Baby Hips are NOT Adult Hips
newborn hip
From birth, your baby’s skeleton takes shape due to muscle activation, position changes, and forces from gravity.
The newborn hip presents in a flexed and outward rotated position. In fact, typical newborn hips do not extend or straighten past 30 degrees, rotate out to approximately 70 degrees, and rotate in approximately 40 degrees. The standard adult hip extends or straightens past neutral to 10 degrees and rotates in and out to 45 degrees (1). These structural changes allow for upright function like walking, running, and jumping.
Developmental Dysplasia of the Hip (DDH) is a problem with the formation of the hip joint (how the thigh bone aligns with the pelvis). From your infant’s very first wellness check, your pediatrician conducts 2 simple hip screens which test the integrity of your newborn’s hips (2).
DDH Risk Factors include (2-4):
Girls; 2-4 times as likely to have DDH than boys;
First born child;
Associated with breech position;
Family history;
Metatarsus Adductus (forefoot turning in);
Congenital Muscular Torticollis;
Tight swaddling with poor hip positioning;
There is an 18% statistically significant correlation with DDH and Congenital Muscular Torticollis (5).
When in doubt, check it out.
Though your pediatrician is continually screening for DDH, the manual test sensitivity rate is only 54% and decreases in accuracy with age (6). If you feel like your baby has risk factors or signs and symptoms of DDH, consult your pediatrician. Your baby might be referred to a specialist who will conduct a diagnostic test like an ultrasound of X-ray.
Remember, if one side does not feel like the other, if baby is unable to use both legs, if your child is limping or complaining of leg pain (especially lasting pain > 2 weeks), or if your parent supermom-senses are going off, get help from your local pediatric PT or skilled clinician! Contact us today!
References:
Forero, N., L.A. Okamura and M.A.Larson. Normal Ranges of Hip Motion in Neonates. JPO. 1989. 9(4):391-395
Scott Yang, Natalie Zusman, Elizabeth Lieberman and Rachel Y. Goldstein. Developmental Dysplasia of the Hip. Pediatrics. January 2019, 143 (1) e20181147.
Ortiz-Neira CL, Paolucci EO, Donnon T. A meta-analysis of common risk factors associated with the diagnosis of developmental dysplasia of the hip in newborns. Eur J Radiol. 2012;81(3):e344–e351.
Panagiotopoulou N, Bitar K, Hart WJ. The association between mode of delivery and developmental dysplasia of the hip in breech infants: a systematic review of 9 cohort studies. Acta Orthop Belg. 2012;78(6):697–702.
Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: a 2018 evidence-based clinical practice guideline from the APTA academy of pediatric physical therapy. Pediatr Phys Ther. 2018;30:240-290.
Rosenberg N, Bialik V, Norman D, Blazer S. The importance of combined clinical and sonographic examination of instability of the neonatal hip. Int Orthop. 1998;22(3):185–188.