Sharaya Stanger, BKin, MPT
Pediatric Physiotherapist with Kids Physio Group Vancouver
One morning you think you hear a “clicking” sound while changing your baby’s diaper. Your suspicions are confirmed when your little one’s hip “clicks” again later that day during another changing. You think to yourself:
Is this a normal sound?
What is causing this “clicking” sound?
Should I bring my child to their doctor to be assessed?
I frequently get asked questions like the ones mentioned above. My name is Sharaya and I am a pediatric physiotherapist with Kids Physio Group in Vancouver.
A “clicking” in your child’s hip may be completely normal but it is important to know when it may not be and what to do about it. As a parent, it is essential to understand how to ensure healthy hip development in your child and to be aware of the potential red flags of hip development.
Babies are born very flexible and remain that way for the first few months of their lives. This flexibility is normal but puts them at risk of developing a condition referred to as hip dysplasia.
What is Hip Dysplasia?
Hip dysplasia is a permanent change to the shape of the hip joint(s). This is often a painless condition that can occur when hips are stretched out too early. The ball (femoral head) is at risk of permanently changing the shape of the socket (acetabulum) when this stretching occurs.
What are the Causes of Hip Dysplasia?
The exact causes of hip dysplasia are unknown. This condition has been linked to the following:
- Family history of hip dysplasia
- Breech positioning in the womb
- Being a twin or multiple
- Increased infant sensitivity to their mother’s hormones (leading to increased ligament laxity)
- A fixed foot deformity and torticollis (neck stiffness) (due to limited space in the womb)
As a new parent, what should you be on the look out for?
Hip clicks or pops
Just because your infant’s hip “clicks” doesn’t mean they have hip dysplasia. There are many ligaments in your child’s hip joint that can produce sounds as they move. If your baby has a hip “click”, their doctor should be informed so their hips can be monitored during their first year of life.
Asymmetrical buttock creases
Observe your child’s buttock creases when they are lying on their stomach to see if they line up. The image below shows a baby’s with uneven gluteal creases (right is lower than the left).
Decreased hip flexibility
This is often noticed when changing your child’s diaper. One or both hips may not fully open, indicating less movement in their hip joint.
Uneven knee height
This can indicate your child’s hip has been shifted up and their leg may appear shorter. Shifting can lead to a loss of hip movement due to the abnormal position of the hip.
Swayback is defined as an excessive forward curve in the lower back. This is often noticed when a child learns to walk. A waddling limp may also be noted.
The above findings do not confirm your child has hip dysplasia. If you notice your child has one or more of the above features, it is best to make an appointment with your family doctor or pediatrician and a physiotherapist. Your doctor will perform a physical exam and may request imaging of your child’s hips (either an ultrasound or x-ray). If clinical suspicion is high enough, imaging will be done to confirm the diagnosis of hip dysplasia. A physiotherapist will assess your child’s gross motor skills and make recommendations to enable normal development.
How is Hip Dysplasia Treated?
Treatment of hip dysplasia depends on your child’s age and the severity of their condition. If your child is diagnosed with hip dysplasia, your doctor will explain the appropriate treatment options with you. For more information on treatment, please visit the Hip Dysplasia Institutes web page.
Role of Physiotherapy for Hip Dysplasia
Developing and maintaining healthy hips, limb movement and core strength is important as your child grows. If your child is diagnosed with hip dysplasia or has a hip “click”, a physiotherapy assessment is recommended.
When a splint or surgery is the recommended treatment, it is important that your child works with a physiotherapist as being immobile for a prolonged period can lead to decreased muscular strength and joint stiffness. Physiotherapy can assist your child in maintaining their strength and joint movement before, during and after splinting and/or surgery.
If your child is a candidate for surgery, it is essential that they are as strong as possible prior to their surgery. After surgery, they will be inactive for numerous weeks, which will decrease their strength and joint movement. These changes are not permanent and when their doctor gives the go-ahead, your child can begin working again with their physiotherapist. This will ensure their hips continue to develop appropriately and will allow them to get back to playing as soon as possible.
For more information on the role of physiotherapy in hip dysplasia, please contact Kids Physio Group (see contact information below).
Hip-Healthy Swaddling and Positioning
Positioning is very important as your child grows and develops. Swaddling your child in a hip-healthy way is crucial during hip development. When you swaddle your baby, it is important that their legs can move around freely. They should be able to bend their hips up and out. This position allows the hips to develop in the correct alignment. Positioning should also be considered when your baby is in a carrier. A hip-healthy carrier is one that provides support for your child’s bum while letting their legs move around freely. One example of a hip-healthy carrier is made by Ergo Baby and can be found at http://store.ergobaby.com/.
When swaddling your baby, ensure that their legs are not pressed together and are not wrapped tightly in a straight down position. If their knees and hips are regularly maintained in a straightened position for a prolonged period, damage to their hip joints can occur further increasing their risk for developing hip dysplasia.
The link below demonstrates 3 different ways to swaddle your baby in a hip-healthy way:
Children move into and out of different positions as they play. If you notice your child prefers to sit and play in W-sitting it is recommended that this be discouraged (see image below). All children should avoid sitting in W-sitting as it can strain their hips and prevent them from weight shifting and rotating their trunk (these movements are important for development of hand dominance and for achieving motor milestones). Avoiding this position is even more important for children with hip dysplasia as it can lead to further hip joint damage.
If you have any questions about swaddling, positioning or would like your child to be assessed by a physiotherapist, please contact Kids Physio Group:
Kids Physio Group
For more detailed information on hip dysplasia please visit: http://hipdysplasia.org/
About Sharaya Stanger
Sharaya was born and raised in Abbotsford, BC. She received her Bachelor of Kinesiology degree at the University of the Fraser Valley followed by her Master in Physical Therapy degree at the University of British Columbia. Upon graduating from her physiotherapy program, Sharaya received the 2013 Pediatrics Award of the Canadian Physiotherapy Association for Excellence in Academic and Clinical Pediatrics.
Sharaya has been working at Kids Physio Group since early 2015. She is passionate about assisting children and teens reach their full movement potential. In her downtime, Sharaya enjoys spending time with her family and friends. She is passionate about running, cycling and cooking!