Developmental dysplasia of the hip (DDH) is a condition that affects how a baby's hip joint develops. When diagnosed early, DDH can often be successfully treated, significantly reducing the chance of lasting issues such as hip pain or mobility problems later in life. However, if left untreated, DDH can affect a child's growth and cause difficulties when they reach walking age, sometimes leading to more complicated procedures or surgery.

Recognising the signs early can make a meaningful difference to your child's health and quality of life. Understanding what developmental dysplasia of the hip is, the risk factors - such as being born in a breech position or having a family history of hip problems - and available treatments can help parents and carers feel informed and confident in managing this condition.

In this guide, we will explain what parents should expect if their child is diagnosed with this form of hip dysplasia, with insights from Dr Guiseppe Aragona, GP and online doctor for Prescription Doctor.

What Is Developmental Dysplasia of the Hip?

Developmental dysplasia of the hip is a condition where a baby’s hip joint does not develop in the usual way, leading to looseness or instability. To understand what happens in cases of DDH, it's helpful to picture the hip as a ball-and-socket joint. Normally, the ball-shaped top of the thigh bone (called the femoral head) sits comfortably in a deep socket (known as the acetabulum) in the pelvis. With DDH, this hip socket might be too shallow or incorrectly formed, meaning the thigh bone can easily slip out, either partially or completely.

DDH ranges from mild to severe. In milder forms, known as acetabular dysplasia, the socket doesn’t provide enough coverage for the femoral head, making the hip less stable. In more serious cases, the femoral head slips out completely, causing a fully dislocated hip.

Several risk factors increase a baby's likelihood of developing DDH, such as family history, being born in a breech position, or conditions like congenital knee dislocation and congenital muscular torticollis (tightness of the neck muscles). Doctors, nurses and health visitors typically check for signs of DDH during routine examinations, but knowing what to look for yourself can help you recognise any issues sooner.

You can find out more about DDH by visiting the NHS website.

How Can DDH Affect a Child’s Development?

This form of hip dysplasia can impact a child's physical development in several ways, particularly if it isn't identified and treated early. The condition affects the way a baby’s hips grow, influencing their ability to move, crawl, and eventually walk.

Dr Aragona explains: “The abnormal development of the hip joint in DDH can significantly influence how a child grows and moves. DDH can affect just one hip or both, and this can lead to delayed walking or walking problems. It’s essential that it is diagnosed as soon as possible in early childhood.”

When the hip joint doesn't develop properly, a child might experience difficulty in achieving key milestones like crawling, standing or walking. Babies who have DDH often develop differences in leg length, uneven movement patterns, or limping as they begin to walk. Without early treatment, these issues can become more pronounced, potentially affecting posture and causing discomfort or hip pain later in life.

Early diagnosis and treatment play a major role in preventing these developmental challenges. By getting your child's hip dysplasia diagnosed and treated promptly, you will give them a better chance of having normal hip function and avoiding longer-term complications.

Why Are the Chances of Hip Dysplasia Higher in Breech Babies?

Babies who are born in a breech position - where their feet or bottom come out first rather than their head - have a higher risk of developing dysplasia of the hip. The position of the baby during birth can influence the formation of the hip joint and increase the chance of instability or hip dislocation.

Dr Aragona explains: “The abnormal development in DDH can be linked directly to a breech birth, as this position can place considerable pressure and strain on a baby's hips. While the overall risk of DDH is relatively low, babies born breech have a higher likelihood compared to those born head-first. Additionally, research has found that girls who are delivered breech have a greater risk of DDH compared to boys.”

The NHS advises additional hip checks and possibly ultrasound scans for babies who were breech at birth, even if initial physical exams appear normal. Early assessment by a healthcare professional helps identify hip instability and enables timely treatment if needed. This early detection improves the outcomes for children, reducing the risk of future walking difficulties or ongoing hip problems.

If your baby was born breech, we recommend you discuss this with your health visitor or GP, who can guide you through any additional checks your baby might need.

What Are the First Signs That Your Child Has DDH?

Parents often notice the first signs of developmental dysplasia of the hip during their baby’s early months. Spotting these signs early helps doctors diagnose hip dysplasia quickly, so your child can receive the best possible care.

