A 6-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). Which assessment finding would be most indicative of DDH in this infant?

Asymmetrical gluteal and thigh skin folds are a classic sign of DDH in infants, indicating unequal leg lengths due to hip displacement. Other options (Babinski reflex, Moro reflex, increased muscle tone) are normal findings or unrelated to DDH.

Core Nursing Explanation Key Concept Analysis This question assesses the ability to identify a key physical sign of Developmental Dysplasia of the Hip (DDH) in an infant. DDH is a condition where the hip joint is improperly formed, ranging from a shallow acetabulum (hip socket) to complete dislocation of the femoral head. Early detection is critical for successful non-surgical treatment. The assessment focuses on identifying asymmetry caused by the unstable or dislocated hip. Answer Rationale Key Point! Asymmetrical gluteal and thigh skin folds is a classic, observable sign of DDH. When one hip is dislocated, the affected leg may appear slightly shorter, causing the skin folds on the buttocks and inner thighs to appear uneven or asymmetric when the infant is placed prone (on their stomach). This is part of the standard Ortolani and Barlow maneuver assessment screening. Therefore, option 2 is the most indicative finding. Distractor Analysis Watch out for confusion! Let's analyze why the other options are not indicative of DDH:
Option 1 (Positive Babinski reflex): A positive Babinski reflex (toes fan upward when the sole is stroked) is a normal finding in infants up to about 12-24 months due to immature nervous system myelination. It is not related to hip joint integrity.
Option 3 (Absence of the Moro reflex): The Moro reflex (startle reflex) is present at birth and typically integrates by 4-6 months. Its absence in a newborn or young infant is concerning for neurological issues, not musculoskeletal problems like DDH.
Option 4 (Increased muscle tone in lower extremities): Increased or hypertonicity is more suggestive of neurological conditions like cerebral palsy. DDH is typically associated with decreased abduction (limited ability to spread the legs apart) due to tight adductor muscles, not a generalized increase in tone. Related Concepts Other key signs of DDH include: Limited hip abduction (the classic sign, especially when changing diapers), an audible or palpable "clunk" during the Ortolani maneuver (reducing a dislocated hip) or Barlow maneuver (dislocating an unstable hip), and leg length discrepancy (Galeazzi sign). Screening is vital during well-baby checks at birth, 2 weeks, 2 months, 4 months, and 6 months.
Concept Summary

Concept	Description	Clinical Relevance
Developmental Dysplasia of the Hip (DDH)	Spectrum of hip joint malformation (instability, subluxation, dislocation).	Early detection via newborn/infant screening is essential for non-surgical treatment (Pavlik harness).
Asymmetrical Skin Folds	Uneven folds on buttocks/thighs when infant is prone.	A soft sign of possible DDH, indicating leg length discrepancy.
Ortolani Maneuver	Hips flexed and abducted; a "clunk" is felt as dislocated hip reduces.	Test for a dislocated hip. Positive after 2-3 months is rare.
Barlow Maneuver	Adduct and gently push posteriorly; a "clunk" is felt as hip dislocates.	Test for a dislocatable (unstable) hip.
Limited Hip Abduction	Inability to abduct the affected hip beyond 45-60 degrees.	The most reliable sign in infants older than 3 months.

Side-by-Side Comparison!

Assessment Finding	Typical Age	Indicates	Not Indicative Of
Asymmetrical Gluteal Folds	Birth - 12 months	Possible DDH (leg length discrepancy)	Neurological status
Positive Babinski Reflex	Birth - 12-24 months	Normal immature nervous system	Pathology in infants (unless persistent past age 2)
Absent Moro Reflex	Newborn period	Possible neurological impairment (e.g., birth injury)	Musculoskeletal disorders like DDH
Limited Hip Abduction	> 3 months	Strong indicator of DDH	Normal hip development

Anatomy, Physiology & Pharmacology Points

• Anatomy: The hip is a ball-and-socket joint. In DDH, the acetabulum (socket) is too shallow, and/or the femoral head (ball) is not stable within it.
• Physiology: Hormonal relaxation of maternal ligaments (relaxin) and intrauterine positioning (breech) are risk factors. The hip is most developable in the first 6 months of life.
• Treatment: No direct pharmacology. Mainstay is mechanical devices: Pavlik harness (for infants

Nursing Clinical Practice Guide Clinical Scenario You are a nurse in a pediatric clinic performing a 6-month well-baby check on infant "Leo." During the assessment, you place Leo prone to examine his back and note that the skin folds on his left buttock and inner thigh appear significantly higher and deeper than those on the right. His mother mentions she sometimes finds it harder to spread his left leg during diaper changes. Nursing Intervention Strategy

1. Assessment: Perform a systematic hip assessment. With Leo supine, compare leg lengths (Galeazzi sign: flex hips and knees; uneven knee heights suggest discrepancy). Gently attempt hip abduction – note if one side is limited (