Developmental Dysplasia of the Hip: Reasons, Signs & Treatment

Clicky Hips in Babies

Medically Reviewed By
Dr. Mahesh Patil (Paediatrician)
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Clicky hips is a condition also known as developmental dysplasia. While it may not cause pain to your baby, this condition can cause serious problems in gait and structure later in life. The sooner you make sure that your baby gets the appropriate treatment, the better is the prognosis for your child.

Video: Developmental Dysplasia of Hips (Clicky Hips) in Babies

What Is Developmental Dysplasia of the Hip?

Developmental dysplasia of the hip (DDH) or clicky hips refers to a range of problems concerning the hip joint. This joint acts as the foundational link between the upper torso and the lower torso.

The hip joint is a ball and socket type joint. The ball on the femur (thigh bone) should ideally sit snugly into the socket of the pelvis. When the ball and socket of the hip joint face issues, it creates instability throughout the body.

DDH occurs when the following conditions are true:

  • The ball of the femur does not develop fully within the socket and gets displaced from it entirely.
  • The socket is too shallow for the ball to stay in and gets dislocated easily.
  • The ball fits into the socket but can slip out easily due to underdeveloped or tight muscles and ligaments around the joint.

Developmental dysplasia of the hip is a condition that occurs when the hip joint of the pelvis and femur is not stable or secure enough in infants. Developmental dysplasia can affect one or both hip joints. In the latter case, the signs of the condition are significantly harder to notice. This is largely because when both joints are damaged, parents have no visual cue to notice the abnormality of the hips. If left untreated or undiagnosed, developmental dysplasia of the hips can lead to several major complications later on in life, such as destruction of head of femur bone destabilising the hip joint permanently, re-dislocation, discomfort or pain in hip joint, as well as painful and stiff joints.

Is Developmental Dysplasia of the Hip in Babies Common?

Slight hip instability is seen in 5-10 children in every 1,000 live births, but only around 1 to 2 children in every 1,000 suffer from actual DDH and require medical assistance. Majority of cases resolve on their own by end of 1st month after birth.

Note: It is recommended that parents who suspect developmental dysplasia in their infants consult their paediatric specialist for a thorough diagnosis and treatment plan.

Which Babies Are Prone to Hip Problems?

Breech babies (babies who are in the bottom-down position while in the womb) are at the highest risk of contracting this condition. Female babies are also more likely (80% cases) to develop hip problems than male babies are. This is because maternal hormones cause looseness in ligaments of girls than boys. Some researchers also suspect genetic causes behind hip problems, but there has been no research to prove its existence.

There are numerous other factors that come into consideration before your infant is diagnosed with this condition. Parents who have children that have been diagnosed with developmental dysplasia are recommended to closely monitor the child and keep a line of clear communication open with the specialist treating the baby.

Is Hip Dysplasia Hereditary?

While genetics do play a role in the development of dysplasia, they are not the main cause of it. The chances of your baby getting developmental dysplasia of the hips are higher if a sibling has had the same condition.

  1. If a sibling has had developmental dysplasia of the hips, then the chances of your baby developing the condition are 6% or one in seventeen.
  2. If a parent has had developmental dysplasia of the hips, then the chances change to 12% or one in eight.
  3. If both a parent and a sibling have had developmental dysplasia of the hips, then the chances increase drastically to 36% or one in three.

Keep your doctor informed of not just your medical history, but also your baby’s siblings’ history as well.

Note: All statistics mentioned are according to

What Causes Hip Dysplasia in Babies?

There is no particular cause for the occurrence of developmental dysplasia of the hips in babies. Some of the factors that cause developmental hip dysplasia in infants include:

  • Your baby was born in the breech position. This position is when the baby is born bottom first rather than head first.
  • You have a female baby. As discussed, they have a higher risk of hip problems as compared to male babies.
  • There isn’t enough amniotic fluid in uterine bag (oligohydrominos).
  • It is associated with tightness of the neck muscles on one side (torticollis) or if it has mild foot abnormalities (metatarsus adductus).
  • You swaddle the baby too tightly. Swaddling is a technique used to provide comfort to a fussy baby by wrapping the baby in blankets or wraps. It also reduces crying and helps develop regular sleep patterns. However, make sure that you do not swaddle your infant too tightly as there needs to be enough space for the limbs to move about.

Your baby’s hip joint is not made of hard bone like an adult’s is. Instead, it is made from soft cartilage that hardens over time. This why you must allow a full range of motion for your baby’s limbs even while he rests.

Signs and Symptoms of Hip Dysplasia

It is usually hard to notice any hip problems in your newborn. However, your doctor will examine your baby for any abnormalities by performing the following tests:

  • He will check the length of your baby’s legs and ensure they are both the same.
  • He will check the position of the knee joint to see if they lie in the same position as each other.
  • If the baby is older than a year, on walking, the baby’s upper body sways towards affected side.
  • He will check your baby’s groin area to see if the creases are normal.
  • He will gently pull at the baby’s legs to check for their stability.

The above are also things that you can check for yourself.

Keep an eye out for the movement of both your baby’s legs and see if they match each other in the range of movement as well as strength. For example, see if both legs move with equal vigor as you change the diaper.

Once your baby is old enough to crawl, a common symptom of DDH is that the baby seems to be dragging one of his legs.

One of the late-stage signs of DDH could be an abnormal gait. If both hips are affected, this could result in a waddling walk. Your child might also walk on his toes in this condition.

Keep an eye on the usage and development of both legs as your baby grows. Don’t forget to inform your doctor if you notice any abnormalities.

