Quick answer: Developmental dysplasia of the hip (DDH) is a condition, usually found in babies, where the hip joint has not formed properly, so the ball of the thigh bone does not sit securely in its socket. It is often silent, which is why every newborn and infant has their hips checked. When it is found and treated early, the outlook is excellent – many babies need only a soft harness that gently holds the hips in a good position while they grow. In Singapore, hip screening is part of routine newborn and infant checks, and a paediatric orthopaedic surgeon at a centre such as KKH or NUH can guide care if anything is picked up.
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If your baby’s hip check has raised a question, it is natural to feel worried. The reassuring truth is that DDH is well understood and, when caught early, usually straightforward to treat. This guide explains what DDH is, how it is found, why the routine checks matter, and what treatment involves – written for parents in Singapore.
What developmental dysplasia of the hip is
DDH is a condition, usually found in babies, in which the hip joint has not formed properly. The hip is a ball-and-socket joint: the rounded top of the thigh bone (the ball) should sit snugly inside a cup-shaped socket in the pelvis. In DDH, the fit is not quite right – the hip may be loose, the ball may sit partly out of the socket, or it may be fully out of place. Sometimes the socket itself is shallow. Because a baby’s hip is still developing, holding the joint in a good position early on lets the socket deepen and the joint settle as it should. This is why newborns are checked, and why finding and treating DDH early usually gives excellent results.
Signs and how it is picked up
DDH often causes no obvious signs, which is exactly why routine newborn and infant hip checks matter so much. A baby with DDH is usually comfortable and not in pain, so it can be easy to miss without an examination. Possible clues that parents or clinicians may notice include:
- Uneven skin creases on the thighs or buttocks
- A difference in leg length, so one leg looks shorter
- Limited or stiff movement of one hip, especially when spreading the legs apart
- A clicking or clunking feeling in the hip
- In older babies starting to walk, a limp or a waddling walk
None of these clues on its own means DDH is definitely present, but any of them is a good reason to have the hips examined.
Causes and risk factors
There is usually no single cause. DDH tends to come from a mix of factors that make a loose hip more likely. These include a family history of hip problems, being in the breech position (bottom or feet down) in late pregnancy, being a first baby, and being a girl. The way a baby is positioned after birth matters too: wrapping the legs tightly and straight can discourage healthy hip development. For this reason, safe “hip-healthy” swaddling is encouraged – wrapping that keeps the arms cosy but leaves plenty of room for the hips and legs to bend and move freely. Baby carriers and slings that support the thighs and let the legs spread naturally are also gentler on developing hips.
How it is diagnosed
Diagnosis begins with a physical examination of the hips, done routinely in newborns and again at infant health checks. The doctor or nurse gently moves the hips to feel whether the joint is stable or slips. If the examination raises a concern, or if a baby has risk factors, imaging helps confirm what is happening. In young babies whose hips are still mostly soft cartilage, an ultrasound of the hips gives a clear picture of the joint. In older babies, once more of the bone has formed, an X-ray is the better test. In Singapore, a paediatric orthopaedic surgeon usually oversees this assessment and decides which test is most useful for your baby’s stage.
Treatment
Treatment depends on your baby’s age and how loose or displaced the hip is, and the general rule is that earlier treatment is usually simpler. In young babies, a soft harness is often all that is needed. The harness holds the hips in a healthy, bent-and-spread position while the joint continues to develop, and it is worn for a period the surgeon advises. Babies generally settle well with it, and it allows the socket to deepen naturally.
If DDH is found later, or if a harness does not fully correct the hip, the next steps may include a procedure to gently reposition the ball back into the socket, followed by a cast that holds the hip in place while it stabilises. In some cases surgery is needed to correct the joint. Your surgeon will explain which approach suits your child and what to expect at each stage. Whatever the path, the goal is the same: a stable hip that develops and works well.
Why early detection matters
Early detection matters because a hip that is left untreated does not usually correct itself and can cause problems over time. As a child grows, an unstable or poorly formed hip can lead to difficulty walking, a lasting limp, and early wear of the joint – a form of hip arthritis – later in life. Treating DDH early, while the hip is still developing, is far simpler than treating the consequences later, and it gives the joint the best chance to grow normally. This is the reason routine hip screening is built into newborn and infant care.
Living with it and follow-up
For most families, living with DDH means a period of treatment followed by regular monitoring rather than any lasting limitation. After a harness, cast, or surgery, the surgeon will arrange follow-up visits, often with occasional imaging, to check that the hip is developing well and staying stable. Most children who are treated early go on to walk, run, and play like their peers, and the long-term outlook is generally very good. It is understandable to feel anxious during treatment, but the routine of check-ups is there to reassure you and to catch anything that needs attention promptly.
When to see a doctor
The most important step is simply to attend your baby’s scheduled newborn and infant hip checks – these are designed to find DDH even when there are no signs. Beyond that, see a doctor if you notice uneven skin creases on the thighs, a hip that clicks, clunks, or seems stiff or hard to spread, a difference in leg length, or a limp or waddling walk when your child begins to walk. If your baby was breech in late pregnancy or hip problems run in the family, mention this to your doctor so the hips can be looked at carefully. Raising a concern early is always the right thing to do, and no worry is too small to check.
Common questions
Is DDH painful for my baby?
Usually not. Babies with DDH are typically comfortable and show no distress, which is why the condition is often silent and why the routine hip checks are so valuable.
Will my baby need surgery?
Most babies do not. When DDH is found early, a soft harness is often enough. Surgery is reserved for hips found later or that do not respond to gentler treatment, and your surgeon will discuss it clearly if it is needed.
Did tight swaddling cause this?
Swaddling is one of several factors, not a single cause, and many babies with DDH were never swaddled tightly. Going forward, hip-healthy swaddling that lets the legs bend and move freely is encouraged.
Can my baby still be carried and swaddled normally?
Yes. The key is to leave room for the hips and legs to move. Wrap so the legs can bend up and out, and choose carriers that support the thighs and let the legs spread naturally.
Will my child walk normally after treatment?
In most cases, yes. Children treated early usually go on to walk, run, and play like their peers, with regular follow-up to confirm the hip is developing well.
Related guides
Sources
- KK Women’s and Children’s Hospital
- HealthHub
- NHS
- American Academy of Orthopaedic Surgeons
Disclaimer: This guide is for general information and does not replace personal medical advice. Please attend your baby’s routine hip checks, and speak to your doctor or a paediatric orthopaedic surgeon about your child’s individual situation.