Quick answer: A hip ‘click’ at the newborn check is common, usually benign (soft tissue sounds), and followed up with an ultrasound to confirm normal hip development. Developmental dysplasia of the hip (DDH) — where the hip joint is shallow or unstable — affects approximately 1–3 per 1,000 births and is very treatable when caught early.
What the newborn hip check involves
The newborn hip examination is part of the NIPE (Newborn and Infant Physical Examination) programme in the UK, performed within 72 hours of birth and again at 6–8 weeks. The examiner uses two specific tests: the Barlow test (attempting to dislocate the hip posteriorly) and the Ortolani test (attempting to reduce a dislocated hip back into the socket). A ‘clunk’ felt during these tests — distinct from a ‘click’ — indicates hip instability or dislocation. A soft ‘click’ without instability is usually a benign soft tissue sound (tendons moving over bony prominences) and is very common.
Benign clicks vs significant findings
The examiner distinguishes between: a soft, high-pitched click (usually benign — soft tissue) and a palpable ‘clunk’ or ‘clonk’ (indicates actual hip movement, warrants further investigation). If only a click is found with no instability on the Barlow/Ortolani examination, the hip is usually declared normal. If instability is found, or if the baby has significant risk factors (breech position, family history of DDH, or abnormal leg position), an ultrasound of the hips is arranged.
Risk factors for DDH
Higher risk of DDH: breech presentation at birth (highest risk — approximately 3–4% prevalence vs 0.1% overall); family history of DDH; oligohydramnios (reduced amniotic fluid); first-born female babies; winter births (more swaddling with legs straight — proper swaddling leaves hips free to flex). NHS screening guidelines recommend hip ultrasound at approximately 6 weeks for all babies with these risk factors, regardless of clinical examination findings.
Treatment if DDH is found
DDH diagnosed early (under 6 months) is treated with a Pavlik harness — a soft harness worn for 6–12 weeks that holds the hips in the correct flexed and abducted position while the joint develops and stabilises. The earlier treatment begins, the better the outcome — hips treated in the first weeks of life with a Pavlik harness have excellent outcomes in most cases. DDH diagnosed later (6–18 months) may require closed or open surgical reduction followed by casting. This is why the newborn screening programme is clinically important.
Frequently Asked Questions
My baby’s hip clicked at the 6-week check — should I be worried?
A soft click alone without instability on examination is usually benign. your doctor or pediatrician will explain whether this is a finding that requires follow-up ultrasound or whether it’s a normal soft tissue sound. If an ultrasound is arranged, attend promptly — early identification of any hip abnormality matters for outcome.
How do I carry my baby to protect their hips?
The M-position (hip-healthy position) for babywearing: knees higher than the bottom, thighs fully supported from knee to knee, legs in a frog-like position. Wide-base baby carriers and properly fitted slings all support this position. Narrow-based carriers where the baby dangles with unsupported thighs do not — check that your carrier provides knee-to-knee thigh support.
Can DDH be missed at the newborn check?
Yes — clinical screening has sensitivity limitations, particularly for mild DDH and for some forms of acetabular dysplasia that develop later. This is why the programme includes a repeat check at 6–8 weeks, and why ultrasound is used for high-risk babies. If you notice asymmetric skin folds on the thighs, one leg appearing shorter than the other, or limited movement in one hip at any age, discuss with your doctor.
Related Reading
- Hip dysplasia in babies: what DDH means and how it’s treated
- Babywearing guide: carriers, safety and benefits
- 1 month old baby: milestones, sleep & feeding guide
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