Pediatricians and Primary Care Providers
Babywearing is becoming increasingly popular along with the growing interest in attachment parenting. Proper infant hip position while babywearing is especially important because the period of time for babywearing is usually longer than baby transport.
The Medical Advisory Board of IHDI does not endorse nor advise against any particular baby carrier or other equipment. The purpose of this educational statement is to provide information about healthy hip development to guide manufacturers in the development of safe designs of infant equipment, and to help parents make informed choices about the devices they use for their babies.
Clinical Practice Guidelines
Clinical Practice Guidelines have been developed by the American Academy of Pediatrics for early diagnosis of Hip Dysplasia. Information on this website is presented in an effort to help pediatricians with the difficult task of diagnosis and appropriate treatment or referral of patients wtih hip dysplasia. PEDIATRICS Vol. 105 No. 4 April 2000, pp. 896-905 American Academy of Pediatrics: Clinical Practice Guideline: Early Detection of Developmental Dysplasia of the Hip Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the Hip Developmental dysplasia of the hip is the preferred term to describe the condition in which the femoral head has an abnormal relationship to the acetabulum. Developmental dysplasia of the hip includes frank dislocation (luxation), partial dislocation (subluxation), instability wherein the femoral head comes in and out of the socket, and an array of radiographic abnormalities that reflect inadequate formation of the acetabulum. Because many of these findings may not be present at birth, the term developmental more accurately reflects the biologic features than does the term congenital. The disorder is uncommon. The earlier a dislocated hip is detected, the simpler and more effective is the treatment. Despite newborn screening programs, dislocated hips continue to be diagnosed later in infancy and childhood,1-11 in some instances delaying appropriate therapy and leading to a substantial number of malpractice claims. The objective of this guideline is to reduce the number of dislocated hips detected later in infancy and childhood. The target audience is the primary care provider. The target patient is the healthy newborn up to 18 months of age, excluding those with neuromuscular disorders, myelodysplasia, or arthrogryposis.
The Pavlik harness has become the mainstay for treatment of children with developmental dysplasia of the hip. The harness is relatively easy to apply and adjust, but still requires some specialist skills. Given the length of time many children remain in the harness, parents also need to be able to feel comfortable with its use. Commenting that educational programmes for the most part focus on operative techniques, the paediatric group in Toronto (Canada) set out to establish a consensus on how best to evaluate the application of the Pavlik harness in addition to the development of a competency-based assessment tool. The tool itself was developed after applying a Delphi process to ten experts, and using the results of this process to produce an objective structured assessment of technical skill with 25 items. A video-based validation exercise suggested that there was excellent consensus on the use of this tool, with a test-retest reliability of 0.98 and an intra-class correlation co-efficient of 0.96.1 The study group then went on to use the scoring template to assess three groups of users: novice (parents), intermediate (junior residents) and experts (staff surgeons, fellows and orthotists). They found the assessment tool to be a reliable and valid method for assessing Pavlik harness application and the expertise of the user (http://links.lww.com/BPO/A42). This is a useful document to review your own knowledge base and gives an excellent structured framework for assessing and teaching trainees and allied health in the application of the Pavlik harness.
Swaddling infants with the hips and knees in an extended position increases the risk of hip dysplasia and dislocation. It is the recommendation of the International Hip Dysplasia Institute that infant hips should be positioned in slight flexion and abduction during swaddling. The knees should also be maintained in slight flexion. Additional free movement in the direction of hip flexion and abduction may have some benefit. Avoidance of forced or sustained passive hip extension and adduction in the first few months of life is essential for proper hip development.