Your baby's developing hips will eventually make it possible for her to crawl, walk, climb, run and even dance.
That's why your pediatrician moves your baby’s legs around during well-baby visits and looks for any signs of hip instability or hip dysplasia — a relatively common condition that could affect your baby’s motor development and lead to other health problems down the road.
Like many other conditions, early diagnosis and treatment lead to better outcomes. Here’s what you need to know about hip dysplasia, including the signs to watch for, causes and treatment options.
What is hip dysplasia?
Hip dysplasia is a musculoskeletal condition that occurs when the hip bone does not develop properly and the top of the femur doesn't fit into it like a ball and socket. In an infant, this leaves the hip joint loose and prone to injury, and can lead to other health problems.[1]
Why? Well unlike an adult’s hip socket made of hard bone, an infant’s hip socket is mostly soft, pliable cartilage.
Hip dysplasia is often referred to as Developmental Dysplasia of the Hip (DDH). Like many other conditions, hip dysplasia has a wide range of severity, from mild (loose joints) to severe (complete dislocation).
Fortunately, the condition does not cause any pain. An estimated 1 in every 100 babies is treated for hip dysplasia in some form. And rarely, 1 or 2 babies out of 1,000 are born with completely dislocated hips.[2]
What are signs of hip dysplasia in babies?
Hip dysplasia in babies is often discovered at or soon after birth during routine wellness exams.
It can be hard to detect because it is, like many others, a “silent” condition. It won’t cause your little one to cry in pain and doesn’t typically prevent babies from learning to walk.
Read This Next
There are some outward signs of hip dysplasia to take note of and bring up with your pediatrician, however, including the following:[3]
- Hip popping noises. We tend to think of cracking joints as something common in adults, but hip clicks or pops in an infant can sometimes suggest hip dysplasia. Listen up! Many parents and providers say there is a distinct sound when a baby’s hips are dislocated.
- Trouble diapering. Many parents of babies with hip dysplasia have difficulty putting diapers on them because their hips have a limited range of motion and can’t fully spread. Talk with your pediatrician if you have concerns.
- Asymmetrical buttock creases. (Yes, you read that correctly). If you notice something seems off on your baby’s tush, bring it up to your pediatrician. An ultrasound or X-ray will need to be done to determine whether the hips are normal or not.
- Limps. If both hips are dislocated, you may notice what’s called a “swayback” after baby starts walking. In other words, it may look like your child has a painless and exaggerated limp. One leg may also appear longer than the other, causing the limp. All toddlers tend to walk a little funny at first, so this sign can be a bit harder to pinpoint.
What causes hip dysplasia in babies?
The exact cause (s) of hip dysplasia are not known, but there are some risk factors:[4]
- Breech positioning in utero. Breech babies are more susceptible to hip dysplasia. Other conditions related to positioning in utero — including oligohydramnios, metatarsus adductus (a congenital foot deformity that causes the forefoot to turn inward) and congenital torticollis — are also thought to potentially cause it or increase the risk. The American Academy of Pediatrics recommends ultrasound DDH screening for all female breech babies.[5]
- Family history. Tell your doctor if you, another child, or a relative has hip problems. This increases the chance of your baby having hip dysplasia.
- Baby's sex. Between 75 and 80 percent of babies with hip dysplasia are girls.[6] Doctors have attributed this to pregnancy hormones. Relaxin, a pregnancy hormone that loosens ligaments and relaxes muscles, is said to be more responsive in female babies.
- Being firstborn. Six out of 10 cases of hip dysplasia occur in firstborn children, according to the International Hip Dysplasia Institute.[7] This is said to be because a mother’s womb is tighter during her first pregnancy, which can sometimes restrict fetal movement.
- Prolonged abnormal positioning after birth, including incorrect swaddling and baby carrier use. Babies with caregivers who practice “tight swaddling” — straightening the baby’s legs and tightly wrapping them so the legs can’t move — have a higher rate of hip dysplasia. While there are plenty of benefits to swaddling babies, the hips should be able to flex within any swaddle and the legs should be able to move and bend freely. In addition, doctors have seen an increase in the number of babies who develop the condition months after birth due to the length of time spent in baby carriers, car seats and other products.[8]
How is hip dysplasia diagnosed in babies?
Newborns are usually screened for hip dysplasia shortly after delivery and by their pediatrician at each wellness exam until they are 1 year old. But the best method for physically examining the hips for the condition is still up for debate by some experts.
As with any newborn screening, the goal is to prevent diagnosed cases and allow for earlier, less aggressive interventions down the road.[9]
Physical exams aren't 100 percent effective for diagnosing hip dysplasia, so babies with apparent risk factors often need additional testing to confirm it, including:[10]
- Ultrasound. This test is recommended for infants 4 months and younger, because the hip is still predominantly cartilage and unable to be seen clearly on other scans.
