In this knowledge base we explain what hip dysplasia is and the different forms thereof.

1. Hip dysplasia baby
If your baby is born with hip dysplasia, it means that the hip joint is not properly developed. The hip has a hip head and a acetabulum. In congenital hip dysplasia, the hip socket is not deep enough to hold the femoral head properly and the hip can easily dislocate. Usually hip dysplasia is not painful.

When the hip comes out and does not go back into the socket by itself, it is called a hip luxation.

About 20 babies in 1000 are born with hip dysplasia. Hip dysplasia is 4x more common in girls than boys, this is because girls are more sensitive to the mother's hormones that make the ligaments softer just before delivery to make them go more smoothly.
It occurs 2x more often in the left hip than in the right hip.
Swaddling can increase the chances of hip dysplasia in a baby

2. Causes of hip dysplasia
The exact cause is not known. We do know that heredity and the position of the baby in the womb play a role, especially if the baby has been in a bump. Children who are worn in a sling with the legs spread out seem to develop hip dysplasia less quickly than children who are also swaddled with the legs. Occasionally a hip abnormality occurs in other congenital abnormalities such as club feet, open back (spina bifida).

Treatment is needed to prevent premature wear to the hip.

3. How is hip dysplasia detected?
At the clinic it is examined whether there is a difference in the position of the hips and whether there is a difference in leg length, an asymmetrical buttock fold can also be an indication of a hip abnormality, but this does not necessarily have to be the case. If there is a leg length difference, this could indicate hip dislocation, then the hip is dislocated. Stiffness in the hips and Clicky Hips can also be an indication of a hip abnormality.

If a hip abnormality is suspected, an ultrasound or X-ray will be made. Sometimes an arthogram is chosen, a contrast fluid is first injected (under anesthesia) into the hip joint and then an X-ray is made.

Unfortunately, hip dysplasia is not always detected in a timely manner in babies. Nevertheless, treatment at a later age can lead to a good result. Even at a later age it is only discovered by pain complaints that there has been hip dysplasia.

4. Research
Leg length difference
In case of a leg length difference, the Galeazzi test is performed. The baby is lying on its back and the knees are bent next to each other. If the knees are not the same height, there may be a hip dysplasia.

Stiffness in the hips
When changing the baby, one leg then falls out more smoothly than the other. Because the body tries to keep the hip in the socket in a hip dysplasia, the hip becomes stiffer.

Clicky Hips
When moving the legs outward, as in the Galeazzi test, you can hear a click, you can even feel it. This may indicate a hip dysplasia, but it does not always have to be, sometimes it can also be the sound of the ligaments.

Asymmetrical buttock crease
When a baby has an asymmetrical buttock, this can indicate a hip dysplasia. This will be determined by ultrasound.

5. What can happen if hip dysplasia is not detected in time?
The consequences of not detecting hip dysplasia in time can be quite serious. Nevertheless, treatment at a later age can lead to a good result. Unfortunately, this is not always the case, there may be premature wear of the hip joint, deformity which can lead to limping and pain. Read on our blog "our story about hip dysplasia".

6. What do you run into with a baby with hip dysplasia?
Special hip dysplasia clothing is almost impossible to find, so I started making these special clothing myself. Pants that fit over or under spreaders or over plaster pants. Dresses with a higher waist so that they can fall over spread pants. There were also no sleeping bags that fit my baby with spreader pants. The car seat was also such a problem, it no longer fit. We solved this by placing a cushion in the car seat so that our daughter sat a bit higher in it and the leg fitted over the sides of the car seat.

Maxi Cosi has special car seats for children in spreader or plaster pants. These can be rented at Maxi Cosi. This is the Maxi Cosi Opal (https://www.maxi-cosi.nl/maxi-cosi-happy-hips-service)

 

Spread pants
Hip dysplasia and hip dislocation are treated with spreading pants. The spreading pants ensure that the legs remain in a spread position so that the femoral head is placed in the center of the acetabulum, so that the acetabulum can develop properly.

From when should my baby wear spread pants?

Usually, spreader pants are used from 3 months or more must have been detected earlier. When the hip dysplasia is discovered a little later, the spreader pants are worn from that moment on. Usually, spreader pants are worn until the age of 2 years.

Should the spreader pants be worn constantly?

Spreader pants should be worn as much as possible, day and night, but may be used when changing or taking off the bath. However, it differs per child and the doctor can advise you well. In recent months this has usually been phased out and the spreader pants only need to be worn at night.
In case of a hip luxation, the spreader pants may sometimes not be taken off at all, not when washing or changing your baby, because the hip can then slip out of the socket again. In this case, your child will wear a bead spreader or a pavlik. Always listen carefully to the advice of your doctor.