Diagnosing Clicky Hips in Babies

When your doctor is examining your baby, he might hear or feel a click. This is usually a sign of DDH. In fact, it could just be that the joint is moving in and out of alignment. Babies do not feel pain with this condition.

Your doctor might recommend an ultrasound on the hip region to determine the exact cause of the abnormality. X-rays are used to diagnose DDH only for older children, as infants still do not have the required bone density to show up on an X-ray.

Treatment for DDH

The treatment for developmental dysplasia of the hips or clicky hips in babies will depend on the age of your baby. The bone density of your child keeps changing as he grows. Here are some of the non-surgical treatments used for different age groups:

Newborn Baby

Infant hip dysplasia treatment involves using a Pavlik harness. This is also known as hip dysplasia in babies harness. It is a soft harness that helps keep your baby’s hip joints in their natural position while allowing for free movement. The harness must only be placed or removed by a medical professional. This harness allows the ligaments surrounding the hip joint to strengthen. Your doctors will help you with techniques on how to change diapers, hold the baby comfortably, and how to clean the harness. This harness is usually recommended to be used for one to two months.

3 to 6 months

In case a harness has proven to be ineffectual, then your doctor might place your baby in a firmer harness known as an abduction harness. Your doctor might also try a closed reduction procedure in which he will gently move the femur and place the ball into the socket and then put the joint in a spica cast. The cast will need special care, and your doctor will advise you on how to take care of it and how to identify problems with it.

Older Than 6 months

Babies who are older than six months will also be treated with a closed reduction procedure with a cast. With older babies, skin traction is also carried out around the hip bone to make preparations for a change in the position of the joint.

In some cases, hip dysplasia surgery is recommended to cure developmental dysplasia of the hips in babies older than 6 months. An incision is made, and the bone is placed into the socket. In some cases, the length of the femur is reduced to fit into the socket properly. After the surgery, the joint is set in a cast and allowed to heal. For hip dysplasia surgery child care, ensure you follow your physician’s instructions thoroughly.

There are four types of surgeries your doctor might recommend. They are:

  • Closed reduction is one of the most common surgeries used to rectify developmental dysplasia of the hips. It is a minimally invasive procedure that takes place under general anesthesia where the doctor will manipulate the joint back into place.
  • Open reduction surgery is used when it is suspected that the tissues surrounding the hip joint are the reason for the dysplasia. In younger babies, clearing out the joint area is all that is required. Hip problems in older children might need ligament repair as well.
  • Pelvic osteotomy is carried out when the socket needs to be restructured surgically. There are many types of pelvic osteotomy surgeries based on the shape of the socket.
  • Femoral osteotomy is when the femur needs to be tipped so that the ball of the bone aligns itself deeper into the socket in the pelvic bone.

Note: Parents who have children diagnosed with clicky hips or developmental dysplasia are recommended to stay vigilant with treatments and be vocal with the primary care physician about their concerns. Time is of the essence to ensure a complete recovery from this condition.


Children who need a cast will see a late development of walking. However, once the cast is removed, the development will begin and continue at a normal rate.

Sometimes, the harness might cause skin rashes that could be painful for your baby. The harness does not address differing lengths of the limbs and is an issue that will have to be dealt with in the future. Continued use of the harness without appropriate reevaluation for any benefits can lead to damage to nerves and blood vessels supplying hip joint and femur bone.

Even after treatment and care, the problem might persist. In this case, surgery will be required in your baby’s early childhood to correct the anatomy of the joint.


The cast used in your baby’s developmental dysplasia of the hips treatment might have to stay in place for 2 to 3 months. Your doctor might change the cast after regular X-ray screenings of the joint to evaluate the progress.

Disclaimer: Recovery periods are estimates based on a general average. Accurate time of recovery is evaluated on a case to case basis. Consult a doctor for a more accurate period of recovery for your baby.

Preventing Developmental Dysplasia of the Hip in Babies

Unfortunately, since the exact cause of developmental dysplasia of the hip in babies is unknown, it can be near impossible to prevent the condition. However, there are certain practices and precautions that you should observe:

  • Avoid improper swaddling –  As discussed earlier, you must take care to allow for free movement of the legs and hip joints when swaddling your baby. The legs must never be wrapped tightly.

Note: Parents are advised to consult experts specialized in swaddling to learn the appropriate technique for their baby.

  • Practise baby wearing –The National Health Service (NHS) also suggests you try traditional methods of carrying your baby (known as baby wearing) to prevent hip dysplasia. In this method, your baby faces you with his hips on either side of your waist. This is the most natural position for your baby’s hips. For further information on clicky hips NHS guidelines, talk to your primary care physician.
  • Use equipment to promote natural leg posture – To ensure that your baby has healthy hips, make sure that your use carriers, seats and other equipment that promote natural posture for the legs, especially if you are concerned about hip problems in older babies. Ask your primary physician to recommend brands of equipment to help ensure the health of the baby’s hip.

Infant hip dysplasia is a condition that can heavily impair your baby’s movements in the long term. Parents are encouraged to be open about all issues regarding developmental dysplasia with their primary care physician.

Disclaimer: Consult your physician before administering any developmental dysplasia medication to your infant.

Conclusion: It is highly recommended that parents not venture into alternative medication for a condition like developmental dysplasia of the hips. If parents choose to, it is recommended that thorough research is done and physicians are consulted on a regular basis. Education about the condition is critical when it comes to treating clicky hips in babies. It is recommended that any medication and treatment is followed to the end and that your primary care physician is kept in the loop about any change in condition at regular intervals.

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