If your baby was born in a frank breech position, it is understandable to wonder whether that position could affect the child years later. Searches for frank breech baby problems later in life often come from parents whose child is now walking, growing, starting school, or even becoming an adult and has developed a concern that makes them look back at the birth history. Positively, the presence of a frank breech presentation does not lead to long-term disability, developmental delay, learning difficulties or neurological illness. The most significant and well-founded anxiety related to breech positioning is developmental dysplasia of the hip, especially where the breech presentation persisted toward the end of pregnancy.
Understanding frank breech baby problems later in life requires separating the position itself from complications that may occur during pregnancy, birth, or infancy. Breech isn’t necessarily a problem-a child can be frank breech and grow without lasting problems-or a baby might appear normal then develop a hip abnormality. Sometimes the difficulty noted can in fact be from another source. Therefore symptoms of child and her medical history are really more important than the name breach:
What Does Frank Breech Mean?
A frank breech presentation is the most common presentation found in breech presentation, where the presenting part is the infants bottom and the legs are extended up, having been extended at the knee and the hip. Its not to be confused with aComplete Breech presentation where both the knee and hip are flexed, or a footling presentation where one or both of the feet are presenting.
Frank breeches are the commonest breech presentation. Breech presentation in fact does not come along with pregnancy any earlier. It is mostly between 36 weeks and 37 weeks of the pregnancy that almost all of babies would position themselves head first and remain there. The Royal College of Obstetricians and Gynaecologist explains that a breech presentation in late pregnancy would not cause concern, that either of mother or baby suffers in anyway.
This distinction is important because parents sometimes interpret frank breech baby problems later in life as though the fetal position itself caused permanent damage. In fact the long term prognosis would depend on many things: hip instability, delivery problems, prematurity, presence of other medical conditions and developmental difficulties in early childhood.
Is Being Born Frank Breech Linked to Problems Later in Life?
The answer to that is somewhere between “yes” and “no”. Breech presentation is a known risk for the development of developmental dysplasia of the hip or DDH. The American Academy of Pediatrics lists breech presentation as one of the key risk factors for DDH, and notes that frank breech presentation seems to have particularly high risk for girls, consistent with breech presentation and developmental dysplasia of the hip
All of that does not mean that all frankly breeched babies will develop hip dysplasia however. Risk factors merely confer a chance of developing a particular condition, they don’t mean the child or person absolutely will.
When parents search for frank breech baby problems later in life, they are often most concerned about whether something could have been missed during infancy. This is a justified question as DDH can have subtleties. It is possible for a child to have an seemingly normal neonatal examination then some signs may subsequently be discovered or even develop. ‘ late presenting DDH can have even with the normal examinations in the neonatal period.’according to American Academy of Pediatrics.
This is the reason why the breech history remains clinically important beyond the neonatal period if no adequate hip assessment has ever occurred or symptoms subsequent development occurs in relation to walking, leg length disparity, hip movement or pain.
The Most Important Long-Term Concern: Hip Development
Among possible frank breech baby problems later in life, developmental dysplasia of the hip deserves the most attention. DDH refers to a spectrum of abnormal development or instability of the hip joint.The hip is a ball and socket joint where normal development relies on the femoral head sitting squarely in the acetabulum. If the joint is too shallow or unstable, problems can arise as a child develops. Breech presentation is associated with a higher likelihood ofDDH because the hips of the baby are less able to achieve normal positioning in the late stages of pregnancy.
Breech presentation is cited as an important risk factor by the AAP and frank breech is particularly associated with girl babies.
For parents the pragmatic point is not to panic if the child has had a breech birth that DDH has been caused. Instead look to see if their hips have been adequately assessed and are any signs of hip abnormality are developing in the older child.
Can Hip Dysplasia Cause Problems Years Later?
Untreated or long-term maldevelopment of the hip may lead to problems as a child ages, depending on the severity; the walking style of the patient may be affected as wild-hip motion, leg length discrepancy,hip pain or other mechanical dysfunction.2015review by the AAP states that the continuum of DDH can include a mildly unstable hip that can resolve, to a chronic dislocation, which may result in a variety of complications that have been associated with DDH including, leg length discrepancy,hip pain,labral injury and earlier osteoarthritis.21
This is why frank breech baby problems later in life should not be reduced to the question of whether breech positioning causes “brain damage.” The more established long-term issue involves musculoskeletal development, particularly the hips.
