Clicky Hips in Babies

When to get help

This is not an emergency topic, but it is a do-not-postpone one, because treatment is much simpler the earlier it starts. Arrange an appointment — GP or health visitor in the UK, GP or public health nurse in Ireland, paediatrician in the US or Canada, GP or child health nurse in Australia and New Zealand — if you notice any of these:

• One leg looks shorter than the other, or one knee sits lower when the legs are bent up together.
• The skin creases on the thighs or buttocks are not symmetrical.
• One hip does not open out as far as the other when you change a nappy, or feels stiff.
• A clunk, rather than a click, when the hip moves.
• Your baby is walking and limps, walks on tiptoe on one side, or waddles.

Go back if a hip was checked as normal but you are still seeing any of the above. Hip dysplasia can present later, and the newborn examination is a screen rather than a guarantee.

What a click actually means

A high-pitched click as a baby's leg moves is common and is usually a ligament or tendon moving over bone. On its own, in a baby whose hips open fully and symmetrically, it typically means nothing.

What clinicians are listening and feeling for is different: a clunk as the head of the thigh bone moves in or out of the socket. That is a deeper, duller sensation felt through the hand rather than heard, and it is the reason hips are examined by pushing and lifting in a specific way at the newborn check and again at the six to eight week review.

In practice, the word clicky is used loosely by parents, midwives and doctors alike, which is exactly why it usually leads to a scan rather than an argument. A scan settles it.

Developmental dysplasia of the hip

In DDH the top of the leg bone does not fit properly into the socket of the hip bone. The joint is looser than it should be and does not move properly. The NHS notes it can affect one or both hips, and that it is not clear why it happens.

The chance is higher if your baby is a girl, if someone else in the family has had it, or if your baby was in a breech position during pregnancy, including if you had treatment to turn them before birth. Being the first born and having had a low level of amniotic fluid are also recognised associations. Many services offer an ultrasound scan on the basis of those risk factors alone, without any abnormality being felt.

How it is checked

Hips are examined as part of the newborn physical examination, which in the UK is done within 72 hours of birth, and again at the six to eight week review. The examiner moves each hip through a specific range while feeling for movement in and out of the socket.

If something is felt, or if the risk factors are present, an ultrasound scan of the hips is arranged. Ultrasound is used in babies because the bones are still largely cartilage and show up better that way; X-rays are used once children are older. A referral is made to an orthopaedic surgeon if the scan is abnormal.

Treatment: the harness

The NHS explains that DDH can sometimes get better by itself, but that most babies need treatment, and that the most common treatment is a soft fabric harness — a Pavlik harness — which gently guides the hip joint into the right position. It is fitted by a healthcare professional.

The practical details matter more than the name. The harness is worn for six to twelve weeks depending on how severe the dysplasia is, and it is left on continuously, including during nappy changes and bathing; the hospital will show you how to manage both. Babies are often restless for the first couple of days and most settle by day two or three. Repeat scans check that the treatment is working, and the harness is adjusted as your baby grows.

Nappies go under the straps, not over them. Clothing goes over the top, and vests with poppers are easier than anything that has to come off over the legs. Car seats and slings can usually still be used, but ask the team to check the specific ones you own rather than guessing.

If a harness does not work

If the harness is not successful, or if your baby is older when the diagnosis is made, a rigid abduction brace made of plastic and foam may be used instead. Rarely, surgery is needed to reposition the joint, followed by a period in a cast to hold the hip while it heals. Those are used for severe dysplasia or when bracing has not worked.

The reason for treating early is that the socket forms properly only if the joint sits correctly while it is still developing. That is the whole logic of screening a newborn's hips: a harness in the first months, or an operation later.

What about swaddling and carrying?

How a baby's legs are held matters for hip development. Wrapping that forces the legs straight and pressed together is not advised; any swaddle should leave the hips and knees free to bend up and out. The same applies to carriers and slings, where the thighs should be supported so that the knees sit at or above hip level in an M shape, rather than the legs dangling straight down.

None of this is a treatment for dysplasia, and none of it replaces a scan. It is simply the version of positioning that hip specialists prefer, and it is easy to do from the start.

Later childhood

Ask again if a walking child limps, waddles, walks on tiptoe on one side, or complains of pain in the groin or knee. Hip problems in children frequently present as knee pain, which sends families to the wrong appointment. Mentioning any early hip history when you go saves a great deal of time.