When the spreader pants or pavlik cannot be removed, it is best to wash your baby with a washcloth on a changing mat. You can wash the hair by placing a changing mat next to a sink. Prepare everything in advance and it is better to do this in pairs. There are possibly inflatable hair wash baths for sale.

Is wearing spreader pants painful for the baby?

Wearing spread pants shouldn't hurt. If you feel that this does hurt, contact the treating doctor immediately.

Are all spreader trousers the same?

No, not all spreader pants are the same. Not every hip abnormality is the same, which is why there are different spreader pants that can be used. The most commonly used spreader pants are:

pavlik
camp spreader
fisherman's spreader
hilgenreiner
Below we explain the differences of these spreader pants.

How do I clean dirty spreader pants?

With a camp spreader and fisherman spreader you close the Velcro and clean the spreader pants with a cloth or old toothbrush with warm water and soapy water. Regularly remove the fabrics and threads from the Velcro.

The Hilgenreiner is a handmade spreader pants and often contains leather. The orthopedic instrument maker can give you cleaning instructions.

If the pavlik cannot be washed off, you cannot wash it. You can try to clean the dirty spots with lukewarm soapy water with a cloth or an old toothbrush, but don't get it too wet.

Is there a suitable sleeping bag?

A child with spreader pants does not fit well in a normal sleeping bag. That is why we make extra wide sleeping bags in our own workshop where the legs have room. You can find these in our pantsuit clothing

 

Can my child develop well by wearing spreader pants?

It may be that your child gets a development delay by wearing spreader pants. This is not permanent and will be made up over time. We engaged a bobath therapist after the treatment with the spreader pants. This therapy is mainly aimed at children with motor difficulties and everything turned out well with our daughter.

My child cannot turn around, does he / she not get a flattened head (plagiocephaly)?

Children with spreading pants or plaster pants often lie on their back, they usually cannot lie on their stomach or side. Because they are constantly lying on their back, this also occurs with a preferred position, there is pressure in the same place and a flattened or crooked skull can arise. In extreme cases, a correction with a helmet may be necessary. Try to put the head alternately to the left and to the right as much as possible, you can do this by switching sides of a favorite hug and regularly dividing the attention to the left and right while playing. As mentioned earlier, a bobath therapist can help you with this. You can also always contact your doctor.

Also regularly laying on the stomach under supervision, of course, this strengthens the neck muscles, adopt a different position with feeding, draw attention to the non-preferred side so that the child also looks the other way.

You can also use a Doomoo supine support to prevent a flattened head. For this we refer you to: https://www.doomoo-webshop.nl/product/doomoo-basics-supreme-sleep-large-rugliggingstijl/

Pavlik
What is a Pavlik?


A pavlik bandage is a type of harness that consists of cotton straps that are reinforced with nylon, so that the legs are pulled up and the femoral head is better held in the hip socket. The bandage will be adjusted regularly until the legs are in the desired spread position. The Pavlik bandage is usually used on children up to seven months of age.

 

 

Can the pavlik finish changing the baby?

Sometimes the pavlik may take a short while to change or bathe, this depends entirely on the advice of the treating doctor. Follow this advice absolutely, otherwise the hip could dislocate in case of hip dislocation.

What kind of clothes do you need when wearing a pavlik?

We sell leggings that can be worn under a pavlik. By using a separate crotch, extra stretch is created and there are few annoying folds. The leggings with press stud fastening are ideal.

Our jumpsuits can also be worn over the pavlik.

Note: Pants with a waistband should NOT be worn over a pavlik. The waistband presses on the straps that run through the shoulders to the knees, changing the position of the legs.

Sleeping with a pavlik how does that work?

It is nice that the legs have a lot of space when wearing a pavlik. Our sleeping bags have been specially developed for children who wear a pavlik, this sleeping bag is extra wide and by wearing a sleeping bag they cannot detach the pavlik.

The sleeping bags can be used with all spreader pants and plaster pants. The sleeping bag has the same length as a normal sleeping bag, so that these sleeping bags can also be used after wearing spread pants. 

Which clothing is best for my child to wear if the pavlik cannot be taken off?

Our jumpsuits are excellent to wear over a pavlik. The jumpsuits can be opened completely from ankle to ankle so that you can change your baby properly. The jumpsuits close with press studs on the shoulder so that the head fits easily through. We use jersey fabric that stretches easily. With a nice cardigan over it, this is a very wearable garment when wearing a pavlik.

How do I replace a bodysuit under a pavlik?

When changing the bodysuit, for example, it is important to remove only one part of the chest part of the harness. It is best to do this together with someone.

Source: International Hip Dysplasia Institute.

Place your baby on a stable surface and first loosen the chest strap at the front which is secured with Velcro, do not take it off!

Release the shoulder strap 1 and remove the right arm from the bodysuit. Place the romper over the baby's head and reattach the shoulder strap 1.