A child born breech who has normal hip exams and subsequent check-ups, while it’s still possible she could have a problem with the hip that goes undetected for many years, has no reason to presume that the problem will arise in the future, whereas a child who is limping, has leg length discrepancy, poor hip range of motion, or ongoing hip discomfort may warrant checking, regardless of the elapsed time frame and common causes of hip pain in children can help provide additional context.
What Signs Might Suggest a Hip Problem?
It is not expected for parents to diagnose DDH themselves, although specific characteristics can help alert parents when to take their child to the doctor.
Signs to watch for in infants include an inability to move one leg well, having different leg length, or asymmetric thigh and/or gluteal creases. The AAP recommends that children’s hips be screened during well-child checks. This is because some children with hip dysplasia are not discovered until they are walking well.
In toddlers and older children, look for limping that does not get better, the development of abnormal gait, limited hip movement on one side, apparent leg-length disparity, or non-specific hip pain. Again, the AAP points out that some developmental hip dysplasia is only noted when a child is walking well and an inability to properly support one’s weight on the hip leads to leg-length inequality and resultant limp. Thus, it is reasonable to bring a breech presentation history to the attention of the pediatrician or orthopedic surgeon if a child later develops abnormal gait, especially if it is significant.
Could Frank Breech Position Cause Developmental Delays?
This is one of the most common concerns surrounding frank breech baby problems later in life, but the evidence does not support assuming that breech presentation by itself causes developmental delay.
Factors such as genetics, immaturity (premature birth), illness, problems at delivery, neurological disorder, the environment and other situations influence development. Because breech presentation can be accompanied by some of these factors it can be problematic to claim that it “causes” a subsequent development delay. Several studies of babies delivered breech failed to establish a straightforward cause-and-effect relation between planned method of delivery and subsequent neurodevelopment.
For example, one study population-based on term breech births found no statistically significant difference between planned vaginal labor and planned cesarean section for neurodevelopmental outcome at 4 years old.
That’s not to say that no complications arise. Difficult births can lead to particular injuries or medical complications, pre term or medically complicated babies have further risk factors and these must be considered on their individual merits rather than every future developmental problem being blamed on the fact that the baby was frankly breech.
Does Frank Breech Birth Cause Brain Damage?
Some parents receive alarming advice that breech delivery is an inevitable cause of neurological damage. This is unsupported by the data.
Potential risk to neurological outcome around breech delivery has mostly been associated with obstetric complications of a difficult birth. Evidence from research studies of longer-term outcome has not found that breech positioning automatically causes neurological disability. One study concluded that differences in long-term neurological outcomes are not attributable merely to the intended management mode.
This is another reason why searches for frank breech baby problems later in life can produce confusing information. Some articles discuss breech presentation, others discuss difficult vaginal breech delivery, and others discuss premature babies. These are not interchangeable situations.
A child who was frank breech but delivered safely and has developed normally should not be assumed to have hidden neurological damage simply because of the birth position.
What About Learning, Speech, or Behavioral Problems?
Without additional reasons to inform them, there’s no appropriate way for physicians to tell expectant or recent parents that being breech at birth causes learning disorders, speech disorders, attention deficit disorders, autism or behavioral problems of later childhood.
A child who shows evidence of speech delay, learning problems, attention problems, or behavioral issues warrants separate developmental evaluation.
Pediatricians can assess hearing, language development, cognitive development, sleeping, academic performance, history and many other things with input into child. It can certainly happen that a formerly breech child does have one of the conditions. It doesn’t mean that the breech caused the condition. This is crucial information because parents search backward after receiving the diagnosis for one cause of subsequent problem. The reality is rarely that simple or medical care is almost never that black and white. A birth finding can be important but not the causative factor in the disease or condition being seen.
Does Delivery Method Change Long-Term Risk?
