Developmental Dysplasia of the Hip (DDH) is a problem that some babies are born with. The hip socket has not formed enough coverage over the ball of the hip joint. If left untreated, these babies are at risk of having dislocated or dislocatable hips. If picked up early, babies can be splinted. Although this seems overwhelming at the time, it is far preferable than if it were missed. Delayed diagnosis can mean surgery is the only option, or even early onset hip arthritis and joint replacement surgery.
I know a lot about this condition – my son was born with DDH. He was breech, and this is a known risk factor. Other risk factors include a family history of DDH, first born babies and girls. It can affect one or both hips. When babies are born, part of the newborn check involves examining the hips and making sure they feel “in the socket” and that they can’t be moved out of the socket. If they are clearly dislocated or dislocatable, the baby will be referred to see an orthopaedic surgeon quickly and splinting will be commenced. If there is uncertainty or any risk factors for DDH, a hip ultrasound is arranged, ideally in the first 2 months of life. This is usually diagnostic – the baby either has normal hips, or has DDH. Occasionally “hip immaturity” is found. These babies are likely to be ok, but are followed up with more scans in the next few months.
Splinting is a relatively easy way of correcting the hip problem. The thigh bone is directed into the hip socket by keeping the legs out to the side (in a ‘frog’ or ‘M’ position). As the baby grows, this position will ensure the hip socket grows to cover the ball joint. There are 2 common types of splints in infancy – the Dennis Browne Splint or the Pavlik Harness. Hip Spicas are made out of plaster and are used in babies older than newborns.
This is my son in his Dennis Browne Splint. This splint has two rings (one around each thigh), and then a bar that goes across his lower back. The fabric tape is tied so it doesn’t swing up or down. This is the “frog” position the thighs are required to be in to encourage normal hip development. This brace was a waterproof option. Hip splints/braces do not get taken off for at least 10 weeks. EVER. Having a waterproof one meant he could have a bath when that poonami came along. It was very handy! But careful drying afterwards is required. I used a hairdryer on a very low setting. No creams can be applied to the skin that comes into contact with the splint.
Weekly or fortnightly visits to the physio are needed so they can adjust the harness to make sure it is not too tight. They grow so quickly!
So how did I feel when my son’s 6 week X-rays were abnormal? Pretty upset to be honest. My logical brain knew this was ok – it was treatable, not life threatening, and once fixed he would have no long term consequences. But the implication this had for looking after my newborn was pretty significant. How did I change his nappy? How would he fit into the capsule in the car? How would I breastfeed him with his splints on? What do I dress him in? How would I hold him? Will he find this uncomfortable and be hard to console?
The reality was – he was completely unfazed and it took me a matter of days to adjust, and life carried on as normal. However, I did learn a few tricks along the way, and got some good advice from other parents who had travelled this path before me, and I’m keen to share my knowledge!
I found 2 FaceBook groups useful. The best one was “Developmental Dysplasia of the Hip (DDH) Babies, Kids & Adults”. This is world-wide and a bit more active. There is an Australian one – “Aussie Hip Kids (Hip Dysplasia, Spicas, Surgery and Harnesses)”. This is great for local knowledge and products. Both these pages are helpful for practical advice about caring for a baby with hip dysplasia.
My baby was diagnosed at 6 weeks. He was already quite big by that stage. I had LOVED using my click-in click-out capsule for my eldest when she was a baby and was looking forward to easy transfers from the car with my son. This was not to be. Capsules are deep and narrow, and by 6 weeks of age, it was not going to accommodate him with his legs out to the side. Cue a frantic drive from the hospital where his brace was fitted (while only just squeezing into his capsule), to the Red Cross Baby Seat Shop on Henley Beach Road, and the amazing staff there were able to fit him into a regular baby car seat, with added padding (terry towelling nappies) and a buckle extender. I was so grateful! He was now safe and comfy in a new car seat.
My fear of not being able to easily transfer in and out of the car was not realised. Luckily he was a placid baby and easily went from car, to arms, to baby carrier, or to pram.
