The nurses’ role in educating, counselling and preparing parents to care for a child with Developmental Dysplasia of the Hip (DDH)

Abstract

Summary Infants can be affected by a number of musculo-skeletal conditions at birth. One of the most common is Developmental Dysplasia of the Hip (DDH). DDH is thought to occur in utero, during birth, and also during infancy and childhood. DDH is a condition that involves a hip joint that is unstable, subluxated, or completely dislocated. This can include a range of conditions from mild malformation of the acetabulum to a dislocation that cannot be reduced. It can be caused by a combination of factors that include hereditary factors, hormonal, and positioning in the uterus due to breech position and multiple births and oligohydramnios. Nurses caring for infants with DDH should have knowledge of the pathophysiology of this condition, and be able to relate it to the treatment interventions and care that is given. The importance of detection cannot be over emphasised, as the risk of developing osteonecrosis and osteoarthritis of the hip into adult life is increased if DDH is left untreated. Along with chronic pain and poor mobility the lifelong implications can be disastrous. There is also a risk of the development of avascular necrosis (AVN) not only in the affected hip, but also the contralateral hip, resulting directly from the treatment given to correct the deformity [Read, H.S., Evans G.A., 2002. Avascular necrosis as a complication in the management of developmental dysplasia of the hip. Current Orthopaedics 16(3), 205–212]. The treatment for DDH can consist of surgical and non-surgical methods depending on severity. These can include various methods of abduction of the hip using splints and casts, ultrasoundmonitoring, and surgery such as pelvic and femoral osteotomies to enable correction of the problem. The nurses' role in educating, counselling and preparing parents to care for a child with DDH is very important. The psychological impact on parents from discovering their child is not as physically perfect as they were expecting has to be considered. In the author's own workplace, an orthopaedic clinic, nurses meet children and their parents diagnosed and treated for DDH during pre operative assessment, in the plaster room and in consultation with the doctor. As a profession it is essential that nurses have the knowledge and understanding of the condition to fulfil this role [Hart, E.S., Albright, M.B., Rebello, G.N., Grottkau, B.E., 2006. Developmental dysplasia of the hip. Nursing implications and anticipatory guidance for parents. Orthopaedic Nursing 25(2), 100–109].