Pediatric and Primary Care Providers

Professional Resources


Pediatric and Primary Care Providers

Brochures on Hip Dysplasia

Brochures are available to share with your patients.

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Babywearing

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.

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Baby Carrying and Infant Car Seats

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.

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The AAP Guidelines

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.

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Learning the Pavlik

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 (https://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.

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Swaddling: IHDI Position Statement

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.

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Updated: February 14th, 2019

Newborn Screening and Prevention

The United States Preventive Services Task Force has concluded that “evidence is insufficient to recommend routine screening for developmental dysplasia of the hip (DDH) in infants”. (Pediatrics 117:898-902, 2006)  However, the absence of evidence does not mean that screening has no value. It probably means that we have not scientifically proven the value of screening to the satisfaction of statisticians and public health officials.

Universal screening of all newborns with hip ultrasound is not generally recommended by the medical community, but screening of all newborn infants with a physical examination followed by appropriate use of hip ultrasound is widely accepted. (Schwend, et.al. J. Pediatr. Orthop. 27:607010, 2007) Scientific publications by IHDI physicians have demonstrated the cost-effectiveness and clinical effectiveness of this combined approach (JBJS 91A:1705, 2009; Acta Paediatr. 90:836, 2001; JBJS 76B:525, 1994).


Recent developments in Ultrasound Diagnostics in relation to Breech Births:
Ultrasound is suggested for:

  • 2 to 6 week-old infant with questionable examination, especially first-born girls
  • 6 week-old with family history of hip dysplasia even when the exam is normal
  • 6 week-old girl who was in the breech position even when the exam is normal
  • Consider an ultrasound for 6 week-old boys who were in breech position even when the exam is normal

American Academy of Pediatrics (AAP) has guidelines for detection of hip dysplasia. These screening guidelines are dependent on the use of history, physical exam, and imaging.  AAP recommends all newborns should be examined at birth for developmental dysplasia of the hip.  If the exam shows instability, then referral or treatment is recommended. The hip examination is repeated at 2-4 weeks of age. An ultrasound study or referral to orthopedics is recommended when that examination is suspicious for hip dysplasia. When the hip examination is normal, then risk factors are considered. Some of the most important risk factors are positive family history of hip dysplasia and breech position in the womb. The AAP suggests that an ultrasound study at six weeks of age or an x-ray of the pelvis at 4 months of age is warranted when there is a positive family history of hip dysplasia and also for girls who were in the breech position. Even boys have a high risk for dysplasia after breech birth so imaging studies may be useful for those infants too. A recent study out of Rady Children’s hospital in San Diego questions whether the current screening practices are sufficient for babies who were in the breech position.  They found that 29% of breech babies with a normal ultrasound at six weeks developed mild hip dysplasia by 4-6 months of age. The study recommended that all breech birth babies have an X-ray of the pelvis at six months of age as a possible method to reduce the risk of developing late DDH in this group of patients..

References:
1. Imrie, Meghan, Scott, Vanessa, Stearns, Philip., “Is ultrasound screening for DDH in babies born breech sufficient?”  Journal of  Child Orthopedics (2010) 4:3-8
2. Committee on Quality Improvement, Subcommittee on Developmental Dysplasia of the hip,. American Academy of Pediatrics (2000) Clinical practice guideline: early detection of developmental dysplasia of the hip. Pediatrics 105: 896-905