Hip dysplasia: Why even healthy babies are at risk—and how it gets missed
Hip dysplasia is a condition where the hip socket is too shallow to properly cover and support the ball-shaped head of the thighbone, leading to joint instability or dislocation.
Highlights
*DDH is a condition where the hip joint doesn't develop properly, often presenting without pain or obvious distress in infants.
*Key signs that warrant professional assessment include uneven leg length, asymmetrical thigh or buttock folds, leg spreading resistance, or a clicking sensation.
*Babies born breech, those with a family history of DDH, and girls are at higher risk, with tight swaddling also increasing the likelihood.
A Paediatric Orthopaedist sees it often: parents arrive at a routine check-up with no idea anything could be wrong. Their baby kicks and wriggles like any other infant — no pain, no crying during a nappy change, nothing to raise a flag. Yet on examination, the hip is unstable: Developmental Dysplasia of the Hip or DDH.
That's exactly what makes DDH so easy to miss. It occurs when the hip joint doesn't develop or fit together properly — the socket may be too shallow to hold the thigh bone securely, allowing it to slip partially or fully out of place. Crucially, none of this needs to show up as pain or visible distress in the early months. A baby can behave entirely normally while the joint underneath tells a different story.
A misconception worth correcting
Many parents assume that no pain means nothing is wrong. But infants don't display joint problems the way an older child or adult would — comfort is not evidence of a healthy hip; it simply means appearance can't be trusted on its own.
One leg appearing slightly longer than the other, uneven thigh or buttock folds, resistance when the legs are gently spread during changing, or a clicking / clunking sensation during movement. In babies already crawling or walking, an unusual gait or limp is also worth noting. Not every click means dysplasia — parents shouldn't try to self-diagnose, but anything that persists or seems out of the ordinary is worth a professional look.
Who's more likely to be affected?
Babies born breech — especially if that position persisted late in pregnancy — those with a family history of DDH, and girls more often than boys. Positioning after birth matters too: swaddling that forces the legs straight and pressed together raises risk, while allowing the hips room to bend and spread supports healthier development. Babies at higher risk should undergo targeted screening — clinical evaluation followed by ultrasound.
Why timing changes everything?
Caught early, DDH is often simple to treat — usually just a brace holding the hip correctly in place while the joint develops. Left undiagnosed, the picture changes: as the child grows, an untreated hip can cause limping, restricted movement, pain, leg-length differences, and a lasting gait abnormality.
What parents can do ?
None of this requires parents to become diagnosticians. Routine newborn and infant hip exams exist precisely to catch what isn't visible — attending them is the single most useful thing a parent can do. It is also worth directly mentioning any family history of DDH or a breech birth to the Pediatrician, rather than assuming it will come up. Beyond that: avoid tight swaddling around the legs, and seek prompt assessment if asymmetry, restricted movement, or an unusual leg position is noticed.
DDH is, in many ways, a quiet condition — it asks nothing of the baby and gives away little on the surface. But it responds well to early attention. The message for parents isn't to worry over every kick and gurgle, but to trust the screening process, flag risk factors when they exist, and take a hip check at a routine appointment as seriously as any other part of their baby's care.