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Newborn clicky hip


When to Worry About Your Child’s Hip Click

Sometimes parents notice a clicking or popping sound with the movement of their baby’s legs. We spoke to a pediatric orthopaedic surgeon for advice on what to do if this is the case.

Jan. 27, 2022 • 4   min read

The hip is a ball-and-socket joint, meaning that the femoral head (the top of the femur) is shaped like a ball and sits within the cup-like socket in the pelvis. In some cases, parents may notice abnormalities when an infant or young child’s legs are moved, such as a clicking sound or the feeling of looseness or displacement of the hip.

James Engels, MD, a pediatric orthopaedic surgeon with Rochester Regional Health, advises parents on what to do if their child has a hip click and provides need-to-know information on hip dysplasia.

What is a hip click?

A “hip click” refers to an audible clicking or popping sound that occurs when a baby’s hips are being examined or moved around. Most clicks are not problematic.

There are tendons or ligaments associated with an infant’s hip joint that can make a snapping or popping sound for a variety of reasons. A hip click could be a sign of abnormalities in hip development, but further examination and possible testing are required to reach a diagnosis. More importantly, instability or displacement of the hip is a significant concern for hip dysplasia. 

“A child that has a hip click or hip instability should be monitored for hip dysplasia or other developmental abnormalities. This is something that is usually caught early on by physicians during well-child visits.”

Should my newborn receive a hip exam?

After a child is born at the hospital, pediatric specialists perform a newborn examination. During this thorough physical exam, a specialist will check the baby's hips and legs for abnormalities to assess for hip dysplasia. They do this by gently pushing and pulling the baby’s thigh bones to see how they move in the hip socket.  

“If we notice an abnormality in a newborn’s hips, we may order an ultrasound to get a more in-depth look. Once we perform further examinations and testing, we can determine the best way to treat the problem,” said Dr. Engels.

Are there risk factors for hip dysplasia?

Some factors may lead to a greater likelihood that a child will have hip dysplasia, such as:

  • if a primary relative of the child had hip dysplasia (a parent or sibling) 
  • if there was an extended breech position while the baby was in the womb
  • a specialist detects laxity during the newborn hip screening exam

If any of the above are present, the patient should receive further testing to check for hip dysplasia.

Should my child see a doctor for their hip click?

Parents may notice clicking or popping sounds when their child walks or moves their hips or legs. In this case, they should schedule an appointment with their child’s pediatrician for an examination. After the exam, the pediatrician can determine whether further evaluation from a pediatric orthopaedic surgeon is necessary.

Children should have routine well-child visits from the moment they are born up through age 21. For children under 2, these exams occur 2-3 months. At these early visits, a physician will check their hips and legs for signs of hip dysplasia or other abnormalities.

If there is no detection of hip dysplasia or other abnormalities and your child is experiencing a hip click after three or more years of age, schedule an exam with their pediatrician to check for any undetected orthopaedic abnormalities.

“Abnormalities or signs of problems in the hip joints can often be identified at the child’s routine well-exams, especially during the first few years of life. However, if a parent notices clicking, popping, abnormal walking pattern, they should schedule an additional exam with their pediatrician.”

What is hip dysplasia?

Hip dysplasia is a condition in which the hip socket does not fully cover the ball of the upper thighbone, allowing the hip joint to become partially or completely dislocated.

Hip dysplasia can damage the cartilage lining in the hip joint, and in some cases, can lead to loss of the soft cartilage that lines the socket portion of the hip joint, resulting in a painful arthritic hip. That’s why early detection and treatment of hip dysplasia is so important.

Hip dysplasia symptoms

Signs and symptoms of hip dysplasia vary based on age and severity. A hip click may be a sign of hip dysplasia, but it does not guarantee the condition. 

Symptoms of hip dysplasia may include:

  • Pain in the hip
  • Loose or unstable hip joint
  • Limping or abnormal walking patterns
  • Unequal leg lengths
  • Loss of motion

“Many of the signs of hip dysplasia go unnoticed in everyday life, which is why it’s so important for infants to have routine well-child exams that include hip screen examination right from the moment they’re born. This way, we are more likely to detect any abnormalities early on and begin treatment as needed,” said Dr. Engels.

Hip dysplasia treatments

Pavlik harness

The most common treatment for hip dysplasia in infants is a Pavlik harness. The Pavlik harness is a soft splint that helps keep the infant’s hips and knees bent and the thighs apart. An infant treated with a Pavlik harness stays in the harness at all times of day and night. 

