American Medical Association Family Medical Guide - American Medical Association [179]
If a hip dislocation is not detected until later in childhood, a child will need to have one or more operations to correct the dislocation. The child is hospitalized and given general anesthesia for this surgery. After the surgery, plaster casts are put on the child’s legs to stabilize them for several months. This can be an extremely difficult time for a child because the casts restrict movement. Try to engage your child in activities that don’t require much movement, such as reading or drawing. If your child doesn’t yet know how to read, read to him or her as much as possible to keep his or her mind occupied and to help stimulate brain development. Some children whose hip dislocation is not corrected until later in childhood continue to have problems walking, the length of their legs may differ, and they are at risk of developing arthritis later in life.
Treating congenital dislocation of the hip
To treat congenital dislocation of the hip, the doctor manually maneuvers the infant’s thighbone back into its correct position in the hip.
Pavlik harness
After the doctor manipulates the child’s thighbone back into its correct position, he or she may place the child in a Pavlik harness to hold the thighbone in place until the hip joint forms properly. The child usually wears the harness continuously for 6 to 8 weeks.
Clubfoot
A baby with clubfoot is born with one or both feet bent either down and in, or up and out. Many babies with normally formed feet persistently turn them inward, but their feet can be manipulated back into the proper position. A clubfoot cannot be placed in the proper position. Clubfoot may run in families and is more common in boys than in girls. In rare cases, clubfoot is linked to other birth defects. Nearly all cases of clubfoot are detected at birth and treated, enabling the child to learn to walk normally.
Symptoms
A clubfoot usually turns down and in. It is seldom painful, but it affects a child’s ability to stand and walk. If not treated, the child cannot move the foot normally and walks on the side or top of the foot.
Diagnosis and Treatment
A doctor usually can diagnose clubfoot from a physical examination and X-rays. If a clubfoot is minor, the doctor will show the parents how to manipulate the child’s foot regularly each day until, as the bones and ligaments develop, the foot settles into a normal position. In more severe cases, the doctor will refer the child to an orthopedic specialist. The orthopedist will manipulate the foot into as close to normal a position as possible and put a splint or plaster cast on it to hold it in place. Every 2 days, and then at 2-week intervals, the orthopedist will remove the splints or cast, manipulate the child’s foot closer to its normal position, and put new splints or a new cast on the foot to hold it in the new position. This treatment takes about 3 to 6 months, after which the child wears corrective shoes. If these measures do not correct the problem, surgery may be necessary.
Clubfoot
Clubfoot is a birth defect in which a child’s foot is twisted or turned out of its normal position, usually down and in. One or both feet may be affected.
Cleft Lip and Cleft Palate
A cleft lip is a vertical split in the upper lip that may be partial or extend up to the base of the nose. In some children who have a cleft lip, the nose appears to be flattened. Some children have two splits that can affect both sides of their upper lip, or a gap that continues along the roof of their mouth (the palate). This gap, called a cleft palate, runs along the middle of the palate and extends from behind the teeth to the cavity of the nose. A child with a cleft palate has difficulty eating and swallowing. A newborn may regurgitate