Josie’s Journey with Hip Dysplasia

I knew from before Josie was 2 weeks old that she was going to be our second Hippy Babe.  Esther also inherited my Dickie Hips so I knew what to look out for.  I can not pin point the first time I noticed, but Josie’s thigh creases were not even.  I knew what this meant and I was fairly prepared when the health nurse confirmed at her 2 week check that her left hip felt stiff (just as her big sisters had 18 months earlier, only that time I was not prepared, not at all).

Developmental Dysplasic Hips, DDH, is the medical term.  I tend to say Dicky Hips or Clicky Hips when explaining it to people.  I don’t at all mind talking about it but it’s just one of those terms that many people have never heard and will need an explanation of anyway.  It basically means that the hips socket has not developed as it should have, sometimes causing the Femur to sit in the wrong position in the socket, be dislocated or ‘click’ when moved.  There are varrying degrees and luckily my girls have both had relatively mild cases with shallow hip sockets but stable joints, that is, the Femur does not dislocate from the socket.

These images from the International Hip Institute show the range of severity that can occur.

human hip joint as it should appear  Subluxation when the ball is not aligned properly with the socket. A mild form of hip dysplasia    Low Dislocation when the ball is just outside of the socket. A more serious form of hip dysplasia.    High dislocation - the ball is completely removed from the hip socket. A severe form of hip dysplasia.

Standard procedure here is to do an ultrasound scan at 6 weeks old if a baby has a high risk or is suspected of having DDH.  We were booked in for this scan from birth as a precaution but I was not willing to wait all that time doing nothing when I knew that a  Pavlik Harness  would be very effective at such a young age when babies are growing so rapidly.

I got an appointment to see the Orthopeidic Surgeon when Josie would be 4 weeks old.  Try as I did, Radiography would not budge, 6 weeks for the ultrasound it was.

In the mean time I used double cloth nappies on Josie day and night to hold her legs out in a position similar to the Pavlik Harness.  This is no longer used as an official form of treatment but I could not wait around and do nothing.  Who knows if it helped but it made me feel better.

All of a sudden Josie was 4 weeks old and the Orthopeadic Surgeon confirmed she had DDH.  I explained my fight with Radiography to get an ultrasound scan done earlier, he agreed with me, lead us up to Radiography and explained that Joise would be having an Ultrasound…NOW!  I was quietly chuffed that a Surgeon was agreeing with me and fighting me case.  The ultrasound confirmed what we already knew and by the end of that outing Josie was fitted with a Pavlik Harness for 23 hours a day for the next 8 weeks.

As I write this now, 6months from the harness first being fitted I don’t remember it being too much of an issue.  Sleeping wasn’t fantastic but she was generally happy.  I found the worst part for me was that she wasn’t all nice a squishy anymore.  All those straps made her feel big, bulky and stiff.

The weeks passed quickly but by the end I was well and truly sick of the harness and looking forward to it coming off.  The ultrasound date came and I was delighted by a following appointment with the Orthopedic Surgeon where we were told her hips now looked normal. Harness off.  Squishy baby back.  Delight!

‘Yes her hips are fine now’ I would explain to people when they asked.  This is what we believed to be true.

At some stage between between 4 and 6 months I noticed her thigh creases were not even again.  I am kicking myself now but I didn’t think anything of it.  The Doctor had never mentioned that she may need further treatment or that the issue could come back.  Her hips are not going to ‘un-grow’ I thought!  I flippantly mentioned the creases to the Health Nurse at her 6 month check, still not thinking much of it.  And then she checked Josie’s hips.  ‘Yep, this one’ pointing to the left hip, ‘You need to get this one looked at, I can feel a click’.  I burst into tears. How could this happen?  What do you mean?  Why was I never told this could happen?  This must be bad.  I had a million thoughts going through my head.  I called our Orthopedic surgeon as soon as we got home and demanded an appointment as soon as possible.  The next day, thank goodness we didn’t have to wait.

