Monday, 8 April 2013

Baby Hip Dysplasia (clicky hips)

Hip dysplasia is a subject I am compelled to cover, as baby hip dysplasia is surprisingly common in new born babies. This was my daughter Izzy, as a baby, in her Pavlik Harness used to treat hip dysplasia.
wearing the pavlik harness

Help and advice:
I have set up a facebook support group forum at: which is a great place to meet other parents in the same boat and there are now hundreds of members.

So, who gets hip dysplasia:
It is worth getting your babies double checked for hip dysplasia as 15% population have some hip disorder, which can present at any stage from babyhood to adulthood. First born girls, breech babies, late and twin babies and babies with hip problems in the family.  
My daughter, now just four years, slipped through the hospital first day (hip click) check, health visitor's 1st week hip click check and doctor's 6 week hip click check. It is a very basic and CHEAP test and can easily miss anything less than the severe hip dysplasia. They spread the legs backward to see if the hips click and dislocate. The trouble is, that does not cover all the bases.. 
Izzy's her hips never actually dislocated out of the socket (clicked out), but never the less, one of her hip sockets turned out to be so shallow that, had I not spotted this, she would have needed a major hip operation before the age of five! Some counties routinely ultrasound newborns, but not here in the county of Yorkshire and not in many other counties/states and countries, for that matter. So parental awareness is key.

How did I know she had hip dysplasia:
By the time Izzy was 4 months old, my hubby and myself grew increasingly concerned at Izzy's leg length discrepancy.  We had initially passed it off as that new born twisted, scrunched up look, thats babies often have as newborns and so had the professionals. I was reassured several times over by the health professionals, but there was always doubt in my mind that something was actually wrong.

One day the LLD (Leg length discrepancy) struck me as dramatically obvious. And also when bouncing her on my knee, she would only put weight through one leg/hip. So, I googled it (thank God for google!!) and she ticked a lot of the boxes for hip dysplasia, also called clicky hips. 
A condition I had never heard of. I was certain this is her problem. 
I then took her back again to my GP. He insisted she was fine and that the 1cm leg length discrepancy was normal  ...I pointed out 1 cm on an adult maybe, but on a baby 56cms long, I wasn't so sure he was right. 
I wouldn't leave the doctors practise without them agreeing to arrange a hip ultrasound scan for her!

What did they find:
I got the scan for Izzy 2 weeks later and she did have hip dysplasia. Her acatabulum was 10 degrees away from normal and was too shallow. They said for some reason her hip socket hadn't fully developed and that it was often a congenital/heriditory condition. 

She was immediately put into a pavlik harness.The pavlik harness was something I'd worried about a great deal, when reading up on dysplasia, but its actually very straight forward to use. Its purpose is to temporarily put the hips into a position that will permanently deepen the hip sockets

How to use the Pavlik Harness:
The pavlik harness is light, its easy to wash and its best for you if you make permanent ink marks where the straps are set, so you can KNOW where to fasten it, if you take it off and want to put it back on.  You'll become aware also of when they're growing too, as the markers need to move. 

Downsides to the Pavlik Harness:
It can cause babies to have a little more wind that usual, but certainly, in our case, nothing significant. The biggest nightmare was her wardrobe. She couldn't wear trousers, baby grows (unless super large) or any dress that wasn't designed to flare out as they would simply ride up to tee shirt height! So she wore party dresses the whole time because they all kicked out at the chest like little princess dresses!! Leg warmers came into their own too!
The other difficulty was seating her. Our pram, the bugaboo was fine and I believe the quinny zap is wide and good with a harness also, probably the best in my experience because of its wide seat shape. 
The stoke highchair also fine. Maxi cosi rear facing car seat was ok, with a little cushion under her bottom to boost her and allow her hips to spread out. I also understand there is a special britax seat designed for this should your child be older, or in a pot version. 
There are products, but it can get expensive and it seems unnecessary for hopefully such a temporary length of time. So at a LATE four and a half months (best results, if applied before 6 weeks) she began wearing her pavlik harness. Initially 24 hours everyday for 6 weeks. 

Progress was slow for Izzy at first, as her hip dysplasia had been discovered late at 4 months.   At the end of the first six weeks she had only improved by 1 degree and they said surgery would be the next step, should she not progress and to brace ourselves for that likelihood. Izzy was now six months old and very few babies made progress after 6 months. 
However we went along with her continuing the wear the pavlik harness for another 6 weeks. She was allowed an hour per day not wearing the harness, but we couldn't see the point, other than for bathing, as it upset her more to put it back on then. Once on, she barely noticed the pavlik harness, although in the final weeks she seemed to kick against it. 

In the last month she suddenly had a growth spurt and this I am 100% sure is what caused the harness to suddenly work, as at our next assessment she progressed the full 10 degrees! We were stunned! Thank you, thank you, thank you, is all we could think. She wore the pavlik harness for 3 months, until seven and a half months old. 

Medium term effects: 
The pavlik harness delayed her sitting at six months, but within literally 2 weeks of the pavlik harness coming off, she could sit unaided AND CRAWL!! The harness actually really strengthened her legs! Then amazingly, she was walking ahead of a lot of her peers, which is a real shock! So please do not fear it will hold your child back.  

We were assured all was well at her age 2 check up and now she is 4 she will have another check up this summer and so on until she is 18. All in all, the pavlik harness is nothing to put your baby through, compared to the alternative of surgery. It will probably irritate you more than them. 

Your biggest problems will be highchairs, car seats and clothes (but girls, its a great excuse to buy all those frufru dresses) Many discuss ways around these issues on the forum. Sometimes people would stare at Izzy, like in supermarket queues... I took to explaining why she was wearing it, more often the person would know of somebody who had had clicky hips too. It certainly became a good ice breaker!

Top tip:
ALWAYS ask for 2 pavlik harness from the hospital, they won't automatically give you two and should you have a spill or nappy disaster (which you will) it makes life much easier not having to wash and dry it within an hour! Also used lots of softener such as Lenor or Comfort.

I have set up a facebook support group, in the groups section of facebook called 'hip dysplasia in babies' (clicky hips or CHD, DDH) I have put on LOTS of links to advice pages, to make it easier for others to search for advice, equipment, help.   
Its a fantastic support group.

It is absolutely worth getting your baby ultrasound scanned if you are at all suspicious, because if your hunch is correct and they don't get the intervention of the pavlik harness, then they really will develop painful symptoms as they grow a little older and almost certainly face surgery.  I can't emphasise the importance of treating hip dysplasia early. If treated within the first 6 weeks of life, the pavlik harness has a success rate of 96%, which is fantastic!  We know we were EXTREMELY lucky with Izzy that she responded to her treatment so well at the late stage of four and a half months. But, had I not pushed the situation with the doctor she would not have been treated so please do not be afraid to politely assert yourself. 

Here is Izzy now age 4 years, recovered!  Those early months of anguish were absolutely worth it!  ...And as you can see, she has not been held her back one bit!

Best of luck to you!

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