Key takeaways: DDH means the hip joint didn’t form normally. Risk factors include breech position, family history, and being female. Hips are checked at well visits, and babies at higher risk may get an ultrasound around 6 weeks. Early treatment, often with a soft harness, works well. Swaddle and carry with legs free to bend at the hips.
The hip is a ball-and-socket joint. In developmental dysplasia of the hip (DDH), the socket is shallow or the ball is loose, which can allow the hip to slip out of place.
Risk Factors
- Breech position in the third trimester (even if the baby turned or was born by cesarean).
- Family history of DDH.
- Female sex.
- First pregnancy or low amniotic fluid.
- Tight swaddling with legs straight and pressed together.
Many babies with DDH have no risk factors.
Screening
Your baby’s doctor checks the hips at birth and at well visits using gentle movements (the Ortolani and Barlow maneuvers in early infancy). Signs may include:
- Uneven thigh or buttock skin folds.
- One leg that seems shorter.
- Limited ability to spread one leg out to the side.
The AAP recommends selective imaging for babies with risk factors such as breech presentation or family history: an ultrasound around 6 weeks of age, or an X-ray after about 4 months.
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From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book covers everyday newborn care month by month, plus the warning signs that mean it’s time to call the doctor.
Treatment
- Pavlik harness: a soft brace that holds the hips in a bent, outward position. It’s used for young babies and is usually worn for several weeks to months.
- Other braces, casting, or surgery may be needed for older babies or when a harness doesn’t work.
Early diagnosis makes treatment simpler and more effective.
Hip-Healthy Swaddling
- Keep the swaddle snug around the chest and arms.
- Leave the hips and legs loose, so the legs can bend up and out at the hips.
- Choose swaddle sacks with roomy bottoms.
Hip-Healthy Babywearing
- Choose carriers that support the thighs from knee to knee, with the hips spread and the knees higher than the bottom, in an “M” position.
- Avoid carriers that let the legs dangle straight down for long periods.
Car Seats and Other Gear
Car seats and other gear are generally fine. If your baby is in a harness, ask your doctor how to use car seats and carriers.
Talk to your baby’s doctor if: you notice uneven leg creases, one leg looks shorter, your baby resists spreading one leg, or later, if your child limps or walks unevenly.
The Bottom Line
DDH is screened for at every early visit and is very treatable when found early. Swaddle and carry with legs free to bend at the hips.
Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.
Related Articles
Sources
- Shaw BA, Segal LS; Section on Orthopaedics. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics. 2016;138(6):e20163107.
- American Academy of Orthopaedic Surgeons. Management of developmental dysplasia of the hip in infants up to six months of age: evidence-based clinical practice guideline. 2014. https://www.aaos.org
- International Hip Dysplasia Institute. Hip-healthy swaddling and babywearing. https://hipdysplasia.org
- Clarke NM. Swaddling and hip dysplasia: an orthopaedic perspective. Arch Dis Child. 2014;99(1):5-6.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
