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Developmental dysplasia of the hip (DDH) is the name for a range of conditions
of a child's hip. It can affect one or both hip joints.
With subluxation or dislocation, the hip socket is often too
shallow, more like a saucer than the deep cup that it should be.
See pictures of
normal hip anatomy in a child and a
The exact cause of DDH is not
known. A number of risk factors can raise your child's chances of having
DDH, including a
family history of DDH and your baby's position in the
womb and at birth.
Having DDH does not cause
pain. A baby with DDH may have:
A child who is walking may:
Usually, DDH is diagnosed
during your newborn's physical exam. If your baby is older, DDH may be
diagnosed during a well-baby checkup. But it may be harder to diagnose
the condition in a baby older than 1 to 3 months, because the only outward sign
may be less mobility or flexibility in the movement of the affected hip
If the results of a physical exam are unclear, an
imaging test such as an
X-rays may be used to evaluate your child's hip
Most children born with looseness (laxity) of the hips won't have problems and won't need treatment. If treatment is needed, the doctor will move
your baby's upper thighbone into the hip socket and keep it in place while
the hip joint grows. A splint, called a
Pavlik harness, is most often used to keep the joint in place in babies younger
than 6 months. A hard cast, known as a
spica cast, is used for older babies. Other forms of treatment, such as
surgery or a brace, also may be needed.
It's important to treat
DDH early. Children with untreated DDH may develop lasting hip problems.
Don't try to treat DDH on your own, such as by diapering a baby with 3 or 4
diapers at a time or by trying to put your baby's legs in certain positions.
These methods don't work well and may cause the joint to develop
Learning about developmental dysplasia of the hip (DDH):
Living with DDH:
Health Tools help you make wise health decisions or take action to improve your health.
The signs of
developmental dysplasia of the hip (DDH) vary
depending on whether one or both hips are affected.
does not cause pain. A newborn or infant with DDH may have:
In rare cases, DDH develops in the first few weeks or
months after birth and signs may not be seen until your child starts to walk.
Then your child may:
Children with untreated DDH may develop lasting
deformities in their hips. Untreated DDH can also lead to hip joint
degeneration, which is a sort of early "wearing out" of the socket. When the
degeneration occurs in the
cartilage that protects and cushions joints, it is
osteoarthritis. Eventually the bones, which had been
separated by the cartilage, rub against each other. This rubbing damages tissue
and bone, and it causes pain.
Developmental dysplasia of the hip (DDH) is usually diagnosed by a
physical exam. A
medical history and other tests also may be useful in
All babies are examined for DDH at birth.
Newborns who have
risk factors for DDH, such as having foot, knee, or leg deformities, are
examined very closely for the condition.
Your child's hips are
also examined during regular
well-child checkups. But a baby with DDH who is older
than 1 to 3 months may have fewer visible signs, making it more difficult to
detect. These babies may have only slightly less mobility or flexibility of the
affected hip joint(s).
orthopedic surgeon or a pediatric orthopedist usually
confirms a diagnosis of and provides treatment for DDH. Your doctor will refer
you to one of these specialists if he or she suspects your child has DDH.
Tests that show
images of the hip joint are often done to help diagnose DDH if results from
physical exams are unclear. These tests are also used to monitor treatments for
Imaging tests used to diagnose and monitor DDH
developmental dysplasia of the hip (DDH) focuses on
moving your child's upper thighbone (femur) into its normal position and
keeping it in place while the
joint grows. The hip socket will not form and grow
properly if the ball at the top of the thighbone (femoral head) does not fit
snugly in the joint.
Treatment for DDH usually includes one of the
If your child has had
successful treatment for DDH, he or she will likely not have any further hip
problems. But have your child examined regularly to make sure his or her hips
continue to grow and develop normally.
The longer an unstable,
dislocatable, or dislocated hip persists, the more likely it is to cause
long-term problems that are hard to treat. For this reason, it is
important to diagnose and treat DDH early.
checkups are very important for monitoring the effectiveness of treatment and
preventing complications. For example, damage sometimes occurs to the blood
supply of the femoral head from treatment. If not detected and treated early,
this damage can lead to the destruction of bone cells (avascular
osteonecrosis). The bone may then grow abnormally, become deformed, and later
Basic home treatment for
developmental dysplasia of the hip (DDH) focuses on
interacting with your child and keeping him or her comfortable.
If your baby or child is wearing a harness, brace, or cast:
Other home treatment depends on the precise medical
Do not remove the
harness and do not adjust the straps for the first 3
to 4 weeks of treatment unless your doctor tells you to. The harness holds the
joint in the correct position for normal development. Removing the harness may
cause the thighbone to move out of position.
Give your child a
sponge bath while he or she is in the harness. Later in your child's treatment,
the harness may be removed for short periods of time, such as for bathing or
for cleaning the harness.
You can put your child's clothing on
under the straps to prevent skin irritation. You can also pad the shoulder
straps if needed.
If your child's cast is made of
plaster, it may need time to dry after it is first put on. Your child will
likely be in a semi-sitting position and may need you to help him or her move.
Turn your child at least every 2 hours for the first 24 to 48 hours to prevent
uneven drying of the cast. You can use a fan to help the cast dry more quickly,
but don't use heat. When you tap the cast and hear a hollow sound, it is
While your child is in a
DDH is a growth and development problem that is beyond your control. Remind yourself that you
did not do anything to cause this condition. Know that it takes time to manage
the frequently shifting emotions that are common when your child is diagnosed
with DDH. Find a doctor with whom you feel comfortable talking about any
concerns you may have.
Caring for a child who has DDH can be
stressful. Take time to care for yourself to reduce stress and to stay healthy.
When you have the energy to function well, you are able to provide the best
care for your child. For more information, see the topic
This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.
The website FamilyDoctor.org is sponsored by the American Academy of Family Physicians. It offers information on adult and child health conditions and healthy living. There are topics on medicines, doctor visits, physical and mental health issues, parenting, and more.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
Other Works Consulted
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics (2010). Developmental dysplasia of the hip. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 1050–1055. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Delahay JN, Lauerman WC (2010). Children’s orthopedics. In SM Wiesel, JN Delahay, eds., Essentials of Orthopedic Surgery, 4th ed., pp. 173–251. New York: Springer.
Podeszwa DA (2011). Developmental dysplasia of the hip. In CD Rudolph et al., eds., Rudolph’s Pediatrics, 22nd ed., pp. 852–856. New York: McGraw-Hill.
Polousky JD (2011). Developmental dysplasia of the hip joint section of Orthopedics. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 779–780. New York: McGraw-Hill.
Sankar WN, et al. (2011). The hip. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 2355–2365. Philadelphia: Saunders.
Shah SA, Stankovits LM (2006). Developmental dysplasia of the hip section of The hip. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 1018–1021. Philadelphia: Saunders Elsevier.
U.S. Preventive Services Task Force (2006). Screening for developmental dysplasia of the hip. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspshipd.htm.
White KK, Goldberg MJ (2012). Common neonatal orthopedic ailments. In CA Gleason, SU Devaskar, eds., Avery's Diseases of the Newborn, 9th ed., pp. 1351–1361. Philadelphia: Elsevier Saunders.
March 12, 2012
Susan C. Kim, MD - Pediatrics & John Pope, MD - Pediatrics
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