The nurse is teaching a family how to care for their infant in a Pavlik harness to treat developmental dysplasia of the hip. Which instruction should be included in the teaching?

The correct answer is a) Positive Ortolani click, b) Unequal gluteal folds, c) Trendelenburg sign, and e) Telescoping of the affected limb.

Choice A reason:

A positive Ortolani click is a clinical manifestation of developmental dysplasia of the hip (DDH). The Ortolani maneuver is used to detect hip dislocation or subluxation in infants. When the hip is abducted and gentle pressure is applied to the proximal thigh from behind, a palpable “clunk” is noticed as the femoral head relocates into the acetabulum. This indicates hip instability, which is a characteristic of DDH.

Choice B reason:

Unequal gluteal folds are another clinical manifestation of DDH. Asymmetrical gluteal creases can suggest hip dysplasia in infants. This is because the dislocation or subluxation of the hip can cause one leg to appear shorter than the other, leading to uneven gluteal folds.

Choice C reason:

The Trendelenburg sign is a clinical test used to assess the integrity and strength of the hip abductor muscles, particularly the gluteus medius and gluteus minimus. A positive Trendelenburg sign usually indicates weakness in these muscles, which can be associated with hip abnormalities such as congenital hip dislocation3. In DDH, the hip instability can lead to a positive Trendelenburg sign.

Choice D reason:

A negative Babinski sign is not a clinical manifestation of DDH. The Babinski reflex is a normal reflex in infants up to 2 years old, where the big toe moves upward and the other toes fan out when the sole of the foot is stroked. A negative Babinski sign would indicate the absence of this reflex, which is not related to DDH.

Choice E reason:

Telescoping of the affected limb is a clinical manifestation of DDH. In a child with DDH, the hip socket is shallow, and the head of the femur may slip in and out, leading to a telescoping effect. This means the femoral head can move further out of the socket, causing the limb to appear shorter or longer depending on the position.

Choice A reason:

Walnuts are a source of protein and contain phenylalanine, an amino acid that individuals with phenylketonuria (PKU) must limit in their diet. While nuts can be a healthy snack for most people, they are not suitable for those with PKU due to their high phenylalanine content. Therefore, walnuts are not the best choice for children with PKU.

Choice B reason:

Cow’s milk is another source of protein and contains significant amounts of phenylalanine. Dairy products, including milk, cheese, and yogurt, are generally high in protein and should be avoided by individuals with PKU. Consuming cow’s milk can lead to elevated levels of phenylalanine in the blood, which can be harmful to children with PKU.

Choice C reason:

Bananas are a fruit that contains very low levels of phenylalanine. Fruits and vegetables are generally safe for individuals with PKU as they are low in protein and phenylalanine. Bananas, in particular, are a good option for children with PKU as they provide essential nutrients without contributing to high phenylalanine levels.

Choice D reason:

Diet soda with aspartame should be avoided by individuals with PKU because aspartame is an artificial sweetener that contains phenylalanine. Consuming products with aspartame can lead to an increase in phenylalanine levels in the blood, which can be harmful to those with PKU. Therefore, diet soda with aspartame is not a suitable choice for children with PKU.