Management of breech presentation and delivery has complex aspects influencing outcomes. Factors may include planned Caesarean section, planned vaginal breech delivery, emergency delivery, gestation, size of the baby, fetal head position, maternal factors, operator expertise and context of delivery. RCOG guidelines highlight a need to review every case individually when considering breech management.
For parents investigating frank breech baby problems later in life, the delivery method can therefore be useful background information, but it should not be used as a standalone prediction of the child’s future health.
A C-section infant may still develop hip dysplasia if the infant was breech. An infant who has had a skilled vaginal delivery of a breech does not necessarily develop neurological or developmental problems.
What Should Parents Do If the Child Is Still Young?
A wise step if your baby was Frank Breech is to clarify if Hip screening was carried out appropriately given the child’s individual clinical risk and local practices. The American Academy of Orthopaedic Surgeons recommended that imaging (either ultrasound or plain X ray for the pelvis AP view depending on age) should be considered for infants less than 6 months with a clinical risk factor including Breech delivery, strong family history of DDH, or unstablehip examination, as outlined in AAOS guidance for developmental dysplasia of the hip screening.
Do not directly pursue independent imaging studies and take the hip examination by the child’s physician to determine need and modality of imaging screening.
Decisions on screening rely on: physical exam, age, individual risk factors, history of previous imaging studies, and local norms.
A fully mobile/walking normal child indicates an assurance that a serious problems likely doesn’t exist, although may not rule out all possibilities.
What If the Child Is Already a Teenager or Adult?
Parents may discover information about frank breech baby problems later in life when their child is already much older. At that point, the focus should shift from the birth position to the person’s current symptoms.
An adult who had a frank breech presentation as a baby but is without hip pain, disturbed gait, normal mobility, and without other suggestive features within history of hip disease does not automatically warrant a further management approach simply because of the presentation at birth.
However, in presence of ongoing hip pain, reduced range of movement at the hip, recurrence of a joint problem, a noticeable discrepancy in the length of the legs, altered gait, or a previous history of unexplained hip pathology warrants a work up. This allows determination by a clinician if the symptom or signs are associated with the hip, spine, muscles, tendons, past injury, other condition, inclusion of the breech birth story into a relevant past medical history being made; without concluding that this caused the present problems.
Can Problems Appear Even After Normal Infant Screening?
Yes- though the probability and severity is variable. There can be cases of hip dysphasia present in developmental fashion. An article reported in the AAP stated that late-appearing developmental hip dysplasia may occur after what initially seem to be perfectly normal ultrasounds.
That is why early examination by the physician should be combined with continuing standard pediatric examinations, so early negative screenings aren’t relied upon with blind confidence.
The parents also shouldn’t over panic each time their child experiences a temporary limp or a minor asymmetry in their legs- there are many cases where they have a normal, childhood injury or are still growing and developing normally. Their pattern of stiffness, duration and severity of symptoms, and the physician’s examination help guide the evaluation.
What Mistakes Should Parents Avoid?
It is an error to conclude that any physical or developmental problem your child encounters is a result of Breech presentation-an unnecessary cause of anxiety and distracter from the correct etiology may arise. It is a mistake to have no follow up after being assured by a very early newborn examination of the hips that everything is normal; the breech presentation poses risk for DDH and continued awareness is important. Parents of children delivered breech should not relate the experience of their delivery compared with a different breech baby to conclude the resulting development/health issues are the same in any way.
Two completely distinct children can be born with frank breech presentation and totally unrelated issues.
Lastly, one cannot diagnose hip status, neurological system integrity, or developmental progress solely from online conversation. Constant, reproducible physical findings would be most meaningful if communicated from and by the pediatrician or other specialist.
What Is the Long-Term Outlook for a Frank Breech Baby?
Good outcome for the majority of these children. A frank breech position is a feature of pregnancy and delivery, not of an inherently, inevitably diseased state. The key, established association is with developmental hip dysplasia and it is on this basis that all breeches are assessed for the hips of a young baby.
