Early Investigation and Bracing in DDH Impacts Maternal Wellbeing and Breastfeeding.

Hoffer A, Chhina H, Mulpuri K, Cooper AP. Early Investigation and Bracing in DDH Impacts Maternal Wellbeing and Breastfeeding. J Pediatr Orthop. January 2023. DOI: 10.1097/BPO.0000000000002274

Abstract

Background: 

The outcomes of Pavlik Harness (PH) management for Developmental Dysplasia of the Hip (DDH) are equivalent regardless of the initiation timing, if it is within the first 6 weeks of life. A PH may be a physical barrier to breastfeeding, which is important for nutrition, immunity, and normal child development. The diagnosis of DDH and early management with a PH may also negatively affect the maternal psychosocial wellbeing and the infant-maternal relationship. The purpose of this study is to investigate the impact of the diagnosis of DDH and the management with a PH has on maternal wellbeing and maintenance of breastfeeding, compared with being screened for but not diagnosed with DDH.

Methods: 

A retrospective cohort of the mothers of infants who were diagnosed with DDH and treated with a PH brace was compared with the mothers of infants who were screened for DDH only. The Hip Worries Inventory and Edinburgh Postnatal Depression Scale were completed by the mothers in both groups. The PH group also completed an in-house questionnaire specific to PH and breastfeeding.

Results: 

Eighty completed surveys were included, 50 from the treatment group. The mean age of the PH initiation was 6.2 weeks. The modified Hip Worries Inventory score was higher in the treatment group, with a mean difference (MD) of 9.7 out of 50 (95% confidence interval, CI, 6.8, 12.5). The MD of the Edinburgh Postnatal Depression Scale was 2.0 out of 30 (CI −0.5, 4.5). Although there was no difference in the breastfeeding ease before and after the PH initiation (MD−0.2, CI−0.7, 0.2), 83% of mothers found breastfeeding more difficult with a PH and 11% of mothers stopped breastfeeding earlier than planned because of the PH.

Conclusions: 

Mothers of infants with DDH worry more about their child’s hips and the PH. Screening alone may contribute to maternal psychological dejection and negative thoughts. The presence of a PH makes breastfeeding more difficult.

Level of Evidence: 

Retrospective comparative study, level III.