Infant Hip Problems

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I was very concerned to read in January of this year, commentary from Professor Clarke advising that 20% of children referred to hip specialists in Southampton, were found to have a deficiency of Vitamin D, which can lead to the condition of "bow legs" caused by the disease rickets. Rickets is due to a vitamin deficiency, that to the western world has largely thought to have been eradicated, but unfortunately that is not the case.

The biggest source of vitamin D is that of sunlight, although diet also plays a part. The rightful concerns of parents about the harmful exposure of children to UVA and UVB rays has lead to them applying sun protection creams which guarantee complete protection to children. This may have ironically lead to their children receiving less than the recommended dose of vitamin D and had an impact upon the number of children being affected by vitamin D deficiency. As a parent myself, I am extremely aware of the danger that sun damage presents, but rickets has not been something that I have given any thought to.

Professor Clarke has now identified another issue that he believes has increased the problem of proper hip joint development in infants. The problem identified is that of "swaddling".   Swaddling involves wrapping the baby in clothing or blankets with the intention of increasing their feeling of security, in that they feel tightly wrapped and protected. This is supposed to reduce the baby's level of distress and to provide a nurturing environment. I have noticed when out and about in Southampton that this is a practice that is being more widely adopted, and swaddling blankets are widely available from suppliers of baby equipment.

However, Professor Clarke, a Consultant paediatric orthopaedic surgeon at Southampton General Hospital, has raised legitimate concerns about some aspects of this practice, particularly when it involves very young infants up to the age of four months. These concerns were published in the Southern Daily Echo on 12 March 2012.

Many parents feel that their child is "forced" into an everted (turned out) hip position by the nappy that they wear, and worry that this may affect their ability to learn to walk in the longer term. Professor Clarke seeks to reassure parents that this is not the case.

Most children love being out of their nappies, being able to straighten their legs, but also being able to play with their feet, and perform moves that most adults would have no hope of doing. Professor Clarke advised that this freedom and full range of movement is essential to the proper development of babies' hip joints, and further warns that to swaddle their legs too tightly could counteract the natural strengthening process and result in the baby having hip deformities.

We have all seen very young babies and children in pushchairs, with their legs in plaster being held at an unnaturally everted angle. This may look extremely uncomfortable for the child, but is done by orthopaedic experts who want to ensure that the same child does not grow up with permanent hip problems. In some cases however, this necessary treatment could perhaps be prevented.

Kym Provan

Senior Solicitor - Clinical Negligence team

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