In most cases, the infant will wear the harness for 3-4 months and will be monitored as they grow.

“The Pavlik harness is very comfortable for baby. It’s soft and easy to clean. Most importantly, it is extremely effective in treating and curing hip dysplasia,” said Dr. Engels.

Semi-rigid orthosis

If an infant’s hips do not stabilize with the Pavlik harness, or if hip dysplasia is diagnosed later than 6-8 months of age, an orthopaedic physician may prescribe a semi-rigid orthosis. 

Instead of a harness, this is more like a brace that keeps the infant’s legs and hips in a more stable and secure position.

Surgery

In severe cases, an infant may need surgery to correct the development of their hips. There are two types of surgical options: closed reduction surgery and open reduction surgery.

Closed reduction surgery occurs under general anesthesia and the infant's hip is placed back into the socket. To help with this process, a tendon in the groin is usually lengthened through a small incision. The infant is then put into a body cast, bracing the pelvis area to hold their hips in position. 

In open reduction surgery, under general anesthesia, an incision is made to put the hip back into place. This option is for severe cases in which bones may also need to be cut to help keep the hip in place.

“After any surgical option, we follow-up with the patient routinely until they’re at least 5-7 years of age. We continue to check on their development to ensure everything is healthy."

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Hip dysplasia in babies | Pregnancy Birth and Baby

Hip dysplasia in babies | Pregnancy Birth and Baby beginning of content

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Hip dysplasia (developmental dysplasia of the hip — DDH) occurs when your baby’s hip doesn’t develop normally.

What is baby hip dysplasia?

Hip dysplasia is sometimes noticed in babies, and sometimes in children around the time they’re learning to walk.

Usually, the ball at the top of your baby’s thighbone (the femoral head) is held in a cup-shaped socket in the pelvis. The ball is held in the socket by ligaments and muscles.

In hip dysplasia, the femoral head is not in the right place and your baby’s hip will not develop correctly.

Nobody really knows what causes hip dysplasia. It is more common in babies who were in a breech position before birth. It is more common in girls than boys and can run in families.

It can also be caused by wrapping your baby tight or swaddling them, if you swaddle your baby, make sure they can bend their legs.

How would I know if my baby has hip dysplasia?

Sometimes hip dysplasia is not obvious. Doctors and early childhood nurses do regular checks to look for hip dysplasia.

They look for a baby who:

  • has uneven skin creases near the buttocks or at the front of the upper leg in the groin
  • has legs that are a different length
  • doesn’t move their legs normally
  • has a turned-out foot

And they look for an older child who:

  • sits or walks late
  • leans to one side when standing or walking
  • waddles when they walk

Your doctor, midwife or early childhood nurse can check your baby’s hips at any time, but often will check them during baby checks done:

  • at birth
  • one week after birth
  • 6 weeks after birth
  • 6 months after birth
  • when they begin to walk

Your doctor, midwife or early childhood nurse might also arrange an ultrasound or refer you to a paediatrician (children’s doctor).

What treatment will my child need?

Treatment varies depending on your baby’s age and how severe the condition is.

If hip dysplasia is picked up at birth, your baby could wear a soft brace (a Pavlik harness) or a plaster cast for up to several months. This helps the hip develop normally. Babies with braces usually have regular ultrasounds to check their progress.

Some babies will need an operation to put the femoral head back into the socket. This is more common if babies are diagnosed after 6 months of age. Sometimes further surgery may be needed.

Your baby’s hips should develop normally after treatment. Your doctor will monitor your child for rare problems such as arthritis.

Where to get help

If you think your baby might have hip dysplasia, speak to your doctor. For help and support with caring for your baby if they need a harness, you can speak to a maternal child health nurse at Pregnancy, Birth and Baby using video call or the telephone on 1800 882 436.

You can also learn how to:

  • breastfeed your baby in a harness
  • wrap your baby so that their legs are able to bend at the hips
  • position your baby in the harness
  • change your baby’s nappy
  • bath your baby while in the harness

Read more about hip dysplasia on the Sydney Children’s Hospital Network and the International Hip Dysplasia Institute websites.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:
Australian Breastfeeding Association (Hip displaysia), Raising Children Network (Hip: developmental dysplasia), Sydney Children’s Hospitals Network (Developmental dysplasia of the hip (DDH))

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: May 2022


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Hip Dysplasia - Miracle Babies

Dysplasia of the hip if adolescent patients successfully treated for developmental dysplasia of the hip The successful treatment of DDH in infancy does not ensure normal hip development; therefore, follow up into maturity may be recommended