Too Many Baby Hip Cases Ignored

Parents and health professionals should be doing more to check babies’ hips in their first few weeks of life to prevent pain and permanent disability.

The advice comes from the charity – STEPS – that supports children and adults with lower-limb disorders.

STEPS is concerned that too many cases of hip conditions go undetected which could be corrected with simple outpatient treatment.

The government insists that it takes infant hip conditions “very seriously”.

Not catching the condition early often results in costly medical treatment and permanent disability, according to STEPS.

In the UK, around 2,000 children children every year are diagnosed with developmental dysplasia of the hip (DDH).

DDH covers a range of conditions from instability to complete dislocation of the hip.

If it is detected early, it can usually be dealt with with simple, non-invasive treatment.

All too often – according to STEPS – the condition is missed and children or adults have to have surgery, lengthy hospital stays and some are permanently disabled.

Babies are routinely screened for hip problems, but STEPS says it has evidence that the process is flawed and that too many babies are not diagnosed.

“The current screening policy – despite being in place for 40 years – is simply not working,” says the charity’s founder, Sue Banton.

“Due to late or missed diagnosis, valuable time is being lost and we are increasingly supporting the victims of a failing system.”

A Department of Health spokesman said that all babies should have a clinical examination for DDH within 72 hours.

Those with an abnormality – or the risk of an abnormality – should then have an ultrasound scan with a follow-up at six to eight weeks.

But according to STEPS, this is where the process is flawed: it has found that many primary care trusts (PCTs) are leaving management of the screening programme to GPs.

And it says there is no written policy on how GPs should do this and no way of measuring the effectiveness of the practice.

Warning signs

STEPS says that there are a number of signs that might indicate that there is a problem:

• One leg appearing to be shorter than the other
• An extra-deep crease on the inside of the thigh
• Dragging one leg when crawling
• Walking with a limp or waddle

“It is unacceptable that children are still being diagnosed late with conditions such as DDH,” said Professor Adrian Davis, director of the NHS Newborn & Infant Physical Examination Programme.

Daisy is now making encouraging progress

He said he is working with STEPS, parents and medical practitioners in order to “stop this unnecessary distress”.

The Pitts family – from Buckinghamshire – did not manage to avoid distress: their daughter, Daisy, was diagnosed with “clicky hips” one day after she was born.

But by the time specialists started to treat her, she was – at five months – a little too old for the Pavlic harness that is used to correct hip problems in infants.

After trying it and failing, her specialist booked her in for surgery – a procedure called “closed reduction”.

This also failed and a second specialist repeated the procedure which, again, failed.

This meant having to have a much more invasive “open reduction” followed by three months in a plaster cast from her ankles to her chest.

Daisy came out of her cast last week and the early signs appear to be encouraging.

“I wish we had known more about what clicky hips meant when we were first told Daisy had them,” said her father, Andy.

“If other parents find themselves with similarly diagnosed babies, they should get in touch with STEPS and use their internet forum…there is support out there and there is a whole load of people who have gone through it or are going through it.”