Some of the most common early signs of DDH include:

• Unequal leg lengths: You may notice that one of your baby's legs looks shorter than the other, especially when their knees are bent.
• Limited hip movement: Your baby's hips might feel stiff, making it difficult to fully spread their legs apart during nappy changes.
• Uneven skin folds: Skin creases around your baby's thighs or buttocks may appear uneven or asymmetrical.
• Hip instability: A gentle clicking or clunking sensation might be noticed during routine checks or when moving your baby's hips, particularly during a physical exam by your GP or health visitor.

These signs can sometimes be subtle and easily missed, especially if DDH is mild or affects only one side. Routine physical exams and careful observation from your child's doctor or nurse can help to identify these issues early, increasing the likelihood of successful treatment without invasive surgery.

If you notice any of these signs or feel concerned about your baby’s hip movement, it's best to speak to your GP or health visitor as soon as possible. They can arrange an appropriate examination or refer your child for specialist evaluation by an orthopaedic surgeon.

How Is DDH Diagnosed?

Developmental dysplasia of the hip is typically diagnosed through a combination of physical examination and imaging techniques such as X-rays. Early diagnosis is the best way to make sure your child receives effective developmental dysplasia of the hip treatment, avoiding further complications as they grow.

Initially, your baby’s hips will be examined by a doctor or health visitor soon after birth, and again during regular health checks in early childhood. During these physical exams, healthcare professionals gently move your baby's hips and legs, checking for instability, clicking, or limited hip movement. They also examine visual indicators, such as uneven skin folds or leg length differences.

If your doctor or health visitor suspects DDH, they may refer your child for further tests, including:

• Ultrasound scans: Usually recommended for babies under six months old, ultrasounds allow healthcare professionals to clearly see the hip joint structure, the femoral head, and the hip socket.
• X-rays: These are often used for older babies and toddlers, particularly after six months of age, to identify clearer radiographic findings of abnormal hip development.

In some cases, diagnosis happens after your child reaches walking age, especially if the signs were initially subtle or missed during earlier checks. At this stage, parents might notice their child limping or having difficulty with movement, prompting further medical investigations.

It’s helpful to speak to your GP or health visitor if you have any concerns about your baby's hips, particularly if they were born in a breech position or there is a family history of hip dysplasia.

How Is DDH Treated?

Treatment for developmental dysplasia of the hip depends on your child’s age and the severity of their condition. Early treatment is generally simple and non-invasive, but if the initial diagnosis is delayed and your child's hip dysplasia is not treated until later in life, it can require more complex interventions.

Common ways of treating hip dysplasia in babies include:

• Hip-healthy swaddling: Adjusting how your baby is swaddled can encourage healthy hip development. Your health visitor or midwife can demonstrate the safest way to swaddle your baby.
• Pavlik harness: This soft harness is often recommended for babies younger than six months. It gently holds the baby's hips in the correct position, promoting natural alignment and proper joint development. Treatment usually lasts for several weeks to a few months.
• Closed reduction and spica cast: If DDH is diagnosed when a baby is slightly older, or if the Pavlik harness hasn't been successful, orthopaedic surgeons might recommend a procedure called closed reduction. The surgeon carefully moves the hip joint into position without surgery and then applies a spica cast to hold the joint securely as it heals.
• Surgical (open reduction): If DDH is diagnosed later or if non-surgical methods have not worked, an orthopaedic surgeon may perform open reduction surgery. This involves repositioning the hip joint surgically and securing it with a spica cast afterwards.

Throughout treatment, regular follow-up appointments help your child’s doctor monitor progress. This usually involves physical exams and imaging to determine how the treatment is progressing.

How Can You Help Your Child if They Have DDH?

If your baby has developmental dysplasia of the hip, your role as a parent can make a real difference. Being aware of the condition, spotting the signs early, and seeking prompt medical advice can all help to manage DDH effectively.

Dr Aragona advises: “The best thing you can do is spot symptoms right away and seek medical help. Do your research on DDH, so you can understand what is most comfortable for your baby in terms of holding, sleeping positions and other ways to make them comfortable. There is a good community for parents of children with DDH where you can get help and support. Your GP might also provide guidance or point you towards valuable resources.”

Early diagnosis and appropriate treatment often lead to positive outcomes, enabling children with DDH to develop healthy hips and avoid long-term complications.