Hip problems in children. Two types of birth defects of the hip joint occur in children: hip dysplasia and hip luxation. In these conditions, the hip joint is not well developed. Normally, the hip has a head that fits nicely into the bowl of the pelvis. The femoral head is in the bowl, but the bowl is not deep enough. About one in fifty children have this congenital defect.
If the femoral head is dislocated, there is a hip luxation. This occurs in one in 1,000 children. If the head is not completely outside the bowl but is not positioned properly either, it is called a subluxation. Luxe hips are more common in the first week of life without a congenital abnormality. Hip abnormalities are four to eight times more common in girls than in boys. The hip defect can occur on one or both legs. In general, the left hip is more often affected than the right hip.
Hip dysplasia occurs more than once in conjunction with other birth defects such as club feet and is also more common with the child’s breech presentation. After a first child with congenital hip dysplasia from parents with normal hips, the chance for the second child is about 6 percent. This percentage goes up to 12 for the first child if one of the parents also had hip dysplasia and even to 36 for a second child of such parents. Let’s see about Hip problems in children.
How do you recognize Hip problems?
As a parent, it is difficult to detect hip dysplasia or hip luxation on your own. As a baby, your child does not suffer from hip problems. There are a few small features that could help you recognize a hip abnormality.
When your child is lying on its stomach, you may notice that the buttock folds are not at the same height. There may also be more butt creases on one side than on the other. Incidentally, a difference in buttocks often occurs without the hips being abnormal. Another sign may be that your child’s legs are different lengths. If your child has a hip problem on both legs, these deviations are symmetrical and are therefore not noticeable.
If your child is already walking, it may limp or stagger or pull with one leg. There may be a significant leg length difference.
Some hip abnormalities do not cause complaints until they are teenaged. There is then a nagging pain in the groin or buttock. Pain in the back or in the thigh can also occur. In that case, your child will especially have complaints when the hip is loaded. This is the case with standing and walking for a long time.
How does it arise?
The exact cause of hip dysplasia is unknown. There are a number of factors that increase the risk of hip dysplasia in your child. Chances are higher if:
- there is a family history of hip dysplasia;
- your baby was in a breech position or was born that way during the last months of pregnancy;
- your child also has other congenital anomalies such as an open back, a club foot or a bend in the back;
- there was little amniotic fluid in the womb so that your child could not move freely.
The hip socket is too shallow due to the hip dysplasia. This allows the femoral head to pop out of the acetabulum. Then there is a hip luxation.
Is it serious and what can you expect?
If hip dysplasia is not detected, your child may have problems walking later. It can also suffer from hip wear later in life. Timely treatment can prevent this. Preferably before your child starts walking.
Check-up Hip problems in children
That is why the midwife or gynecologist will examine your child’s hips immediately after birth. The consultation office doctor will also pay special attention to the hips when examining your child. If the clinic doctor finds abnormalities during the hip examination or if your child has an increased risk of hip dysplasia, you will be referred to the doctor.
The GP will refer you to the hospital where an ultrasound or X-ray of the hips will be made. If the ultrasound or the photo shows a hip abnormality, the orthopedic surgeon will treat your child for this or at least keep it under control until the abnormality has disappeared.
Treatment of hip dysplasia
Hip dysplasia is treated by spreading the hips (fixation). This usually has to be done for several months. Your child can simply stay at home. In the straddled position, the femoral head is well centered in the acetabulum. When your child moves the legs, the femoral head presses well into the bowl. In this way, the acetabulum is stimulated to develop properly. The flat cup deepens and encloses the femoral head better. Older children sometimes require surgery.
- Spreading aid
There are various aids that keep the hips spread out. The orthopedic surgeon can use the examination data to determine which method is most suitable for your child. The spreader must usually be worn day and night. It may only be taken off for changing and bathing. It is not painful for your child and it does not adversely affect its development. Your child can also learn to sit and crawl with a spreader.
If the spreading treatment is started at a young age, the treatment usually lasts two to six months. The later the treatment is started, the longer the treatment will take. After a few months, the ultrasound or X-ray is repeated. If it appears that the acetabulum has developed properly, treatment can be discontinued. If your child does not have a spreading aid during the day, it can develop further. It can learn to stand and walk. Some children also do this with the spreader and there is no objection to that. Physiotherapy is sometimes useful if your child is not trying to move around. The physiotherapist can stimulate your child with exercises.
In older children with hip dysplasia, spreading treatment sometimes has insufficient effect. The acetabulum is then made deeper by the orthopedic surgeon during an operation and the acetabulum is rotated so that it remains securely in the socket.
- Follow-up after hip dysplasia
After the treatment, your baby will be monitored by the orthopedic surgeon until the examination and photo are normal.
Treatment of hip (sub) luxation
A hip (sub) luxation is often first treated with a spreading aid, but this is only possible if the hip can be spread in the socket. If not, they switch to traction treatment.
