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If detected and treated before the child is six months old, developmental dysplasia of the hip shouldn’t cause significant delays when it comes to learning to walk. Well-child care visits play an enormous role here.

My child is still not walking — should I get worried?

We want our babies to reach important milestones at similar age as most children. When it comes to unassisted walking, the sooner is often considered to be better, but the window when children learn to walk individually is quite wide — between 8.2 an 17.6 months for healthy children. This means that some of them will walk alone when they're just slightly older than eight months, and others will double this time. [1]

If a baby is unable to walk at 16 or 17 months, it's usually not health-related and shouldn't cause worry. While most children walk independently at around 12 months of age, some perfectly healthy babies won't reach this milestone until they're much older. If a seemingly healthy child doesn't walk by 18 months of age, this is the time to get the appropriate screening, but it’s still not a reason to officially freak out.

Some children are late bloomers and reach certain milestones later than their peers with no underlying “wrongs“. Some late walkers become high achievers later in life, or the other way around. It’s proven that the time of the first individual steps is of little or no consequence. [2]

A baby walker is now known to cause some delays in walking, as well as a lot of unnecessary carrying [3]. If you use a walker, make sure to limit the time your child spends inside one, and put away all the dangerous objects that might be lying around.

Even though it is commonly believed that developmental dysplasia of the hip (DDH) leads to delays in walking, according to research, children with this condition walk about a month later that the average child — which is considered clinically insignificant and not a real delay. [4]

The causes of hip dysplasia in children

According to research, dysplasia of the hip affects one to three percent of newborns, and is a lot more common in girls than boys — among 10 children with this condition, eight are girls. Studies have shown that hip dysplasia is more common among cultures that swaddle their babies, because it forces the hips to extend and adduct. [1, 5]

Nobody knows exactly what causes dysplasia, but it’s proven to be more common in babies who were in breech (head up) position before birth, probably because of the limited space inside the womb.

It can also be caused by maternal hormones that are released just before birth so that a baby can pass through the canal easier. Girls are more sensitive to these hormones, hence more likely to develop the condition. If there's a family history of hip dysplasia, there's a higher chance that the child will be born with this condition as well. [6]

The treatment of hip dysplasia

One of the best things you can do for your newborn is to carry him to regular pediatric checkups. The first checkup usually occurs while the mother and the newborn are still in the hospital and — if everything is okay — the next one is recommended about a month later. We visited a pediatrician roughly once a month until our daughter's first birthday. The American Academy of Pediatrics recommends at least nine well-child care visits by the first birthday. [7] By the age of 12 months, it's easiest to spot and treat possible issues that could compromise your child's health.

Hip dysplasia is highly unlikely to form a problem if diagnosed and treated on time, but it doesn't mean it's harmless. 

The treatment of hip dysplasia depends on the reducibility of the hips and the age of the child. If one or both hips are just slightly out of the socket and go back when the legs are held apart, the treatment starts with holding the hip in the joint until it becomes more stable. This is usually done by an abduction brace, or the Pavlik harness if the dysplasia was picked on birth and the child is younger than six months. It’s usually worn six to ten weeks. [8]

Some children — and more often adolescents and adults — will need an operation to put the hip back into the socket. The operation is called periacetabular osteotomy (PAO), and it’s usually scheduled for patients that were diagnosed late and experience pain. After the treatment, the hips should develop normally.

The abduction brace is proven to be a safe and effective way to treat hip dysplasia in babies and it doesn't significantly affect motor or any other part of child's development. Studies have shown that a child with abduction brace starts walking two weeks after the first birthday, and having in mind that some perfectly healthy children stat walking with 14 or 15 months of age, this is indeed not a delay. [9]

When it comes to other difficulties related to hip dysplasia, this is where the early diagnosis and treatment play the biggest role. Where we live, it’s a common practice for a pediatrician to arrange a preventive ultrasound by the time the baby is two months old.

If dysplasia persists into adulthood, it can result in abnormal gait and degenerative hip and joint disease [10].

There's a possibility that some children have shallow joints and sockets that can't fully develop, which isn't so obvious by a checkup or ultrasound, so that they become unstable later in life. Hip pain and the joints that wear out much faster than normal hip joints can cause problems for adults. You can read more about the symptoms, treatment options, as well as about struggling with hip pain as a result of childhood hip dysplasia from a person who's born with the condition. 

The bottom line

Children with developmental dysplasia will need regular checkups until the bones are fully formed — which is probably throughout the whole childhood. Hip dysplasia is the most common abnormality in newborns and shouldn't be the cause for significant delays in walking.

If not treated well in the childhood, hip dysplasia can lead to pain, walking with a limp, much faster wear out of the hip joint, arthritis, and many other problems in the adulthood.

If you have a healthy child that won’t walk, just give her some time. Some children are lazy, or you’ve used a baby walker too much so it’s now hard for her to move around on her own.

If you want your child to practice her walking skills, it’s important to encourage her by making a safe environment around the house for her to cruise around the furniture and fall. Yes — spontaneity is perhaps the most important aspect in learning to walk. According to research, a child who is learning to walk will take more than two thousand steps, and fall 17 times per hour on average. [11]

The sooner the hip dysplasia is diagnosed and treated, the better the outcome. It would be best if the child is treated before she's six months old. If the treatment is delayed for any reason, especially if the child starts waking before the hip dysplasia is diagnosed, it is a lot harder to recover, and growing up can be hard and painful.

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