Provided the child’s subsequent development, motor function, and gait are normal, there are no ongoing symptoms referable to the hip and an appropriate level of paediatric surveillance, there appears no indication that the fact of being born frank breech would per se dictate some insurmountable later difficulty.
Research into the consequences of long term breech presentation requires careful study due to differing gestations, delivery methods, complications and definition of outcome reported in individual papers, and a systematic review has acknowledged a wide variability in long term follow-up methods.
When Should a Child Be Evaluated?
A limping child with clear asymmetry in leg length, limited hip motion on one side, pain in the hip without explanation, abnormal gait, or rapid change in capabilities warrants assessment by a healthcare provider.
Unequal leg movement or poor hip motion is cause for evaluation by the infant’s pediatrician whereas, pain or unusual gait in a child or adolescent may warrant evaluation by a pediatrician, orthopedic physician, or other appropriate physician. This assessment should not be a search for evidence of a causative breech position but should rather establish a diagnosis for present problem.
The Bottom Line on Frank Breech Baby Problems Later in Life
The search for frank breech baby problems later in life often reflects a fear that a baby’s position before birth automatically creates lifelong consequences. Current evidence does not support that conclusion.
The issue that is most definitely confirmed to be a definite concern is Developmental Dysplasia of the Hip (DDH). Breech delivery particularly frank breeching late in pregnancy is a risk factor for DDH so proper screening and follow up of hip positioning of infants.
On the flip side, being born frank breech certainly does not guarantee later learning difficulties, neurological illness, developmental delay,or Chronic Disability. Later outcomes are most dependent on the child’s total clinical picture and actual future conditions that occur.
If your child is at present healthy and thriving, do not use frank breech history alone to predict that any future symptoms or problems are definitely associated with the position of delivery. If there are complaints of current hip pain, a limp or abnormal walk, limited range of motion, or any of any kind of other problem that you cannot account for then take the history of frank breech to the physician but do not jump to the conclusion that all present symptoms are related and use the current information to get the problem evaluated.
The ideal management does not lie at either end of either embracing a concern that does not necessarily exist or disregarding a potential risk. Evaluate as a piece of medical information while keeping all hips under surveillance, have all routine pediatric care performed, and explore concerning factors when they do arise.
Frequently Asked Questions
Can a frank breech baby have normal development?
Yes. Babies presenting with the frank breech presentation do have good development in many cases. Breech presentation does not imply developmental handicap. The baby’s own development, progress and motor milestones, neurological examinations, and overall wellbeing tell far more than his position at birth.
What is the biggest long-term concern for a frank breech baby?
By far the greatest confirmed problem with breech presentation is developmental hip dysplasia. Breech presentation is the most recognized risk factor for DDH, according to the AAP, with very specific girls being most at risk with frank breech presentation
Can a frank breech baby develop hip problems later?
Yes. Sometimes hip dysplasia may be detected more subtly and can be detected postnatally. Symptoms in such infants may range from limitations in the range of hip movement, leg length inequality to an unusual gait.
Does being born breech cause cerebral palsy?
Single evidence alone should not be considered proof for CP development at a later stage in life. Several factors effect outcome on the neurology and one cannot directly attribute disability due to the presenting part in pregnancy alone, through research trials on the topic.
Can a frank breech position cause learning disabilities?
There is no good basis for assuming that a frank breech position alone causes learning disabilities. If a child develops learning, speech, attention, or behavioral difficulties, those concerns should receive an individual developmental assessment rather than automatically being attributed to breech birth.
Should an older child who was born frank breech have a hip X-ray?
Age and presentation – It is not the case that every breech baby over this age require an x-ray. This varies according to the presentation and history the child has had such as presence or absence of previous screening results, the childs physical examination, clinical suspicion, and a list of other risk factors, as well as the child’s age. If the child exhibits unexplained limp, joint stiffness, joint pain or any concern, talk to your doctor about what to investigate and to arrange what assessment to be done on a case to case basis.
Can a breech baby have problems even if the newborn examination was normal?
Despite a re-assuring first assessment, developmental hip dysplasia can later become apparent. Regular pediatric hip assessments and correct follow-up of breach-born babies remain therefore crucial.
