Developmental Dysplasia of the Hip (DDH)
As we near the end of ‘Healthy Hip Awareness Month’ I thought I would share a little about our hip baby and hip dysplasia. Olive is now 3.5 months old and has been in her Dennis Browne Brace/Bar (DBB) for a little over 5 weeks.
I knew very little about DDH until two months ago. Being our second child, I knew the Community (or Child and Family Health) Nurse was rotating our daughter’s legs in the hip joint to test for ‘clicky hip’ when she was one week old. I didn’t know what a ‘clicky hip’ indicated. The nurse told me that she wasn’t too sure on one of her hips. It wasn’t clicking each time but didn’t feel quite right and she recommended I get them looked at again in the drop in clinic in a week or two to see if it is still present. The nurse said the right hip was the concern. When I went to the drop in clinic, the nurse there felt the left hip was the concern.
At the advise of two Community Nurses but still unphased by what ‘clicky hip’ actually indicated, we went to the doctor for a referral to an ultrasound. They don’t do the ultrasound until 7 weeks at the place my referral was for which didn’t phase me. For some reason, I was still pretty sure that my little one didn’t have whatever it was they were looking for. I even remember saying to her during the ultrasound when she got a little upset, “It is alright, Olive. We are just here to be told everything is fine.”
The results indicated otherwise, Olive had a moderate Developmental Dysplasia of both hips. Now I had a name for this ‘clicky hip’ issue, I went to the internet for some information beyond what I was told today. Being told your daughter’s hip hasn’t developed properly and to see your Doctor as soon as possible is a little unsettling. Now the one week wait to see our Paediatrician felt grueling. We were told by our Paediatrician to get in to Westmead Children’s Hospital’s clinic within the week if we could. If it was going to take longer, he would put some temporary measures in place. There were so many new words but subluxation and acetabulum were the ones mentioned most. Basically, our daughter’s hip was not dislocated but the hip socket hadn’t developed deep enough to allow the ball of the femur to sit and operate how it should.
Developmental Dysplasia of the Hip is the name given when a hip joint has not formed properly causing instability or looseness. As with most medical intervention, the earlier the detection and treatment, the better the outlook.
Being female is the only risk factor Olive has. The risk factors* are;
- Breech position
- Low levels of fluid in the womb
- Weighing 4kg+ at birth
- First born child
- 42+ weeks gestated
- A family history
My first thoughts after being told by the Orthopaedic specialist that she would be braced 23hrs/day included;
- What about my special little baby cuddles?
- Will she be able to have tummy time, roll or crawl?
- How long will it be on for?
- What about breastfeeding?
- Will she be in pain?
- What about babywearing?
While we are limited in the ways we can cuddle her, she still gets many cuddles. I have to resist the urge to hold her in her brace free hour as I know it is most fun for her to be kicking around.
After spending some time on a DDH Facebook page (https://www.facebook.com/groups/ddhsupportworldwide/) I had come to learn that so many of our hip babies had no risk factors. This page armed me with so much hope that while the first few weeks in the brace would be potentially quite unsettling, more for the parents than the child, the early intervention was a positive and the brace will quickly become our ‘normal’. I saw videos of children rolling over in braces and taking their first steps, looking like a cowboy due to the brace, but first steps none the less!
As expected, the first few hours home were pretty traumatic. Our first few attempts at breastfeeding were not very successful with both of us in tears. Olive will not take a bottle, despite a few attempts prior to the fitting, so we had to work this feeding thing out! The aforementioned Facebook group was filled with other people’s stories and tips on things like breastfeeding, sleeping, comfort during up time and general comfort. The feeding position that worked for us involved her braced legs straddling my opposite leg to the side she was to be feeding on and angling towards the breast.
I was assured by the professionals that she won’t be in pain, just some discomfort while she gets used to it. It didn’t take as long for her to get used to the brace as I had thought it would. Only a few days in she was smiling and playing again.
There are some baby carriers out there that are not ‘hip healthy’. Some have dubbed them ‘crotch danglers’ as the baby has no hip support. We use woven wraps to wear our little ones so were well versed in the importance of the seat, ‘w’ position of the hips and not facing out frontwards. We love our babywearing and I didn’t want that to have to stop. When Olive was fitted in the brace, I asked the orthotist if it would be possible. My understanding of his reply was that since her hips were in the position the brace hold them in, we could wear brace free. This was great news and was my silver lining. While I knew it would be best for her to get used to the brace and to wear it as prescribed, if we were having a rough day then brace free, wrapped cuddles were not breaking the ‘rules’.
We had our first check up last week and her hip shape still needs more improvement but the depth of her socket is improving. While she is still 23/7, now when I am putting the brace back on and I say to her, “This is helping your hips and before you know it, you won’t need it anymore”, I actually believe what I am saying.
For more information on DDH, head to http://hipdysplasia.org/developmental-dysplasia-of-the-hip/