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Hips and Clicks in Infants
Early diagnosis prevents problems later
Shortly after birth, each newborn receives a thorough physical exam. This exam is likely to be repeated at least once while the baby is in hospital, and several times over the first year of life. These exams are often done by the family doctor, but may be done by other health professionals such as nurses and medical specialists. An important part of the exam is a check of the hips. This check is done to ensure that both hips are solid, and that the joint cannot be easily dislocated.
In about one or two babies in every hundred, the examiner will find a 'click.' The click may be found on the first exam, or the discovery may be delayed for weeks or even months. A click is the noise or sensation that is felt when a hip dislocates under pressure. Hips are not supposed to dislocate, so a click is not a good thing to find.
If a click is heard or felt, there will be many checks of the hips in the next few days. Some of the early clicks are due simply to looseness in the ligaments (tissue that connects the bones) at birth, and disappear in a few days. In other babies, the click persists, and requires review by a specialist. This is usually done by either a pediatrician (specialist for babies and children) or an orthopedic surgeon (specialist for bones, joints and muscles).
The review includes getting an image of the joint. This is not always as simple as you might think. At birth and for a few months after, the hip joint primarily consists of cartilage. Since cartilage is not seen on x-rays, they are not helpful in examining hip joints during the first few months. At that time, ultrasound will give a reasonable picture of the joint. After about four months of age, the joint contains enough bone that a standard x-ray will show how it is lined up.
If the physical exam and the image confirm that the joint is poorly formed, the condition is called congenital hip dysplasia (CHD). If CHD is found, it is important to get the correct treatment quickly. This usually means the baby will be placed in some kind of brace, to hold the leg and hip in the correct position. By placing the baby's hip(s) in the right position, it is possible to mould the hip into the correct structure.
Moulding works very quickly and easily if CHD is detected and treated shortly after birth. When treated in babies less than a couple of months old, it is likely the problem can be corrected before the baby begins to walk. If the problem is not found until the baby is walking (and most babies with this problem will walk), it takes much longer and much more aggressive bracing to bring about the necessary changes in the hip joint.
Treatment varies according to the severity of the hip problem. Some babies simply have a hip socket that is slightly shallower than usual, while others have almost no socket at all. In mild cases found early, the only treatment that may be needed is double diapering for a few weeks. In more severe cases, it may be necessary to put the baby in a special brace, called a Pavlik harness, for many months.
Fortunately, with treatment, almost all babies with CHD recover fully and go on to lead completely normal lives. If left untreated, these children will have serious problems with many activities throughout their lives.
When your family doctor examines your newborn or young baby for CHD, the baby's legs will be pushed vigorously back and to the sides. Many times the baby will object to these movements by crying. Please remember that your doctor is not trying to hurt your baby. The doctor is trying to ensure that your child will have every opportunity to grow up and walk normally.
Only rarely will a family doctor find a problem, but, when found, CHD is almost always completely curable. Only limited measures are needed to prevent what could be a serious lifelong disability.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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