- X-rays. After around 4 to 6 months of age, X-rays are the preferred method for evaluating and monitoring hip dysplasia.
How is hip dysplasia treated in babies?
If a physical exam, an ultrasound or an X-ray confirm a diagnosis, your pediatrician will likely refer you to a pediatric orthopedic specialist for continued care and treatment.
The treatment for babies with hip dysplasia depends on the factors, including your baby's age and the severity of their condition (i.e. how much the thigh bone is displaced from fitting inside the hipbone socket). For example, some cases of hip dysplasia do correct themselves over the first six months of development, as the femur and pelvis grow, but other cases can take months to years to correct.
Treatment options may include the following:[11]
Pavlik harness
These suspender-like harnesses are considered the routine treatment for infants up to 6 months of age with confirmed cases of hip instability or dislocation and are anywhere from 60 to 90 percent effective.
They hold the legs in the “M” or froggy position to help mold the ball into the socket of the hip. Because the harness is typically worn full-time for six weeks, and then part-time for another six weeks, it can make the day-to-day lives of new parenthood significantly more difficult (causing trouble finding baby clothes, changing diapers, keeping the brace clean and so on). Babies rarely seem bothered by the brace, especially if they’ve worn it since birth.
After about six weeks, the doctor will do an ultrasound and look for improvement. If the hips are still dislocated, the harness is worn longer.[12]
Closed reduction surgery with hip spica cast
If wearing the harness hasn’t solved the problem, a closed reduction surgery may be considered for babies between 6 and 12 months old. It’s considered minimally invasive (no incisions) but does require your baby to be put under anesthesia for the pediatric orthopedic surgeon to position the hipbone correctly in the socket.
Afterwards, a plaster cast, called a spica, is applied to hold the hips in the “M” position and is worn for a few months. Follow-up tests will determine whether the procedure was successful.
Open reduction surgery with hip spica cast
Babies older than 12 months who don’t have success with the closed reduction surgery are considered candidates for open reduction surgery. (Sometimes babies older than 6 months qualify if the Pavlik harness didn’t improve the condition).
These cases of hip dysplasia are considered severe. While the baby is under anesthesia, the surgeon will make an incision to reposition the hip socket and repair the ligaments. Similar to the closed reduction surgery, a plaster spica cast will then be applied and worn for a few months.
While these treatments can seem extreme — particularly if your baby appears completely healthy — it’s important to keep in mind what can happen down the road if the condition is left untreated.
What happens if hip dysplasia is left untreated?
There is the potential for some long-term problems if hip dysplasia is left untreated or isn't properly diagnosed early on.
Teens may experience hip pain and discomfort, and many young adults go on to develop early hip osteoarthritis. In fact, untreated hip dysplasia is the most common cause of early-onset hip arthritis in young women.
The goal of treating hip dysplasia early in infancy and childhood is to prevent these subsequent impairments and conditions as your child grows into adolescence and adulthood.
Can hip dysplasia be prevented in babies?
Hip dysplasia cannot be prevented, because the exact cause is unknown. However, there are some things you can do to keep your little one’s hip development on track and avoid any existing hip dysplasia from getting worse:
- Practice hip-healthy, safe swaddling. The Pediatric Orthopaedic Society of North America, with the AAP Section on Orthopedics, recommends allowing your baby’s legs to bend up and out within a swaddle. In other words, the swaddle blanket should be loose around her hips so she can move her legs freely.
- Consider sleepsuits. If your baby isn’t a fan of the swaddle or you are working on a transition, sleepsuits can be a great alternative. They keep babies feeling snug and safe, while allowing your infant to move her arms.
- Wear baby safely. There is no shortage of options when it comes to babywearing — from simple cloth wraps to specialized baby carriers with padding, pockets and straps. Whichever style of baby carrier or sling you choose, make sure your baby’s hips are spread out in the squat position. This means that baby’s thighs are spread around the parent’s torso and baby's hips are open with his knees are bent at the same height as or higher than his bottom, in an "M" shape like a sitting frog. Always check with your baby’s pediatrician before wearing your baby as some infants lack the muscle strength to keep their airways open in an unsupported position.
- Limit time spent in baby carriers, car seats, baby seats and other products. Where does your baby hang out the most during the day? Too much time spent in infant equipment like carriers and seats can not only up his chances of hip dysplasia but also increase the risk of delays in sitting, crawling, walking and even talking. Try to use this kind of baby gear only when necessary, practice tummy time every day and carry baby often and in different positions.
Remember, the vast majority of babies with hip dysplasia do tremendously well with treatment and are able to walk at a typical age. Most are not limited in terms of what activities they can do later in life and often excel in sports, dance and gymnastics due to their increased range of flexibility.[13]
Although having hip dysplasia may present some additional hurdles early on — and plenty of doctor's appointments — your baby will likely grow out of the condition and go onto have a normal childhood.
Yes 
No 
Trending On What to Expect