This brings me to baby wearing. It is SO EASY with a splint on. I LOVED my Baby K’Tan. It looks like a stretchy wrap carrier but it is more like a T-shirt you put on. His legs being held out to the side made it quite easy to put him in, and he loved it! He would have also fitted into a structured carrier, but I found the stretchy way more comfortable at this stage.
This was the most daunting but actually become a blessing in disguise! Firstly, undo the tabs at the front of the nappy. Then turn baby over, onto their tummy. Roll the back of the nappy down, underneath the bar of the splint (which sits along the sacrum/upper bottom/lower back). Clean up the skin etc (bottom first, then the front). Take the dirty nappy away and place a clean one underneath. Push the back of the nappy up under the bar of the splint; turn baby over, and do up the tabs at the front. It is SO WEIRD changing a baby on their tummy! But babies get a lot of incidental tummy time. And they can’t roll anywhere because of the splint. Bonus!
TUMMY TIME and SITTING
I was told by my physio that babies in hip braces are usually ahead in their gross-motor strength in terms of sitting and head control. I think this is from all the tummy-time with nappy changes. But the splint also makes it easier to put them into a sitting positing. Tummy time is also easy with a pillow under their torso. Although, to be honest, most of my son’s tummy time was done in a baby carrier or at nappy change time.
Here he is sitting up like a big boy.
Playing with his feet. Not fussed by the braces at all!
If you have had a breastfeeding consult with us, you would know that we are big on “Gestalt Breastfeeding”, an evidence-based style of breastfeeding that has been developed by Dr Pamela Douglas and her team at Possums in Brisbane. Having splints on your baby does make this a bit challenging, but it’s not impossible. I found it was easiest to hold him with my arm between his legs. His body was still being held across my torso (horizontal to the ground). Luckily, by the time he was 6 weeks of age, his torso was long enough that his bottom and legs were already beyond my torso width, so his little legs could dangle off to the side. It was a bit squishy at times and it did create more distance between my body and his, but it was the best we could manage. I tried sitting him up, in more of a koala position, where he was straddling my thigh. I have a very short torso, and this didn’t work well for us, but could be an option for others. I also managed to feed in a side-lying position but needed some pillows/blankets to prop his torso up a bit, and adjusted my lean to the side. Once we got used to it, it was easier than I expected.
When babies in a splint are put on their back, their legs are actually hanging in the air, with their thighs supported by the rings of the splint. Advice I got from other mothers was to place a folded blanket under his lower legs, so that they had something to rest on and wouldn’t dig into the splint. Such good advice! I was putting him in a sleeping bag, as wrapping with his legs like this was a bit hard. There were a few brands of sleeping bags that were “hip safe” and very generous in the leg area. This worked for us, as well as a blanket over the top when it was cold.
This was the easy part! The braces stabilised his hips and torso. I could easily carry him on my hip from a young age. Baby wearing was much easier than I expected. Holding him with an arm between his legs was effortless.
This was hard! Harem pants for girl babies works well – they are very generous around the thigh/hip area and can be stretched over the harness. Luckily my summer baby could be dressed in onesies. I also ordered “leg warmers” online. These were great! I could tuck them up under the splint to keep his legs warm. Onesies that covered the legs had to be at least 1 size bigger. I preferred using a onesie that did up under the bottom, and then larger-sized pants over the top. Dresses for girls would be easy.
Here are some examples of what I dressed him in. 1) Leg-warmers and a onesie that buttoned up under his nappy. 2) Short sleeved/legged onesie that had press studs under the nappy. 3) Generous pants that I could get over his harness and a long armed onesie that buttoned up under his nappy.
In summary, despite my worry about how difficult these splints would be to manage, it really wasn’t too bad at all. It didn’t get in the way of breastfeeding or caring for my baby, and in some ways made it a bit easier. I hope this blog post gives other parents who are just starting their journey with their hip baby some relief and reassurance that things will be ok. You and your baby will thrive.
-Dr Briony Andrew