Loosen the other shoulder strap 2 and remove the bodysuit. Immediately put on the new romper over the left arm and over the head, fasten the shoulder strap 2 again.

Then loosen shoulder strap 1 again and pull the right arm through the sleeve opening again

Pass the bodysuit under the loose chest strap and fasten the bodysuit at the bottom with press studs. Make sure that shoulder straps 1 and 2 are properly secured over the bodysuit. Check that the shoulder straps are back to their mark.

Pull the transmitter tight again so that you can get four fingers between the baby's chest and the transmitter

How do I exchange socks with a pavlik?

Use knee socks under the leg straps and booties to prevent chafing. If you want to change the socks, make both
loosen straps 5 and remove only one foot at a time from the pavlik, change the sock and put the foot back in the pavlik and repeat for the other sock. It is recommended to use cotton socks.

Camp spreader
What is a camp spreader?

A camp spreader is a spreader pants that can be easily removed. It is made of plastic with an adjustable metal strip on the front. The waistband and leg straps close with Velcro). The upper legs stay in place while the lower legs can move easily. This position keeps the femoral head well in the hip joint. With the metal strip, the desired spreading width can be adjusted by the doctor.

 

Which clothing is suitable when wearing a camp spreader?

It is nice to wear something under the camp spreader, which is why our leggings with an extra crotch inserted are ideal for this. But our harem pants are also nice to wear over the camp spreader, you will not see the spreader pants.
In warm weather the thighs could sweat, a solution could be to cut the feet off socks and put them under the leg straps.

Our extra wide sleeping bags can also be used if your child is wearing a camp spreader. The legs have extra space and your child cannot detach the camp spreader.


Plaster pants
What is a plaster pant?

Plaster pants consist of plastic plaster. The cast ensures that the legs remain in a spread position in case of hip dysplasia. The cast fits from the waist to the ankles and the crotch is left open for the space of a diaper. The inside of the cast is soft so that there is as little irritation as possible and the skin is not damaged. You cannot take off casts. If problems arise with the cast, such as skin inflammation or pain, the cast master can solve this and possibly apply new cast. Sometimes there is a stick between the legs for reinforcement, which is not intended to lift your child. Plaster pants are usually put on for a period of about 3 months.

How do I change my child with a plaster pant?

When wearing casts it is important to change the diaper regularly. Prevent the diaper from sitting too long. Keeping plaster clean is quite a job, especially on the inside this is almost impossible to do. There is no reason to replace the plaster, this only happens in very exceptional situations, for example when the skin is inflamed.

You can keep the outside clean with a damp cloth. Try to prevent the plaster from getting wet on the inside. You can dry this with a hairdryer, not too hot, note that or with paper tissues that you remove later. If stool or diarrhea gets in the cast, clean it with wipes. Products against odors, Confort Aid and Nilodor are available at the pharmacy.

What should I keep an eye on if my child is wearing a plaster pant?

You can cover any sharp edges with felt or terry cloth, you can get this in the plaster room or with a pantyliner. If your baby develops colic, it is very difficult with a cast, after all, they cannot stretch their legs, something they do when they get colic. Take a little longer to burp your baby after feeding. If the colic becomes a problem, contact the doctor to get any other food or medication for colic.

Which clothes fit over plaster pants?

Regular pants do not fit over casts. With us you will find pants and jumpsuits that do fit over plaster pants. The entire bottom can be opened to make changing a lot easier. They can also be used with plaster pants with a stick in between.
With pants over the cast prevents the cast from getting dirty and it is more pleasant to have a child on your lap if he / she wears pants over it (with bare legs) cast is very hard and can feel sharp on your skin. It also looks better and does not immediately look that medical.

How do I lift my child with plaster pants?

Never lift your child with plaster pants only under his / her armpits, but also support the lower body. Lifting a child with a cast is very heavy, it does not yield. What can help is a hip carrier, which is a carrying strap with a built-in seat so that you can carry your child more easily, the weight is evenly distributed.

What is the best way for my child to sit in a plaster pant?

It is not easy to sit in plaster casts, as regular highchairs and bouncers often no longer fit. The Doomoo seat is an ideal seat for small children who cannot yet sit on their own. The Doomoo seat is filled with very small grains and the doomoo seat can be shaped in the desired position. Because the grains form the beanbag to the body, which is particularly nice for children with plaster pants. The back and head are supported so well. Also very handy with feeding. If your child no longer needs the cast, you can also continue to use this doomoo seat as a regular beanbag. A doomoo seat is recommended for children up to 30 kilos.

For children who can sit themselves there are special plaster trouser chairs for rent, the krabat jockey

How does my child sleep with plaster pants?

We have special sleeping bags that fit children in plaster pants. They are extra wide and your child stays nice and warm. It depends on how the cast is placed, but it may be more comfortable to place a rolled-up towel under the legs for support so that the cast does not weigh in the back.

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