Healthy hips - Coping with a toddler in a body cast

Thursday, February 13, 2003

Editor's note: Associated Press medical writer Lauran Neergaard's 16-month-old daughter was immobilized in a waist-to-ankles cast for four months to correct a birth defect called hip dysplasia. Here is her story.

By Lauran Neergaard

The Associated Press

WASHINGTON

For days, Julia would scream and beat her little fists against her cast. A healthy 1-year-old used to running and climbing, she now could only lie propped up on a hill of pillows -- plaster encasing her from navel to ankles.

Her legs were frozen apart in a frog-like split.

She no longer fit in her car seat or high chair or stroller. Her diapers wouldn't stuff through the little opening in the cast's middle -- how would we keep her dry? And what could she do for entertainment? Yikes.

For four months, this awkward cast was to hold my daughter's hip together and start correcting her hip dysplasia, a mysterious condition in babies that, if not caught early, can lead to excruciating arthritis by the time they're young adults.

Early in life, the ball of Julia's left hip silently slipped out of a socket that was too loose or shallow.

Regular exams designed to catch this defect, called developmental dysplasia of the hip, or DDH, in early infancy when it's easiest to fix never turned up the warning "clunky" sounds. And no one knew she was at risk because no one even knows what causes DDH, which can range from mild loose hips to the full dislocation that occurs in one in 1,000 newborns. The biggest risk is simply gender -- for unknown reasons, DDH is at least four times more common in girls, especially the first born.

Then Julia started walking and dragged her left foot a little. Kids do that a lot -- let's monitor it, the pediatrician said. Sure enough, the foot drag soon disappeared. But a very subtle limp remained, along with a telltale extra skin fold atop her left thigh that finally had me seeking an X-ray when she was 16 months old.

It could have been far worse. Even when caught so late, DDH is a treatable disorder. And while wearing a special harness often easily cures infants, some babies require multiple surgeries, something Julia hopefully will avoid.

It took half a dozen surgeries, including bone-cutting operations and metal pins inserted in her thighs, to force both of Samantha's hips back into their sockets. Phillips knew the treatments were necessary because her own brother, at 36, can hardly spread his legs because of DDH-caused arthritis. At 4, Samantha's doing well.

By comparison, Julia seems lucky so far. She was just under the magic 18-month age when hip repair would have required open-pelvic surgery. Instead, while Julia was under general anesthesia, her surgeon manhandled her left hip back into place with only a small incision. The frog-style cast -- three of them, actually, replaced as she grew -- let it grow into place.

Like most tots, Julia adapted amazingly well to the cast. Within a month, she had built up enough arm strength to pull herself across the floor, delighting in being mobile again. A month after that, she gleefully learned to stand, looking like a midget sumo wrestler.

It will be another year before we know if she'll need more treatment. But six weeks after the cast came off, her prognosis is good.

Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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