Quick answer: Developmental dysplasia of the hip (DDH) is one of the most common structural problems identified in newborns and young infants.
Developmental dysplasia of the hip (DDH) is one of the most common structural problems identified in newborns and young infants. Early identification and treatment leads to excellent outcomes; delayed diagnosis can lead to long-term joint problems. Here’s what every parent needs to know.
What DDH Is
DDH refers to abnormal development of the hip joint — ranging from mild instability (the hip can be temporarily displaced) to frank dislocation (the femoral head is completely out of the socket). The hip joint consists of the femoral head (ball) fitting into the acetabulum (socket) of the pelvis. In DDH, this relationship is abnormal — the socket may be shallow, the ball may be loose, or the joint may be fully dislocated. DDH affects approximately 1–2% of newborns to some degree, with the full dislocation rate being lower (0.1–0.2%). Risk factors: female sex (4–8x higher risk), breech presentation, family history of DDH, firstborn child, and oligohydramnios.
How It’s Detected
Newborn physical examination includes two clinical tests: Ortolani test: Abducting and externally rotating the hip — a clunk (not a click) indicates a reducible dislocation (the femoral head moving back into the socket). Barlow test: Adducting and pushing posteriorly — a dislocatable hip can be felt to sublux. These tests are done by a trained examiner at birth and the 6-week check. Ultrasound: The gold-standard diagnostic test. Recommended for high-risk babies (breech, positive family history, abnormal clinical exam) at 6 weeks. In the UK, universal ultrasound screening was trialled and found to have high false-positive rates; selective ultrasound for risk factors remains standard. Some countries use universal ultrasound.
Treatment: The Earlier the Better
0–6 months — Pavlik harness: A soft harness that holds the hips in a flexed, abducted position (‘frog’ position), allowing the femoral head to centre in the socket as it develops. Worn 23 hours per day, typically for 6–12 weeks. Success rate is high when started early (80–90% for mild-moderate DDH). 6–18 months — Closed reduction: Under anaesthesia, the hip is manually reduced and held in a hip spica cast for several months. Over 18 months — Open reduction: Surgical reduction of the hip, typically with femoral or pelvic osteotomy to improve socket cover. The older the child at diagnosis, the more complex the treatment required — which is why early screening matters.
Parent Questions About the Harness
The Pavlik harness looks alarming but is well-tolerated by babies. Tips: nappy changes can be done without removing the harness; baby can still be bathed (sponge baths only while in the harness unless specifically told otherwise); the harness should be worn as instructed — 23 hours is not a suggestion; contact your orthopaedic team if straps loosen, baby seems in pain, or any redness develops. Most babies adapt quickly and the harness has minimal impact on their daily comfort.
Frequently Asked Questions
My baby had a ‘clicky hip’ mentioned at the newborn check — should I be worried?
A ‘click’ (a soft clicking sound when the hip is moved) is different from a ‘clunk’ (a palpable movement of the femoral head). Clicks are common and usually represent soft tissue snapping — they rarely indicate DDH. A clunk — particularly in a high-risk baby — is more significant. Your midwife or doctor will determine whether referral for ultrasound is needed based on the nature of the sound and your baby’s risk factors.
Can DDH be prevented?
Swaddling with the hips in extension (legs straight, tightly wrapped) is associated with increased DDH risk — always swaddle with the hips in natural flexion and external rotation (‘frog position’). Hip-healthy baby carriers (those that support the hips in the M-position, facing inward with knees above bottom) are designed to support normal hip development. These measures are particularly important in high-risk babies.
Does DDH run in families?
Yes — first-degree relatives of DDH patients have a 6–10x increased risk. If you have DDH in a parent or sibling, inform your midwife or paediatrician at birth so that ultrasound screening can be arranged.
Related Reading
- Safe sleep for newborns: the complete ABCs guide
- 1 month old baby: milestones, sleep & feeding guide
- Best baby carriers 2025: wraps, ring slings and structured SSCs
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