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STEPS Charity Worldwide

Registered Charity No 1094343. A Not for Profit Company Registration No 4379997

The STEPS National Office Help-Line is open Monday-Friday, 9.30am - 4.00pm (calls charged at national rate)

Address: STEPS, Wright House, Crouchley Lane, Lymm, Cheshire WA13 0AS

Helpline: +44 (0)1925 750271

Admin Telephone: +44 (0)1925 750273

Fax: +44 (0)1925 750 270

Email: info@steps-charity.org.uk

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Understanding Developmental Dysplasia of the Hip

bhh-front-coverDevelopmental dysplasia of the hip (DDH) is when the ball and socket do not fit snugly together:  there are varying degrees of severity.

If the ball (femoral head) is not held safely in place, the socket (acetabulum) may be more shallow than usual; this is called acetabular dysplasia. Sometimes this makes the joint less stable and the ball may slide in and out of the socket, this is called a dislocatable or subluxatable hip. If the ball loses contact with the socket and stays outside the joint it is called a dislocated hip.

These are all forms of DDH. One or both hips may be affected.

About 1 or 2 in every 1,000 babies has a hip problem that requires treatment. Many more babies will have immature hips that will get better by themselves. With DDH, the problem persists and requires early diagnosis to help reduce the severity of the treatment.

For a guide to hip development please download our BMA (British Medical Association) award winning FREE Baby Hip Health leaflet for more detailed information.

We understand that this can be a very confusing time. If you have questions, concerns or simply feel you would like someone to talk to - please do not hesitate to contact us - we will be happy to help. You can call our Helpline on 01925 750271 (Monday – Friday 9.30am to 4pm) or email us

You may also want to visit our online community where you will find a wealth of information written by parents with children affected by developmental dysplasia of the hip.  You will also be able to read personal stories, shared experiences, ask questions and receive encouragement.

Can DDH be prevented

When Developmental Dysplasia of the Hip (DDH) occurs, it is important to understand that it is not anyone’s fault. 

New mothers make hormones that help ligaments relax during the birth. These relaxing hormones can stay in a baby’s blood stream for a few weeks making it normal for babies’ hips to be ‘stretchier’ and looser shortly after birth.  Babies’ hips are always flexed so their thighs lie against their stomachs. They should be allowed to kick them straight on their own and not be stretched out.

It is important to leave the hips free to move and not tightly strapped down with the legs straight out and pressed together. Let your baby hold his or her hips bent up as they were in the womb and allow room for the legs to move freely.

Things that could hinder normal hip development are tight swaddling and spending long periods of time in baby seats used for transport.

If you have any questions please contact the STEPS helpline 01925 750271 or email us for help and advice about the next stage.

You may also want to take a look at the video on Hip healthy swaddling courtesy of the International Hip Dysplasia Institute

DDH can happen to any baby but some factors make the condition more likely.

The two most important risk factors are:

  • a baby born by breech or who was in the breech position in the last three months of pregnancy
  • a close family history of DDH or hip problems that came on in early childhood.

DDH is more common in first pregnancies and in baby girls and also babies who have mild foot abnormalities or tightness in the neck.

Usually, however, there is no identified risk factor and it is not known why a baby has the condition.

How is DDH detected

ALL babies’ hips are checked at birth and at 6-8 weeks as part of a national screening programme called the Newborn Infant Physical Examination (NIPE). This is because some babies may have hips that are not properly in joint or not shaped perfectly, a condition called Developmental Dysplasia of the Hip (DDH).

The baby’s hips are gently manipulated to see if they are safely in joint by tests known as the Ortolani and Barlow Tests.

The manipulation is very gentle and should not cause discomfort, but most babies object to being examined, however gently. It can help to calm your baby by giving a breast or bottle feed before the examination.

Even if the physical examination is normal your baby’s hips will have an ultrasound examination within 6 weeks if the following applies:

  1. there is a history of early childhood hip problems in your family or
  2. your baby was in the breech position:
  • at or after 36 weeks of pregnancy even if the baby turned round and was then delivered head first.
  • born before 36 weeks in a breech position.
  • in a multiple birth, if any of the babies is in either of the groups above, every baby should have an ultrasound examination.

If further treatment is required please contact the our Helpline on 01925 750271 (Monday – Friday 9.30am to 4pm) or email us for help and advice about the next stage.

You may also want to take a look at our section Treatment methods for DDH

Signs to help detect DDH

The physical examination is not 100% accurate as this only detects hip instability at the time of the examination. This means that some babies might appear to be normal at the tests but develop problems later or that DDH has not been picked up at the initial examination. As formal checks finish after the 6-8 week check, parents or grandparents are often best at noticing signs of a hip problem. 

Early diagnosis gives the best chance for effective treatment.  Untreated, developmental dysplasia of the hip becomes more difficult to treat as child gets older and there is a risk of developing osteoarthritis of the hip at a young age.

If you notice any of these signs you should contact your health professional as soon as possible to be referred to an orthopaedic specialist for an ultrasound or xray to confirm a diagnosis of DDH:

  • Deep unequal creases in the buttocks or thighs
  • When changing a nappy one leg does not seem to move outwards as fully as the other or both legs seem restricted
  • Your child crawls with one leg dragging
  • Inequality in leg length
  • A limp if one leg is affected or abnormal ‘waddling’ walk if both hips are affected.
  • Do remember that a hip not properly in joint does not hurt in childhood.

You can call our Helpline on 01925 750271 (Monday – Friday 9.30am to 4pm) or email us for confidential help and advice.

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Welcome to STEPS. We are a national charity supporting children and adults affected by a lower limb condition such as clubfoot or a hip condition. Our website is a great source of information but if you would like to talk to someone please call our helpline on 01925 750271 or email info@steps-charity.org.uk.

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Address: STEPS, Wright House, Crouchley Lane, Lymm, Cheshire WA13 0AS