Friday, December 5, 2008

Developmental Dysplasia of the Hip or DDH

I'm not sure how to start this or even if I want to. Oh, let me start at the end then go to the beginning.
Two days ago the term Developmental Dysplasia of the Hip (DDH) came into our lives. Actually the doctor said Hip Dysplasia which led to a lot of interesting sites about dog hips. Once he gave me the full term in kicked all the dogs out of my searches. Now back to the beginning...

Kaitlyn started pulled up at 7.5 months. She probably would have been walking at 10 or 11 months if her gait wasn't off so much. She didn't actually walk in public without me being afraid of her falling every other step until she was about 14 months. When she first pulled up, like most babies, she was on the balls of her feet. She finally wised up and put her left heel down. However her right heel stayed up. Back around May (17 months old) I took her to EDIS where little kids go if they need special help in different areas like eating, speech, and so forth. The nurse checked Kaitlyn out making sure she didn't have a tight tendon pulling her heel up. After a couple exercises she said Kaitlyn was fine just doing it out of habit. For over an hour she showed me different things to do to get her heel down. I went home to work on it. A month later she called me to see if I wanted to set up another appointment. I told her I didn't feel she could show me anything more that would actually help so I declined. Basically, I'm pushing her heel down like the nurse told me too and going back to learn more ways to push her heel down didn't sound like it would make any difference. Seeing how I expected her to be walking long before her first birthday I was a bit concerned when she was delayed. At every well baby check up from 12 months on I asked the pediatrician about her gait. They all pushed the problem off as something she would grow out of, a habit, her being cute and quirk (what???) and so on. We took her in at different times for vaccinations outside of her appointments and even mentioned it then. I got nowhere enough that I began to believe them that yes, she will grow out of it; however I would still mention it so they would make note in her file that it's still an ongoing problem.

Over this past month I've started to become really concerned. She will be two on Christmas Eve and she is still walking on her toe. I was expected by what the nurse at EDIS said, that she would put her heel down by two. I really started working with her on it. I noticed while she was on the changing table if I pushed her heel down she would squat. Her being "cute and quirky" wasn't sounding so legit anymore. I had real problems getting her to stand as she should. Mind you she has the ability to have both feet flat on the ground when standing still, but she still favors the left side.

Armed with a determination to get answers before we PCS out of here I made an appointment just for her walking issue. Wednesday I took Kaitlyn to see a pediatric doctor we haven't seen before. At first he checked her tendons then started to give me the same answers everyone before him did. Then I began to tick off different things I've observed like pushing her heel down and her squatting. Suddenly he became more serious. With her sitting in his lap he checked her leg length. He flipped her on her tummy to see if her crack was straight. Now how many people look at their child's crack to see if it's straight? He asked me if it was before he checked. Even if I ever thought it was, which I didn't, I wouldn't even consider it being a symptom. Could you picture that conversation, "hey doc her crack goes to the left..." Anyway, it is off. Now when I look at it I can tell it isn't perfectly straight at the top. He then laid her on the examining table and pushed her knees up. He pointed out how her right heel was closer to her rear then her left. Her left knee was noticeably higher then her right. He immediately sent us to get a x-ray.

Yesterday the doctor called to confirm she has DDH on the right side. I was very confused how it could be the right side seeing how the leg appears shorter on that side. I kept picturing us having the hip put back in the socket and the leg being even shorter. With all my searching last night I discovered the top of the femur is actually to the side and higher then the socket. It was like a big "oooooh, I get it" when I read that. Suddenly it made more since why her right leg is shorter (in appearance only), she walks on the ball of her right foot, and even the creases on the back of her skinny legs when she was a baby.

For those who don't know it (I didn't) the creases on a baby's leg should be the same on both legs. I don't mean if there are two on one leg there should be two on the other. I mean lay the child on their tummy. You should be able to draw a straight line across both legs starting with one leg crease and ending with the crease on the other leg. If the creases do not go straight across there is a problem. A leg pushed up out of the socket like Kaitlyn's will basically have everything more compacted possibly causing more creases or at least putting them in different places then the other leg. Another way to tell if something might be wrong is putting the child on a flat surface on their back. Push their feet up to their rear equally; are their knees the same height? Of course the crack check, is it straight. Does the child's hips pop? Kaitlyn's did for a time. It concerned me, but I didn't know how serious it was. Is the child's gait off?

Hip Dysplasia is more common in:
  • Firstborns

  • Girls

  • Breech births or babies who were breech for long periods of time during the last three months of the pregnancy

  • Heredity

Kaitlyn has at least two out of the four markers. I have no idea if she was breech until close to the end. I asked at several appointments and was told she was head down. I don't know of anyone in my family with the problem, but maybe in Neal's. I really don't know though.

If I knew this was a real problem and something that needed to be caught early (BTW, catching it at 2 isn't early) I would have been checking Kaitlyn myself. If all the pediatricians she saw up to six months old would have noticed the problem we could have put her in a sling/brace and corrected the problem early. If it would have been caught before she was 18 months old they would have sedated her, put the hip in place, then put a full body cast on her for a couple months. Now she must endure at least one surgery and a full to partial body cast. It needs to be done ASAP as the longer it goes on the more damage is done to her hip. The doctor told me yesterday her hip wasn't properly formed. I'm really curious how off it is.

Here's Kaitlyn with her new doll bed last night. She was all smiles until I pulled out the camera... as usually. You have to wonder if she thinks that is how we put her to bed. Notice the yellow arm sticking out from under the pink blanket. She completely covered her baby up other then the arm.


Hilary said...

Oh Wow!! I'm not sure what to say..I can only imagine how much you are worrying and how scary that was to hear..hang in there! I will be praying for you all!! :)

MistySkye said...

Wow! I'm sorry your going through this. It's always scarry when something is happening to your child. I'll be praying everything goes well. I'm going to go check all my kids cracks! HA!HA!

Nanette said...

So sorry to read about this. I had a friend who's granddaughter had the same thing but she was younger. She wore the cast. For the most part she did ok other than the aggravation of the cast, I don't think she was in much pain from it. I'll keep you in my prayers.

Jenni said...

Praying for comfort for all your family, and quick healing for Kaitlyn. *hugs*

Catherine said...

hey there- i just delivered on january 12th and on the 13th, the peditrician told me that my child had DDH. I am so sorry that it did take so long for the doctors to hear what u were saying. In my case it was my second born son so to me thats odd cosidering he doesnt fit the typical criteria. My prayers are with you and tomorrow my son goes for his two week checkup and we will see where we stand. good luck.

Lisa said...

I actually went throught the same thing. My son is now 28th months and going to have a surgery next week. Sad, but have to deal with it. Did Kaitlyn have the surgery? And if so, how was the recovery? thanks