Is it okay to wait a week for an appointment if a parent suspects developmental dysplasia of the hip (DDH) in their child?

Management of Suspected Developmental Dysplasia of the Hip (DDH)

Waiting one week for an appointment is generally acceptable if a parent suspects developmental dysplasia of the hip (DDH) in their child, as a short delay in intervention has no negative impact on outcomes. 1

Assessment of Risk and Urgency

When a parent suspects DDH, the urgency of evaluation depends on several factors:

• Age of the child:

  • For infants under 6 months: Early detection is beneficial, but a delay of 1-2 weeks is not critical
  • For older infants/children: A short delay has minimal impact on outcomes

• Severity of symptoms:

  • Mild instability often resolves spontaneously (60-80% of cases identified on physical exam and >90% on ultrasound) 1, 2
  • Studies show that 84-95% of Graf type II hips (mild dysplasia) normalize by 3 months of age 1

Evidence Supporting Safety of Brief Delay

The American College of Radiology guidelines specifically note that "a short delay in intervention has no negative impact on outcome" 1. This is supported by several key findings:

• The vast majority of mild cases spontaneously normalize without intervention 1
• Treatment success rates remain high even with brief delays in diagnosis
• The American Academy of Pediatrics recommends screening with ultrasound at 4-6 weeks of age, not immediately after birth 1

Appropriate Next Steps

While waiting for the appointment:

1. Document parental concerns about specific symptoms (limited hip abduction, asymmetric skin folds, etc.)

2. Avoid tight swaddling that keeps the baby's legs straight and close together

3. Practice "hip-healthy" positioning - when carrying, position the baby's legs spread around your body with hips bent 2

4. Monitor for worsening symptoms - increasing asymmetry or limitation of movement would warrant earlier evaluation

Imaging Considerations

The appropriate imaging modality depends on the child's age:

• Under 4 months: Ultrasound is preferred 1, 2
• 4-6 months and older: Radiographs become more reliable as the femoral head ossifies 1, 2

Cautions and Special Considerations

• If the child has multiple risk factors (female gender, breech presentation, family history), consider requesting an earlier appointment
• If the child shows signs of frank dislocation (significant leg length discrepancy, severely limited abduction), seek more urgent evaluation
• During the COVID-19 pandemic, the American Academy of Orthopaedic Surgeons noted that even deferring DDH evaluation for up to three months was acceptable when weighing the risks of viral transmission 1

A one-week wait for evaluation of suspected DDH is reasonable and unlikely to negatively impact treatment outcomes or long-term prognosis, particularly given the high rate of spontaneous resolution in mild cases.