs.
What is hip dysplasia?
Hip dysplasia, also known as developmental displacement of the hip (DDH), is a condition where one or both hip joints are partially or completely dislocated. The hips are ball and socket joints – sometimes the ball has not developed properly, sometimes the socket is too shallow, so the ball slips and and out.
According to the International Hip Displacement Institute (IHDI), between two and three infants in every 1,000 will need treatment for DDH – but where it does occur, it's not always easy to detect, and this can cause more severe problems down the line.
Sometimes DDH is present from birth. It's not clear cut in terms of what causes it, but genetics may play a part. Girls are more likely to have clicky hips than boys, as are breech babies, who had little room inside the uterus to stretch and kick.
In any case, your midwife will routinely check the stability of your baby's hips soon after they are born, spreading their legs wide apart, bending and unbending their legs. This examination won't hurt your baby – it might make them a bit cross though!
If the midwife hears a clunk when manoeuvering your baby's hips, they might tell you your baby has hip instability. This does not necessarily mean they have DDH – and in most cases the problem will correct itself – but you should be offered further tests and an ultrasound to see what's going on in there.
If all is well, your baby will be checked routinely as they grow, at around eight weeks and again at nine months. Babies over six months of age presenting symptoms of DDH should be given an x-ray.
As the name of the condition suggests, DDH can be something which develops as your baby grows and so it is important to know the signs because the sooner DDH is diagnosed, the higher the chances of successful treatment.
There are many subtle and not so subtle giveaways. For example, when you change your baby's nappy, you might notice that one leg flops further outwards than the other; your baby might have asymmetrical creases on their thighs or bottom; when your baby begins crawling, they might drag one leg a bit; you might notice one knee seems to turn outwards; your child might resist weight bearing; or when they are beginning to walk, one leg might appear shorter than the other, they might walk on tip toes, or limp.
Don't ignore the symptoms – if left untreated DDH which is mild in a baby can become much worse. The cartilage of the hip joint can be worn away, by the time your child is in their teens they might have mobility issues or a limp, and DDH is the leading cause of osteoarthritis in adults. In short, DDH can lead to serious problems requiring hospital stays, operations and if all fails, permanent disability.
If you notice any of the symptoms associated with DDH, it is important to get your child checked out as soon as possible by your GP – the earlier it is detected, the less invasive the treatment and the more likely it is the treatment will be successful.
The treatment for DDH varies according to how early it is diagnosed.
Up to four months of age, your baby will probably be treated with a Pavlik harness, a sort of fabric splint which must be worn for several weeks to keep the hips in the correct position. Often this relatively simple method solves the problem, which is why it's so much better if DDH is spotted when a baby is tiny. Sometimes, though, the harness won't be enough.
If your child is not diagnosed until six months of age or older, they may need to have surgery under general anaesthetic to realign the ball and socket joint properly (possibly preceded by a period of time in traction) and perhaps to deepen the socket, to prevent the ball slipping out.
After the operation, your child will need to wear a special cast, called a spica cast, for about six weeks, before undergoing a further operation to check the stability of the hips. Then the spica cast will be replaced again. Checks and amendments need to be made, under general anaesthetic, every six weeks or so due to a child's natural growth – how long it goes on for will depend on the severity of your child's condition and their progress.
You can read about two mums' experiences of their children's DDH diagnosis and treatment here.
Although it's not possible to prevent DDH completely (because sometimes it occurs before a baby is even born), there are some factors known to potentially cause it or exacerbate it in children following birth.
The first is swaddling. Many parents swaddle their newborns – many babies find it comforting to be wrapped up securely. But swaddling in the wrong way can cause problems.
It's important, when swaddling your baby, to ensure that their legs are free to bend upwards towards their chest and outwards towards their hips (their natural position in utero). Swaddling your baby tightly with their legs in a straight down position, so they are unable to move them around freely, can contribute to the onset of DDH.
The IHDI has a video demonstrating how to safely swaddle.
Similarly, any other devices which might force your baby's legs into an unnatural position can be harmful. For example, baby seats, car seats, baby carriers and slings, should all allow your child's legs to remain in, or at least freely move into, their natural position – bent at the knee, turning out towards the hip (think of a frog on its back!).
Any seat or carrier which forces or encourages your baby's legs to lie or hang straight, or anything which brings your baby's legs in at the knees, is not the right choice. The IHDI has some diagrams to illustrate.
The International Hip Dysplasia Institute has heaps of useful information.
Steps is a UK charity offering advice and support to people suffering with lower limb conditions, including DDH. You can call their helpline on 01925 750721.