Developmental Dysplasia of the Hip (DDH) is an abnormality in the formation of the hip joint, where the top of the thigh bone (the ball) does not fit securely into the hip socket. This condition ranges from a mildly shallow socket (dysplasia) to a complete hip dislocation. If left undiagnosed or untreated, DDH can lead to chronic hip pain, an altered gait, and premature osteoarthritis later in life. Early identification and management are paramount, as treatment initiated in the first few months of life is highly successful and often non-surgical. This article details preventative measures and the necessary medical vigilance required for healthy hip development.
Understanding Non-Controllable Risk Factors
Parents should be aware that certain biological and mechanical factors present at birth increase a baby’s susceptibility to DDH. A positive family history of hip dysplasia in a parent or sibling significantly raises the likelihood, suggesting a genetic predisposition. Female infants are also disproportionately affected, with DDH occurring four to five times more frequently in girls than in boys.
The baby’s position in the womb also plays a role, particularly a breech presentation, especially if the baby was in this position late in the third trimester. This positioning can mechanically restrict the hip’s natural movement and put stress on the joint. While firstborn status has historically been cited, its role is complex, but it may relate to a less pliable uterus restricting movement. Recognizing these factors should prompt parents to communicate these risks to their pediatrician, ensuring proactive screening and medical vigilance.
Protective Positioning: Swaddling and Carrying Safely
The way an infant is positioned in the first months of life significantly influences the physical development of the hip joint. Improper positioning, particularly those that force the legs straight and together, increases the risk of hip dysplasia. The healthiest position mimics the natural fetal position, allowing the hips to bend up and out.
This position, often described as the “M-position” or “spread-squat,” keeps the femoral head securely centered in the hip socket, promoting proper cartilage and bone formation. The knees should be bent, and the hips allowed to spread naturally apart. Restrictive swaddling that tightly wraps the legs straight and pressed together prevents this natural positioning.
To practice hip-healthy swaddling, caregivers must ensure the lower half of the swaddle is loose enough to allow the baby’s legs to flex, spread, and move freely. Many commercial swaddle products feature a wide, loose pouch designed to accommodate this movement. The goal is to restrict the arms for calming purposes while leaving the hips unrestricted. Avoid any technique that forces the hips into a sustained, extended, or adducted position.
The same biomechanical principle applies to baby carriers, slings, and car seats, especially during prolonged use. A hip-healthy carrier supports the baby’s thighs from knee-to-knee, ensuring the knees are positioned slightly higher than the buttocks to maintain the optimal “M” shape. This supports the hip joint in a stable position.
The International Hip Dysplasia Institute (IHDI) recommends avoiding carriers that allow the baby’s legs to dangle straight down, which puts undue pressure on the soft cartilage of the hip socket. For the first six months, when hip development is most rapid, inward-facing carrying is often recommended. This orientation encourages the baby to use their inner thigh muscles, generating beneficial forces for hip development.
Parents should look for carriers and seats that allow for adjustability to ensure the hip-healthy position is maintained as the infant grows. While short-term transport in a device that is not perfectly hip-healthy is unlikely to cause harm, prolonged periods must prioritize the supported spread-squat position. Choosing products endorsed by organizations like the IHDI provides confidence in a device’s design.
The Critical Importance of Medical Screening
Even with preventative positioning, DDH requires medical vigilance because it often presents without obvious symptoms in infancy. Early detection is the most effective way to prevent long-term severity, as non-surgical treatment is highly effective when started promptly.
Pediatricians perform specific physical maneuvers during routine well-baby check-ups to assess hip stability. The Ortolani maneuver reduces an already dislocated hip back into the socket, producing a palpable “clunk.” Conversely, the Barlow maneuver attempts to gently dislocate an unstable but currently reduced hip.
For infants identified as high-risk, such as those with a history of breech presentation or a positive family history, a hip ultrasound is typically recommended. Ultrasound imaging provides a detailed view of the cartilage and bone structure before the bone fully hardens, which usually happens around three to six months of age. Screening is often timed around four to six weeks of age to allow for the spontaneous resolution of newborn hip laxity.
When DDH is diagnosed early, the standard treatment for infants under six months is often the Pavlik harness. This soft, adjustable brace keeps the hips flexed and abducted, maintaining the healthy “M-position” full-time. The Pavlik harness has a success rate of up to 90% in stabilizing the hip, avoiding the need for later, more invasive treatments like surgery and casting.