Silicon Simplicity

Some babies are born with a dislocation, or lack of fit, between the top of the thigh bone (which is shaped like a ball) and the socket in the hip bone. This occurs in approximately 1 in 700 births, and is more common in girls by a ratio of 4:1. Usually only one hip is affected, but both hips are involved in 25% of cases.

Cause

There is no one cause of congenital dislocation of the hip (CDH). Genetic factors seem to play a part, as it is more common in girls than in boys, and especially in daughters of mothers who themselves had CDH as babies. The posture of the baby in the womb also seems important, so that it is more common in breech presentations (where the baby is born legs first instead of the usual head first).

Clinical features

Often there are no easily detectable signs of CDH in infancy. Sometimes the skin creases in the thighs are asymmetrical. Parents may notice when changing the nappy that one thigh is restricted in its movement, and cannot be laid all the way back on the table. Later, an abnormal position of the leg on the affected side may be noticed, and the leg itself may be shorter than the other due to dislocation. There may be a delay in walking, or the child may walk with a limp or with the pelvis tilted to one side.

During the doctor’s examination of a newborn baby, both hips are carefully checked for any signs of dislocation. Several tests are performed specifically to detect CDH or an unstable hip. On examination of your baby’s hip a faint click may be heard (‘clicky hips’), which may be due only to stretched ligaments and simply requires monitoring. If this click is accompanied by an abnormal movement of the hip, the diagnosis of congenital hip dislocation is likely.

Investigation

A very careful physical examination of both hips should be done in the first few-days of life, and repeated at 6 weeks of age. In experienced hands, this should detect most cases of CDH. Sometimes an X-ray of the hip may be helpful, and ultrasound is being increasingly used

Growing pains are very common. It is said that 1 in 5 children suffers from them at some stage, especially during the early school years.

Cause

The cause of growing pains is uncertain. They are said to be related to exercise, but this is not always so, and in most cases there are no known precipitating events.

Clinical features

The child complains of aching or a burning sensation in the legs — in the thighs, calves, feet or joints. The pains can also occur, though far less commonly, in the arms or other parts of the body. They usually occur at night, and sometimes wake the child from sleep, but are also common in the daytime. They are rarely severe enough to interfere with daily activity. In most children, the pain or discomfort is transient, irregular and unpredictable — it tends to come and go. The natural history is for growing pains to get better over time.

Investigations

No investigations are usually necessary. Occasionally the doctor will order an X-ray or blood test to exclude other conditions, such as a fracture or inflammation.

Treatment

There is no specific treatment for growing pains. Massaging the affected area may help. Occasionally a mild analgesic is given to the child, but mostly all that is necessary is reassurance and the general measures described above. There is no need to restrict activity.

When to see your doctor

See your doctor if you suspect that there is something more serious going on — if the pains are very severe and persistent, if there is a limp, or an affected part is tender or feels hot.

Prevention

There is nothing that can be done to prevent growing pains.

Toothache in children is almost always caused by dental caries. Often hot or cold foods will irritate a dental cavity. Have your child see a dentist as soon as possible. Temporary pain relief may be obtained by giving paracetamol according to directions, and occasionally by a warm compress applied to the jaw.

Teeth grinding

This is relatively common in children, often occurring at night during a child’s sleep. Sometimes it is due to stress or anxiety. In many cases grinding of teeth is the result of a temporary problem of alignment (malocclusion) between upper and lower teeth, during the period when the child is losing his milk teeth and acquiring his permanent teeth. The poor fit between the teeth may cause discomfort of the jaw which is relieved by grinding the teeth. In severe cases, the teeth may be damaged, with the enamel being worn down. If grinding of the teeth is severe or persistent, you should obtain advice from your dentist.