Developmental Dysplasia of the Hip
Developmental dysplasia of the hip (DDH), or hip dysplasia, is the most common cause of hip problems in children. It also has been at the center of two controversies in the last several years.
The United States Preventive Services Task Force in 2006 concluded there was insufficient evidence to recommend routine screening of all infants for DDH. A recent decision analysis study, conducted at Boston Children’s Hospital, suggests that with universal screening and selective ultrasound screening of some infants for DDH, there is less chance of the hip becoming prematurely arthritic.
Ultrasound screening can be ordered by the primary care provider and should be targeted to infants with a family history of hip dysplasia and breech babies or those with any clinical suspicion of hip dysplasia on physical exam. The ultrasound exam should be performed at approximately 6 weeks of age, if the hip is stable, because exams performed earlier than 6 weeks have a fairly high false-positive rate.
If ultrasound findings are questionable or positive, the child should be referred to an orthopedic surgeon.
The second controversy relates to swaddling, which is recommended as a way to soothe infants. However, infants should be swaddled at the torso level only, as swaddling the legs can increase the risk of hip dislocation. Earlier studies looking at cultures that swaddled their children had made this connection. Providers should teach new parents how to safely and appropriately swaddle infants.