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Infant hip dysplasia screening

Babies have their hips checked at birth and again at later visits, because a hip that is loose or out of its socket is often painless and easy to miss. Most babies have a normal check. Babies with an abnormal check or certain risk factors may have a hip ultrasound. (MedlinePlus, 2025) (NHS, 2025) (NIPE handbook, 2025)

What the hip check looks for

Developmental dysplasia of the hip (DDH) is a problem with the hip joint that is present at birth. The hip is a ball and socket joint; in some newborns the socket is too shallow and the ball at the top of the thigh bone may slip out of it, part of the way or completely. One or both hips may be involved. (MedlinePlus, 2025) DDH is not usually painful, so many parents do not notice it. (NHS, 2026)

MedlinePlus puts DDH at about 1 to 1.5 of every 1,000 births. (MedlinePlus, 2025) The AAP 2016 report says hip instability on the exam occurs in 1% to 2% of full-term infants, up to 15% have instability or immaturity seen on imaging, and many mild forms resolve without treatment. (AAP, 2016)

Risk factors

The cause is unknown. MedlinePlus lists being the first child, being female, breech position during pregnancy, a family history of DDH, large birth weight and low levels of amniotic fluid in the womb. (MedlinePlus, 2025) The UK programme's national hip risk factors are narrower: (NIPE handbook, 2025)

  • A parent, brother or sister who had a hip problem starting as a baby or young child that needed treatment with a splint, harness or operation. (NIPE handbook, 2025)
  • Breech position at or after 36 completed weeks of pregnancy, whatever the position at birth or the type of delivery, including after a successful turning of the baby (external cephalic version). (NIPE handbook, 2025)
  • Breech position at birth between 28 weeks and term. (NIPE handbook, 2025)

In twins and other multiple births, all the babies have a hip ultrasound if any of them has one of these risk factors or an abnormal hip check. (NIPE handbook, 2025) A 2026 review notes that the AAP 2016 report calls breech position and family history poor predictors, and says that female sex alone accounts for about 75% of all cases. (Children review, 2026)

When the hips are checked

When babies have their hips checked and what the check includes, from the NHS, the NIPE handbook, MedlinePlus and the AAP
AgeWhat happens
Within 72 hours of birthNewborn physical exam of the whole baby, including a check that the hips have grown properly and move as expected (NHS, 2025)
6 to 8 weeksThe same check again, because some problems take longer to show (NHS, 2025)
Up to 3 monthsThe Barlow and Ortolani checks can still be done; after 3 months they are no longer accurate (NIPE handbook, 2025)
After 3 monthsUneven leg length and limited spreading of the hip are checked, and the walk is watched once the child walks (NIPE handbook, 2025)
US well-baby visitsPediatric providers routinely screen all newborns and infants, with several exams because some mild cases show up only after birth (MedlinePlus, 2025); the AAP aims to find a dislocated hip by 6 to 12 months of age (AAP, 2016)

More on the other visits: well-child checkup screenings by age and newborn screening results.

The exam: Barlow and Ortolani

The baby lies undressed and settled on a firm, flat surface in a warm room. The examiner first looks at whether the legs are the same length, whether the knees are level when the hips and knees are bent, and whether either hip does not spread out to the side as far as it should. (NIPE handbook, 2025)

  • Barlow maneuver. Screens for a hip that can be dislocated: such a hip is pushed out of the joint by the maneuver. (NIPE handbook, 2025)
  • Ortolani maneuver. Screens for a hip that is already dislocated: such a hip is felt clunking back into place. (NIPE handbook, 2025)

The NHS says the exam is not painful or uncomfortable, has no known risks, and parents are told the results straight away. (NHS, 2025) Some mild cases are silent and cannot be found on a physical exam. (MedlinePlus, 2025)

Who gets a hip ultrasound

Ultrasound is used to look at the hips of younger babies, and an x-ray in older infants and children, whose bones show up more clearly. (MedlinePlus, 2025) (NHS, 2026)

  • UK. Babies with an abnormal hip check or a national hip risk factor have a hip ultrasound at 4 to 6 weeks of age and a review by a bone (orthopaedic) specialist by 6 weeks. Babies born before 34 weeks have it at 38 to 40 weeks corrected age. (NIPE hip pathway)
  • US. A 2024 review summarizes the AAP as generally not recommending ultrasound for every baby, and as recommending it for babies with risk factors such as breech position or a family history. (Scoping review, 2024)