I hardly got a minute of sleep that night and the next day the Ortho confirmed that he could feel a click but didn’t think it was much to worry about.  Wow, I thought.  He sent us up for X-rays to be sure.  The Radiographer didn’t think there was much to worry about either, I was feeling so relieved!  Then back to the Ortho to review the X-ray.  He explained that her hips were not perfect but that he would review when she turned one and treat then if necessary.  Umm.  Sorry.  No way!  I was not waiting until she was one and wanting to move around to put a damn brace on her.  I asked if she would benefit from wearing a brace even just part time.  We agreed she would wear a Rhino Brace for day time only and he would review in 6 (6!!!!) months.

So the Rhino Brace went on and she honestly wasn’t fussed by it at all.  Clever little lady!

I couldn’t help thinking that 6 months was just too long to wait and see.  If it hadn’t worked in that time then what?  Surgery?  And as relieved as I was that the brace wasn’t on at night, it just didn’t feel quite right.  Too good to be true I guess you could say.

I organised a second opinion.

We had that opointment on Wednesday.  This Doctor was brilliant.  Reassuring yet cautious and thorough.  He confirmed my suspicions that the brace should be on at night time and that 6 months was too long to wait before reviewing.  He is going to review in 2 months time, (when the brace has been on for 3 months) and was confident that the brace would work, he wasn’t sure on a time frame though.  He also wants to X-ray and review Esther, who had her brace off at 6 months at which time we were told there was no need to review.  Turns out there is every need to review for several years after treatment of DDH as the hips can sometimes not maintain their growth and development after treatment is ceased.  Esther will have an X-ray next week.  I feel sick thinking about the possibility that she may need further treatment.  We will keep our fingers crossed that she is fine and cross that bridge when we come to it.


5 things you can do to get your child ready for school

My Nelly will be turning 4 in March and here in Tassie that means she will start school next year. She is busting to go already and would love it if I would drop her off at Play Group and go home 😀.

In a former life (before children) I was a teacher. I have taught K-3 although mostly Prep/1 classes. My teacher brain has been turning on a bit lately since Nelly has all of a sudden become interested in reading and writing (in a very abstract sense at this stage) 😉. With her soon to begin Pre-Kinder and school next year I have also been thinking about what it is I need to be doing to get her ready. As a teacher, I would say these are the most important things a parent can do to ready their child for school.

Get them to carry their own bag
Sounds simple yes but this I believe is quite important. As a teacher I noticed that kids who carried their own bag and unpacked it as they arrived where generally more organised and independent throughout the day. It gives them a sense of ownership and independence.

Teach them to recognize and write their name
Don’t panic if your child doesn’t write their name perfectly before starting school but talking to them about it, modeling writing it and pointing it out will get them on the right track. Talk about the shape of the letters and the way they are written. Point out the letter that your child’s name starts with in lots of different situations and see if they can do the same. Use a capital letter for the first letter and lower case for the rest. Please 😀 It is sooo difficult for kids to understand why their teacher is asking them to write their name a differently to the way their parents have taught them if they are used to using all capitals. Parents are always right after all (in our kids eyes anyway).

Get involved with the school
If your school provides playgroups, embrace it! Get involved. We are lucky and our local Primary School has the funding to run a Playgroup and a Music session to children from birth to 5 and Pre-Kinder for children in the year before they go to school. It is never to early to start. The more familiar your child becomes with the school, the teachers and the other children the easier it will be for them to make the transition to Kinder.

You know the deal. Read. Get them involved in reading. Ask them to choose the book (even if they choose the same bloody book every bloody day for a bloody week!). Read the title together and then flick through and look at the pictures. Talk about what might happen in the story, what do the pictures tell them about the storyline? Then when you read the story, try and be enthusiastic (if you can possibly find the energy), use interesting voices, volume and tone.

Talk to them about school
Tell them the obvious things; that there will be rules, they have to listen to the teacher, use their manners and take turns. But also tell them the less obvious things. Like at recess and lunch time their will be a teacher in the playground if they need help. That they can ask to go to the toilet anytime they need to. That they are in charge of their things and have to look after them. That there will be lots of new kids to make friends with, but not all of them will always want to play. Tell them school is fun.