Hip xray of a child (image courtesy of images.radiopaedia.org/)
Whenever I treat a newborn or infant I will always assess the child’s hips – this is commonly done at birth by the attending Lead Maternity Carer (LMC) and checked regularly throughout infancy by GPs, midwives and Plunket. When assessing hips for any kind of instability/unevenness we are checking for the potential signs of hip dysplagia, known as CDH or Congenital Dysplasia of the Hip. This means the growth of one or both hips is not progressing well, and may lead to potential crawling or walking problems for the child.
Assessing evenness of the child’s skinfolds at the groin, thigh, knee and buttock may give an indication of this, however testing the function and stability of the hips is more important, as often skinfolds in growing children may appear uneven when there is no problem. When assessing the function of the hip I assess range of movement and stability, determining whether there may be any instability of the hip joint – this is often referred to as ‘clicky hips’. If any instability or dysfunction is found I will refer for xray to confirm – looking at the skinfolds only is not a very accurate method of determining the likelihood of CDH.
Plunket nurses are instructed to look for uneven skinfolds in children, however accurate functional and stability tests should be performed before referral for xray – our Plunket nurse, at our son’s last visit, advised that she estimates she has detected approximately 3 kids per month with uneven skinfolds. She reports this to the parents, advising them to seek further assessment (often from their GP) before referral for xray, and reported that in six years there have been only 2 confirmed CDH cases out of over 200 detected uneven skinfolds.
If you are advised that your child’s skinfolds are uneven don’t panic, as the likelihood of CDH without any other symptoms is small, but I recommend consulting with a health professional (such as an osteopath!) for a full assessment.