10 May Newborn Feet, Hips and Neck…Miss E
Recently I have seen several newborns presenting in clinic at 7 days old, following concerns about their feet. So I thought I would share with you a success story of early intervention and how great teamwork can make a big difference. The main points to highlight are these:
- Conditions of the feet in newborns, often present together with hip and neck conditions, so its very important to ensure that baby is checked for all three areas;
- Having good communications between your baby’s health professionals and yourself is vitally important; and
- Early intervention will prevent later serious consequences for baby’s development!
Success Story of Miss E
7 day old, Miss E was referred by her Paediatrician with concerns that her feet were both turned in at birth. I explained to Miss E’s parents that as part of my assessment of babies’ feet, I also check their hips and neck, because studies have shown that conditions of the feet (known as Talipes) often present together with conditions of the hips (known as Developmental Dysplasia of the Hips) and conditions of the neck (known as Torticollis).
Fortunately, Miss E only has positional Talipes, which is a “packaging problem” as a result of being a very long baby curled up in mummy’s tummy. In contrast to structural Talipes, which is a “bone problem” as a result of the mal-development of the foot bones. The treatment method of the two different types of Talipes condition is vastly different, so it is important to have an experienced Paediatric Physiotherapist make a correct diagnosis.
As we moved up to her hips, I became quite concerned that her hips felt stiff and it was difficult to open her hips out. This indicated a possibility of Developmental Dysplasia of the Hips (DDH), which is the malformation of the hip joint including dislocated hips ( the thigh bone is sitting outside the hip joint) , dislocatable hips ( the thigh bone easily pops in and out of the hip joint) and subluxable hips ( the hip joint is too shallow and there is a risk of the thigh bone popping out of the hip joint later on). All three types of DDH need to be treated as early as possible with the use of a Palvik Harness, double nappies will not do anything to position the thigh bone correctly into the hip joint. Miss E’s parents reported that the Paediatrician had checked her hips at birth and again a few days later, was initially concerned but because her hips improved, the decision was to have her hips checked with an ultrasound when Miss E was 6 weeks old. With that, I had enough concern, and a great working relationship with the Paediatrician to be able to ring him up immediately to discuss my concerns about Miss E’s hips while Miss E was in clinic with her parents. Her Paediatrician immediately agreed that since we both had concerns about her hips, then Miss E should have the hip ultrasound immediately instead of waiting for another 5 weeks. Miss E’s parents would immediately organize for an ultrasound appointment, and based on the results we will treat her hips appropriately.
I then finally moved up to her neck to check if she had Torticollis. Torticollis a condition whereby the neck muscle ( Sternocleidomastoid muscle) is too tight limiting baby’s neck movements and sometimes this presents with a palpable muscle lump. More often, parents will present with concerns that baby only turns to one side and at 6 weeks old often also have a flatten head shape on one side because baby has been constantly lying with their heads turned to one side. Fortunately Miss E did not have Torticollis, however I did take the opportunity to advise Miss E’s parents on how to carry out Tummy Time activities in order to strength her neck muscles and prevent a mis-shapen head.
Miss E had her hip ultrasound done on the Monday, and her Paediatrician rang me on Tuesday morning with her results. Miss E has bilateral DDH, her hips were not dislocated, but the hip joints were very swallow. This meant that she should be treated as soon as possible to correct her DDH, to prevent future problems with walking because her hips joints are too shallow. The Paediatrician rang Miss E’s parents to inform them of the results and the need to have a Palvik Harness fitted for Miss E. I immediately organized for Miss E to come into clinic on the Wednesday morning, and we fitted her with a Palvik Harness. Miss E will need to wear the Palvik Harness for the next 6 weeks, 24 hours a day, 7 days a week. She will be reviewed weekly and we adjust her Palvik Harness each week as she grows. Miss E will be monitored for her feet, hips and neck as we continue to review her over the coming weeks.
Miss E’s parents are very happy that she is getting early intervention to prevent serious hips problems and mobility issues in future. I am very pleased that working in partnership with Miss E’s parents and Paediatrician, we were able to detect her DDH early and prevent more serious invasive surgery to her hips!
If the story of Miss E sounds familiar to you, and you are concerned about your baby’s feet, hips or neck don’t wait any longer because in most conditions Early Intervention is crucial! Make an appointment with our clinic today on 9790 4233 and find out how our Paediatric Physiotherapist can help your child!