Developmental dysplasia of the hip

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ReasonChoose oneFirst line

Hip exam presentChoose any

Hip exam absentChoose any

PlanChoose one

SideChoose one

SwaddlingChoose any

Follow-upChoose one

Counseling

Most hips checked for risk factors are normal, and many minor findings on early ultrasound settle on their own. Recommended supportive care with an emphasis on swaddling loosely around the hips and carrying positions that let the legs spread apart. Return precautions given including a limp or uneven walking once walking, one leg looking shorter, new hip clicks or clunks, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

CounselingNot in the note with these choices

Hip dysplasia found early in infancy usually responds well to treatment. Recommended supportive care with an emphasis on following the harness instructions from orthopedics and loose swaddling around the hips. Return precautions given including skin problems under the harness, the harness not fitting, a leg that stops moving, one leg looking shorter, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Developmental dysplasia of the hip
Screening for hip dysplasia given breech position in the third trimester
• Hip exam without Ortolani sign, Barlow sign, limited or asymmetric abduction, or leg length difference
• Hip ultrasound ordered at 6 weeks of age or later
• Discussed hip-healthy swaddling with room for the legs to bend up and out
• Follow up after the imaging results

Most hips checked for risk factors are normal, and many minor findings on early ultrasound settle on their own. Recommended supportive care with an emphasis on swaddling loosely around the hips and carrying positions that let the legs spread apart. Return precautions given including a limp or uneven walking once walking, one leg looking shorter, new hip clicks or clunks, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Reason: breech, family history, abnormal exam, known DDH
Ortolani, Barlow, abduction, Galeazzi
Ultrasound after 6 weeks; x-ray after 4 months; ortho without imaging; continue harness
Hip-healthy swaddling

Return precautions in the template

a limp or uneven walking once walkingone leg looking shorternew hip clicks or clunks

Sources

Shaw BA, Segal LS; AAP Section on Orthopaedics. Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics 2016;138(6):e20163107.…