Newborn Orthopaedics: 0-12 Months
Hip dysplasia, clubfoot, newborn torticollis: what to check in the first year. When an orthopaedic visit is needed. Dr. Priano's guide.
The First Year: Critical for Bone Development
The first 12 months are a window of opportunity for several orthopaedic conditions: when they are recognised early, treatment is often simpler and the outcome more favourable. Baseline checks belong to the neonatologist and the paediatrician, who examine hips, feet, neck and limb symmetry at the routine well-child visits. A specialist orthopaedic assessment is not needed for every newborn: it is added when there are risk factors, an abnormal or doubtful finding, a persistent asymmetry or a stiff joint.
Key Conditions to Know
Hip Dysplasia (DDH)
A condition where the hip joint does not develop properly. Hip ultrasound is performed by the imaging service and is interpreted together with the clinical examination and risk factors; timing and indication are decided case by case. When treatment with a Pavlik harness is needed, physiotherapy afterwards is not a routine requirement for every child.
What to watch for:
- Asymmetric thigh folds
- Limited leg movement on one side
- Family history or breech presentation
Congenital Clubfoot
The foot is twisted inward and downward. The standard pathway is the Ponseti method: manipulation and serial casts by trained staff, in most cases a percutaneous Achilles tenotomy, and then an abduction brace to maintain the correction. Times and results vary between children.
What to watch for:
- Foot turned inward at birth
- Reduced ankle dorsiflexion
- Smaller calf muscle on affected side
Congenital Torticollis
Tightness of the sternocleidomastoid muscle causing a head tilt. Early physiotherapy, when indicated, gives a favourable outcome in most infants. A stiff neck that does not improve, or an unusual pattern, deserves review to exclude bony cervical anomalies, eye problems or neurological causes.
What to watch for:
- Head tilted to one side with rotation to the other
- Difficulty turning head both ways
- Possible flat spot on skull
Positional Plagiocephaly
Flat spot on the skull related to position. Repositioning and tummy time while awake and directly supervised may help; sleep remains on the back. Helmets are considered only in selected cases.
What to watch for:
- Flat area on back or side of head
- Ear misalignment
- Facial asymmetry in more marked cases
When to Seek Urgent Evaluation
- Fever combined with reluctance to move a limb
- Swelling, redness or warmth around a joint
- Sudden refusal to use an arm or leg
- Visible deformity after a fall or injury
Most Concerns Are Normal Variations
Remember that many apparent 'abnormalities' in newborns are actually normal variations that resolve on their own. Bowed legs, flat feet, and flexible joints are expected at this age. When in doubt, a quick check with a specialist can provide peace of mind.