Hip dysplasia — also called developmental dysplasia of the hip (DDH) — is one of the most common congenital conditions in babies. It means the hip socket is too shallow, which can make the hip joint unstable.

The good news? Early detection and simple treatment give very good outcomes. The vast majority of children end up with completely normal hips.

What is hip dysplasia?

The hip joint is a ball-and-socket joint where the head of the femur (the ball) sits in a socket in the pelvis. In babies with hip dysplasia, this socket is too shallow. This can cause the ball to be unstable in the joint.

The condition varies in severity:

Mild dysplasia — the hip socket is slightly too shallow, but the hip is stable
Unstable hip — the femoral head can be pushed partially out of the socket (subluxation)
Dislocated hip — the femoral head lies completely outside the socket (rare)

How common is it?

Developmental dysplasia of the hip affects approximately 1–3 percent of newborns, according to the AAP. Girls are affected about six times more often than boys. About one quarter of patients under 40 who receive a total hip replacement have underlying hip dysplasia — which underscores how important early treatment is.

Risk factors

Some babies are at higher risk:

Breech position in the final trimester (the single most important factor)
Family history — parent or sibling with hip dysplasia
Firstborn — slightly increased risk
Girls — significantly higher incidence
Foot deformities at birth
Cramped conditions in the uterus (low amniotic fluid, large babies)

Even though risk factors increase the chance, hip dysplasia can develop in any baby. That is why all newborns are clinically examined in the maternity ward.

How is hip dysplasia detected?

Clinical examination at birth

All newborns are examined by a pediatrician in the maternity ward using two specific tests:

Ortolani test — checks whether the femoral head can be pushed back into the socket
Barlow test — checks whether the femoral head can be pushed out of the socket

These tests catch many, but not all, cases. Clinical examination alone identifies around 40 percent of seriously dysplastic hips.

Ultrasound screening

Babies with risk factors or uncertain clinical findings receive a hip ultrasound. The AAP recommends ultrasound between 4 and 6 weeks of age for babies with risk factors. When dysplasia is suspected during the clinical examination, ultrasound is often done in the first week of life.

Pediatric well-child visits

Your pediatrician examines the hips at every well-child visit during the first year. Limited range of motion in the hip (abduction under 60 degrees) or asymmetric skin folds can raise suspicion of hip dysplasia that was not detected at birth.

After 4–5 months of age, X-rays are used instead of ultrasound.

Treatment

Pavlik harness — the most common treatment

The Pavlik harness is the most widely used treatment method. It is a soft harness that holds the baby's legs in a frog-leg (abducted) position, promoting normal development of the hip socket. Treatment is pain-free for the baby.

Practical information about the Pavlik harness:

Worn all day — removed only for diaper changes and bathing
Treatment typically lasts 6–12 weeks for uncomplicated dysplasia
The harness is adjusted as the baby grows
Follow-up ultrasound at 6 weeks and after treatment ends

Use diaper changes as an opportunity for extra skin-to-skin contact while the baby is out of the harness. Avoid lifting the baby by the legs during diaper changes, and don't leave the baby without the harness for extended periods.

Other treatment options

Frejka pillow — a foam pillow used at some centers as an alternative to the harness
Rigid abduction orthosis — a stiffer brace used in some cases
Casting — for more severe cases where the hip has dislocated
Surgery — very rarely necessary, only for the most severe cases

Prognosis

The prognosis is very good with early treatment. Most babies with uncomplicated hip dysplasia develop completely normal hips after 2–4 months of harness treatment.

Research confirms that the potential for normalization is greatest in the first months of life. Early detection and starting treatment promptly are therefore critical.

The myth of double diapers

You may have heard that "double diapering" can prevent or treat hip dysplasia. This is not correct. Double diapers do not provide sufficient hip abduction to have a therapeutic effect. Hip dysplasia requires proper medical treatment — not extra diapers.

Everyday life with the Pavlik harness

It can feel overwhelming to be told that your baby needs treatment. Here are some practical tips:

Clothes: The harness goes on the outside of clothing. Choose clothes that are easy to put on and take off
Carrying: You can carry your baby while wearing the harness, but check with your treating doctor about baby carriers
Car seat: Most car seats work with the harness, but test that the baby sits safely
Sleeping: The baby can sleep with the harness. Back sleeping is always recommended
Baby swimming: Not recommended during harness treatment

Hip dysplasia detected later

Some cases are not identified in the newborn period. Signs parents should watch for as the baby grows:

Asymmetric skin folds on the thighs
One leg appears shorter than the other
Limited movement in one hip joint
Limping or waddling when the child starts to walk

If hip dysplasia is detected late, treatment can be longer and more extensive. Contact your pediatrician if you are concerned.

Follow-up after treatment

After harness treatment ends, the child is followed up with X-rays at around 4–6 months of age and usually a follow-up image at 15 months. Some children need monitoring through school age.

Frequently asked questions

Does the Pavlik harness hurt the baby?

No, the harness is pain-free. The baby may cry a little during the first few days because it is unfamiliar, but most babies adjust quickly. The harness does not prevent normal movement or development.

Can we prevent hip dysplasia?

Hip dysplasia is a congenital condition that cannot be prevented. What you can do is make sure your baby is examined as recommended, so that any dysplasia is detected early.

Will my child have hip problems later in life?

With early detection and correct treatment, the prognosis is very good. The vast majority of children end up with completely normal hips. Untreated hip dysplasia can, however, lead to arthritis and the need for a hip replacement in adult life.

Should the next child be screened more thoroughly?

Yes. Family history of hip dysplasia is a known risk factor. Tell your pediatrician that a sibling has had hip dysplasia, so that the next child can receive ultrasound screening early.

Sources

American Academy of Pediatrics. "Developmental Dysplasia of the Hip." AAP, 2024.
International Hip Dysplasia Institute. "Hip Dysplasia in Infants." IHDI, 2024.
Orthopaedic Research Society. "Early Treatment Outcomes for DDH." ORS, 2024.

Hip Dysplasia in Babies: Symptoms and Treatment