Why every baby is not scanned in the US

Many hip findings seen in newborns go away on their own. The USPSTF evidence review found that a significant share of hip problems found by exam or ultrasound in the newborn period resolve, and that there is no trial linking screening to better long-term function. (USPSTF evidence review, 2006) The AAP report adds that many mild forms resolve without treatment and that there is no agreement on which ultrasound findings are disease and which are normal developmental variation. (AAP, 2016) The 2024 review says the AAP expects most minor ultrasound findings seen from 6 weeks to 4 months to go away. (Scoping review, 2024)

The 2006 USPSTF statement

The USPSTF published its statement on screening infants for DDH in 2006. (USPSTF, 2006) Its evidence review concluded that exams or ultrasound can identify newborns at higher risk, but that because hip instability and dysplasia in newborns so often resolve and treatment had not been shown to improve function, the net benefits of screening were not clear. (USPSTF evidence review, 2006) The AAP 2016 report describes it as an inconclusive determination, and still describes newborn and periodic hip screening as long-standing practice. (AAP, 2016) What the letter grades mean: USPSTF grades explained.

What an abnormal check or ultrasound means

An abnormal check is a screening result, not a diagnosis. In the UK programme, a screen positive hip result is any of these, with or without risk factors, or a national risk factor on its own: (NIPE handbook, 2025)

  • a difference in leg length;
  • knees at different levels when the hips and knees are bent;
  • one hip that spreads out at least 20 degrees less than the other, or both hips limited by 30 degrees or more;
  • a clunk felt during the Ortolani or Barlow check. (NIPE handbook, 2025)

A screen positive result leads to the hip ultrasound and specialist review above. If the ultrasound looks normal, the baby can leave the hip screening pathway. (NIPE hip pathway) If the ultrasound shows hips that are still immature, a repeat scan may be needed later. (NIPE handbook, 2025) If a problem is suspected, the baby is referred to a doctor who specializes in bone problems. (NHS, 2026) What happens next depends on the findings, and your baby's doctor or the specialist explains it.

When to contact a doctor

MedlinePlus, in full: "Contact your provider if you suspect that your child's hip is not properly positioned." (MedlinePlus, 2025)

The UK programme tells parents to contact their healthcare professional at any time with concerns about their baby's hips, including if: (NIPE handbook, 2025)

  • one leg cannot be moved out sideways as far as the other at diaper changes;
  • one leg seems longer than the other;
  • one leg drags when the baby starts crawling;
  • the child walks with a limp or a waddle once walking. (NIPE handbook, 2025)

The NHS also says to see a doctor about hip pain in a child, and that mild DDH missed at birth can first cause symptoms in late childhood, puberty or adulthood. (NHS, 2026)

Where they differ:

Your doctor decides what your result means for you.

Questions people ask

What is the hip click test on a newborn?

The examiner gently moves each hip with two checks. The Barlow maneuver looks for a hip that can be pushed out of the joint, and the Ortolani maneuver for a hip that is out and can be felt clunking back into place. The UK programme does both on each hip separately. (NIPE handbook, 2025) (MedlinePlus, 2025)

Does every baby get a hip ultrasound?

No, not in the US or the UK. The AAP generally does not recommend ultrasound for every baby; it is used for babies with risk factors such as breech position or a family history, or an abnormal exam. Many mild findings seen on imaging get better without treatment. (Scoping review, 2024) (AAP, 2016)

My baby was breech. Do they need a hip ultrasound?

Breech position is a risk factor in both countries. In the UK, breech at or after 36 completed weeks of pregnancy, even if the baby turned before birth, means a hip ultrasound by 6 weeks of age. US guidance summarized from the AAP 2016 report uses breech as a reason for imaging. Ask your baby's doctor what applies. (NIPE handbook, 2025) (Scoping review, 2024)

Is a hip click a sign of hip dysplasia?

Not on its own, in the UK programme. It says isolated clicks without other findings are not a screen positive result and do not need a hip ultrasound. A palpable clunk during the Ortolani or Barlow check is a screen positive finding. (NIPE handbook, 2025)

What does the USPSTF say about hip dysplasia screening?

Its statement dates from 2006. Its evidence review found that exams and ultrasound can find newborns at higher risk, but because many cases resolve on their own and treatment effects on long-term function were not proven, the net benefits of screening were not clear. The AAP calls this an inconclusive determination. (USPSTF, 2006) (USPSTF evidence review, 2006) (AAP, 2016)

What are signs of hip dysplasia after the newborn checks?

Signs can include one leg that does not move out to the side as far as the other at diaper changes, one leg that looks longer, a leg that drags when crawling, and a limp or waddle once walking. Tell your baby's doctor about any of these. (NIPE handbook, 2025) (MedlinePlus, 2025)

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