New Guidelines for Evaluation and Referral of DDH
After 16 years the American Academy of Pediatrics has updated and revised the Guidelines for Evaluation and Referral of Developmental Dysplasia of the Hip (DDH). This new report was published in December, 2016 in Pediatrics – a major scientific journal.
Most of the guidelines remain the same as the clinical practice guidelines published in the year 2000. However, there are some important changes. One of the most notable changes is the addition of tight swaddling as a risk factor for DDH. Pediatricians are encouraged to educate parents about hip-healthy methods of swaddling such as the ones identified by IHDI.
The new guidelines recognize IHDI as a resource for parents and note that hip-healthy swaddling allows freedom of hip motion while avoiding forced position with the legs straight and thighs held together.
The new guidelines recognize the increased awareness that dislocations of the hip may develop after birth and during early childhood. The term “Surveillance” is recommended instead of the term “Screening”. This is because “screening” suggests a one-time process, but “surveillance” is performed with periodic clinical exams until walking age. Continued surveillance may be more likely to discover dislocations that develop after birth. The report notes that “no screening program has been shown to completely eliminate the risk of a late-presenting dislocated hip.”
Medical imaging is recommended when the pediatrician is concerned that the infant may have hip dysplasia. This can be accomplished either by ultrasonography between six weeks and 6 months of age, or by a simple x-ray at age 4-6 months of age. Imaging prior to six weeks of age may result in false positive findings with excessive referrals for minor degrees of dysplasia that would resolve spontaneously.
Finally, the report recognizes that the objective of surveillance is to detect significant hip dysplasia so that early treatment may be initiated. However, the diagnosis and treatment of mild dysplasia remains controversial.
The International Hip Dysplasia Institute was pleased to participate in the review of these guidelines, and we congratulate the authors – Brian Shaw MD, and Lee Segal MD along with the American Academy of Pediatrics on a job well done.