Hip dysplasia is an abnormal development of the hip that results in a very shallow hip socket and can lead to hip subluxation, dislocation and degeneration. On this week’s On Call for All Kids, Drew Warnick, M.D., an orthopaedic surgeon who treats patients at Johns Hopkins All Children’s Hospital, tells parents what to look for to determine if their child has hip dysplasia.

Who is at risk for hip dysplasia?

It is a very common hip problem in newborns. It is more common in females, first-born children, children born in the breech position, oligohydramnios (not enough fluid around the child in pregnancy) and children who have a family history of hip disorders.

What causes hip dysplasia?

There are a variety of different causes:

• Ligamentous laxity or loose joints
• Not enough space for the baby in the womb
• Position of the baby’s hips during pregnancy
• Malpositioning of the baby’s hips after birth

How do you know if your child has hip dysplasia?

Your pediatrician will examine for hip dysplasia after birth. If you have any risk factors, an ultrasound study to examine the hips at six weeks is recommended.

How do you treat hip dysplasia?

Initial treatment of hip dysplasia is using a special brace called a Pavlik harness. This harness places the hips in the proper position for normal hip development. This special brace usually is needed for a few months.

Does swaddling cause hip dysplasia?

Swaddling is commonly used to warm and comfort the baby. But swaddling too tight with the legs straight can stress the hip joint and contribute to hip dysplasia. So when you swaddle a baby appropriately you want to allow enough space to provide free range of hip motion to prevent dysplasia.

These are the motions that we would like to have the hips do when swaddled:

• First take the top edge of the blanket and fold it over.
• Then lay the baby chest side up.
• Then place both arms on the chest, and this mimics the natural position in the womb.
• Then take the right corner and pull over the baby.
• Then we're going to take the bottom edge and fold it up. It's important to know that the edge should not go higher than the shoulders.
• The last step is taking a left corner and folding it over.
• Make sure that you have enough space for the hips to move freely.

Drew Warnick, M.D., is on the medical staff of Johns Hopkins All Children’s Hospital, Inc. (“JHACH”), but is an independent practitioner who is not an employee or agent of JHACH.

On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report. Visit HopkinsAllChildrens.org/parenting for more information on infants and toddlers.