PediatricsPediatric OrthopedicsAdvanced LevelProfessionals
Developmental Dysplasia of the Hip in Infants: Recognition, Surveillance and Referral
A safety-focused guide to DDH risk factors, age-appropriate findings, imaging pathways and timely referral.
13 October 20268–12 min readEvidence sources included
What You Should Be Able to Explain After Reading
- Identify risk factors and age-dependent findings that warrant DDH assessment.
- Explain the role and limits of clinical screening and imaging.
- Use timely referral and avoid forceful hip manipulation.
- Support families while coordinating pediatric care.
Condition framework and risk factors
- DDH spans abnormal hip development from acetabular shallowness and instability to subluxation or dislocation. Risk factors include breech presentation and family history, but DDH can occur without recognized risks.
- Screening is age-dependent and belongs within the pediatric care pathway. A physiotherapist may identify concerns but should not claim to exclude DDH with a normal movement screen.
Assessment and imaging
- In young infants, trained clinicians may assess hip stability with age-appropriate maneuvers. As the infant grows, limited hip abduction or apparent leg-length asymmetry may become more informative.
- Ask about breech position, family history, prior screening and asymmetric leg movement. Observe spontaneous movement gently; do not force end-range positions to provoke a sign.
- Ultrasound is commonly used in younger infants when indicated; pelvic radiography becomes more useful with age. Imaging choice and timing should follow the pediatric/orthopedic pathway.
Differentials and referral
- Positional variation, neuromuscular conditions and congenital limb differences may affect symmetry, but should not delay referral when DDH findings are concerning.
- Arrange prompt pediatric/orthopedic assessment for limited abduction, leg-length asymmetry, abnormal stability reported by a trained examiner or significant risk factors not appropriately evaluated. Acute pain, systemic illness or inability to bear weight in an older child needs urgent assessment.
Physiotherapy role and precautions
- The priority is timely diagnostic assessment and specialist-led management when indicated. Physiotherapy can support developmental function and family education in coordination with the treating team.
- When a harness or brace is used, follow specialist instructions for handling, skin checks and permitted movement. Do not alter settings or duration without the specialist team.
- Avoid forceful stretching, repeated provocative testing or attempting to reduce a suspected dislocation. Document findings, referral destination and whether follow-up was confirmed.
Clinical pearl and summary
- A physiotherapist's most valuable contribution may be recognition and referral, not treatment. Age, risk factors and the pattern of findings determine next steps; diagnosis and imaging should be coordinated by the pediatric team.
Evidence & Further Reading
These sources are provided so learners can trace the clinical recommendations and read the original guidance.