- Traction treatment
In case of insufficient results of the spreading treatment, a traction treatment will be chosen. Your child will be admitted to hospital for this. It should be on the bed with the legs spread in the air. Weights are hung on both legs using adhesive plasters and pulleys, so that the muscles around the hip are stretched. Every day the legs are spread a little further. It looks annoying but it is not painful for your child. The treatment usually takes one to two weeks, but sometimes traction is needed longer. After the traction treatment, a photo with contrast fluid is taken of the hip joint under anesthesia. This allows the orthopedic surgeon to see in which position of the legs the head is best in the bowl.
- Spread pants
If, after the traction treatment, it appears that the femoral head can be placed in the acetabulum, your child will be given a cast or synthetic pants. This runs from the abdomen to the knee or foot. There is no plaster at the crotch so that you can take care of your child normally. Sometimes a stick is placed between the legs for stability. The cast usually needs to be worn for two to three months. Your child can develop normally with such plaster or synthetic pants. Roll over and crawl are possible. After the spreader pants, a removable spreader is often necessary for the treatment of the hip dysplasia. After all, hip luxation always involves hip dysplasia.
If the treatment has not had sufficient effect, surgery is necessary. The orthopedic surgeon then places the femoral head in the center of the acetabulum. After this, your child will also receive casts for two to three months. Sometimes it is decided to make the acetabulum deeper during surgery.
- Follow-up after hip dislocation
Your child will be monitored by the orthopedic surgeon until the hip has developed normally. Sometimes it is necessary to operate again at an older age.
Prognosis Almost all children who undergo timely treatment develop a normal hip joint and can walk normally.
When to go to the doctor?
It is advisable to contact your doctor if:
- you suspect that your child has a difference in leg length or a difference in buttock folds;
- your child has been walking loose for a while, but continues to stagger or has a very hollow back;
- your teen complains of groin, knee, buttock, back, or thigh pain for several weeks.
What can you do about it yourself?
When your child is treated for a congenital hip defect, you may face a number of practical problems. Here are some points to consider.
Care: Spreading aid Caring for a child with a spreading aid requires some extra attention, it is wise to change the diapers regularly. Due to the spread of the legs, they are more likely to leak. It is also easier for blemishes and pressure spots to develop in the groin or knees. A thin layer of zinc ointment can help restore the skin. Under the spreading aid, your child can wear a romper, a playsuit or tights. This also protects against chafing on the legs. Loose clothing can be worn over the spreading aid. Clothes with an inner leg closure are very useful.
Traction treatment With the traction treatment, your child is not allowed to leave the bed. It will have to be washed in bed. Change your baby regularly (every three hours). Your child will be wearing traction pants with which it is attached to the bed. This prevents your child from rolling over or falling down.
Plaster pantsYou may not pick up your child with a cast under the arms alone. It should also always be supported between the legs. A child with a cast has a considerable extra weight. Use good lifting technique to reduce your back strain. Special diapers (Klinion S, Tena lady) are handy and prevent the cast from getting wet and dirty quickly. Trousers can be worn over casts. Often these have to be specially made with an inner closure or a side closure. It is wise to check regularly whether your child’s stools are not too hard. Because your child moves little, it is sensitive to constipation (constipation). You can read more about this in the doctordokter.nl folder ‘constipation in children’. Also pay attention to the color of the feet. If these are blue-red, this may indicate a cast that is too tight. The blood circulation in the feet cannot proceed properly. The feet can also be somewhat stiff, but usually this does not require any measures.
Transport: With a spreading aid You can transport your child in a baby carrier on the stomach or the back. Hereby the hips are well spread; the spreading aid does not cause any difficulties in these positions. Transporting your child in a pram can sometimes be difficult. A stroller or buggy has a bit more space and is usually easier. Your child must then look away from you, otherwise the bars of the car will usually get in the way. In the car, your child can best sit in an ordinary car seat with a low side. A maxi-cosi is not suitable in this case. You can fill the space that remains behind the back with towels. If your child is older than nine months, you can take it with you on the bike in an open-sided bicycle seat.
With plaster pants Transporting your child with plaster pants is actually not possible safely. A seat with a low side rest offers an option. The space between the seat and the back of your child must then be filled with towels. Only do this if it is absolutely necessary to transport your child.
Development : Because your child must constantly remain in bed during the traction treatment, it is wise to hang stimulating toys on the bed. In this way, the development of your child is stimulated. When your child is at home, it can do whatever it wants to do itself. A belly trolley (a wide board on castors) can be a godsend from the age of nine months to allow your child to move. Make sure your child is securely attached to the board and cannot fall off.
General advice and precautions for Hip problems
If you have hip abnormalities in your family, report this to the consultation office doctor or the general practitioner. It is important in this respect whether the parents used to have a spreading aid themselves, or whether there are people in the family who already had a worn hip at a relatively young age.
The consultation office doctor or the general practitioner can then pay extra attention to the hips. It can also be a reason to still have an ultrasound or an X-ray at the age of four to five months without abnormalities.
It is also important that you do not fully extend your child’s legs during the first three months, not even to measure the height. This can also cause a hip to dislocate.
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