Hip Dysplasia
It is a medical condition in which the cup-shaped socket (acetabulum) into which the ball (femoral head) of the thigh bone (femur) fits fails to develop fully thus it cannot hold it in place. Often, it allows the hip joint to be dislocated.
Facts
- Called developmental dysplasia of the hip (DDH) or congenital hip dislocation.
- May affect one or both hips.
- Early diagnosis and appropriate interventions will allow the child to grow and live a normal life.
Signs and symptoms
- Infants, one leg appears to be longer than the other. The affected hip may be more flexible during diaper change.
- One leg drags behind the other as the child crawls.
- Uneven skin folds on the thighs and buttocks.
- Parent my notice a limp when the child starts to walk.
- Child complains of groin pain, especially after being physically active.
Diagnosis
A thorough newborn physical examination by a qualified Paediatrician will allow early suspicion and detection of hip dysplasia. If the hip joint feels unstable to the examiner, a follow-up ultrasound scan of the hip should be done around 6 weeks of age.
During well-baby visits, doctors typically check for hip dysplasia by moving the legs through various positions.
Mild cases often present later in life and X-ray or magnetic resonance imaging (MRI) will be required to definitively diagnose hip dysplasia.
Management
Several methods are available:
- Pavlick Harness involves use of a splint to stabilize the hip joint thus allowing it to develop normally.
- Surgical intervention is needed if there is late diagnosis (usually after 6 months) or the Pavlick harness fails to produce the desired outcomes. Commonly it is a reduction procedure where the femoral head is put in the socket. The child might have to wear a Spica cast (immobilizes the hip to allow proper and quick healing) thereafter.
Treatment
0 — 6 months of age
In this age group, the baby is made to wear a Pavlik harness. This harness keeps the two legs away from the midline while allowing the baby to move them and to exercise. It is painless and works by ensuring the head of the femur is maintained inside the socket of the acetabulum.
The Pavlik harness is 90% successful in most cases.
6 months to 18 months
If the harness is unsuccessful, the child may need to wear a cast to firmly ensure that the hip stays in the socket. Open reduction through surgery may also be needed.
Older than 18 months
The child may need surgery to realign the legs in the socket. They may then be required to wear a Spica cast to keep the femur in place.
Book an appointment with our Paediatricians at Kids Health Space for the right choice of management.
Inguinal Hernia
A hernia occurs when internal body organs (commonly) bowels push through a weakness in the belly (abdominal wall). An inguinal hernia happens in the part where the thigh and the abdomen meet, near the groin. In boys, it may present in the scrotum.
Quick Facts:
- Inguinal hernias affect approximately 5% of full-term babies as well as about 30% of preterm babies.
- Boys are predominantly affected. This is because the testes descend from the abdomen into the scrotum through the inguinal canal (a passage in the groin). Thereafter the area closes off but if it doesn’t, it may be a site for a hernia in future.
Signs and symptoms:
- A swelling in the groin.
- Swelling of the scrotum.
- The swelling is often painless, but the child may display signs of discomfort.
- Coughing or straining or crying may cause the swelling to enlarge to become more prominent.
- When the baby is relaxed or lying flat, the swelling may disappear or decrease in size.
- A hernia that appears and disappears or can be pushed into the belly is said to be reducible.
Strangulated Inguinal Hernia
A strangulated inguinal hernia is when the part of the bowel outside the abdomen is constricted and its blood supply cut off. The child needs urgent medical attention in such a case.
Symptoms of strangulated hernia include:
- The child is generally unwell
- Vomiting
- A full round tummy
- Fever
- A red or blue-grey swelling in the groin that is painful to touch
If fluid fills up in the scrotal sac, the child may develop a condition known as hydrocele.
When to see our doctor
Whenever a parent or guardian suspects a hernia, the child should be reviewed by our qualified medical practitioner. Especially a preterm baby with suspected hernia needs an immediate review. In case the symptoms are those of a strangulated hernia, urgent review at the Emergency department should be sought for the child.
Diagnosis
This is a clinical diagnosis and sometimes requires an ultrasound scan.
Treatment of Inguinal Hernia
Surgery is the standard treatment for hernia. During the procedure, the bowels are put back in the tummy and the abdominal well is repaired to prevent recurrence of the hernia. The repair involves stitching the muscles together. Sometimes meshed material may be added to the area to further strengthen it. The child will be placed under general anaesthesia during the procedure so that they don’t feel pain.
The Surgical Repair of a Hernia
The child can eat the day before as there is no nil-per-oral rule on this surgery. On the day of the surgery, the child is put under general anaesthesia. The child may then stay in for few hours after which they may go home same day or the next day.
At home, ensure the incision site is kept clean at all times. Any pain can be controlled by painkillers. In a week or so the incision will be well healed, and you may bring in the child for a review. There is no risk of recurrence of this condition.
Book an appointment with our Paediatrician or the Paediatric Surgeon Dr Asish Jiwane at Kids Health Space for guiding you towards the right management.
Undescended Testes
An undescended testicle is one that has not migrated from the abdomen into the sac below the penis (scrotum) before birth. It usually affects one testicle but sometimes both are can fail to move down.
Quick Facts:
- It is medically called cryptorchidism.
- Testes develop in the abdomen in the foetus after which they migrate into the scrotum the third trimester.
- It is the most frequently encountered Paediatric genital problem.
- Mostly affects prematurely born boys.
Signs and symptoms:
The parent will notice the absence of the testicle as they won’t feel or see it in the scrotum.
Risks associated with Undescended Testes
Testicular torsion
The parent will notice the absence of the testicle as they won’t feel or see it in the scrotum.
Testicular cancer
There is a small but almost clear risk of developing testicular cancer when the testes remain in the abdomen. This is because there is no way for the individual to self-exam and check for any tumours early enough.
Infertility
The testes are held outside the body to ensure that they are at an optimum cool temperature ideal for spermatogenesis. It is therefore likely that spermatogenesis may be impaired if the testes remain in the abdomen. This is by far the primary concern with undescended testes.
After surgery, there is a very minimal chance of the testes reverting back to the abdomen. In most of the cases, the testes remain in the scrotum for the rest of life.
When to see our doctor
Ideally, a child should be born in a clinical setting where our doctor will examine him shortly after birth. If the child has an undescended testis the doctor will then recommend appropriate follow-up. This usually will last for about six months after which the problem is unlikely to resolve on its own. If proper and timely intervention by a healthcare provider is not done, the child will have complications later in life such as infertility and testicular cancer, testicular torsion, trauma and inguinal hernia.
Management
Medical therapy
Use of hormones (chemicals either produced by the body naturally or given externally by a doctor that control various body processes) such as human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) or luteinizing hormone (LHRH) can help induce the descent of the testis. Due to low success rates, doctors will likely recommend surgery once the diagnosis is made.
Surgical therapy
The surgeon will locate the testicle within the abdomen and then carefully move it and the accompanying structures into the correct position in the scrotum. Thereafter they will stitch it in place. The procedure can be done laparoscopically (a small incision is made and a probe with a camera and instruments is inserted into the abdomen) or open surgery. The timing of the surgery will be determined by the preferences of both the parents and the doctors treating the child. Research has shown surgery done within the first year of life has better long-term outcomes compared to when it is done later.
Please book an appointment with our Paediatricians or Paediatric surgeon Dr Asish Jiwane, at Kids Health Space for multidisciplinary team management.