Birth Injury Answers

Hip problems in babies after birth

The short answer

Hip dysplasia means the ball and socket of the hip joint have not formed or fitted together properly. The hip can be loose, partly out of place, or fully dislocated. 1

It is not usually painful in a baby and there is often nothing a parent would notice, which is why every newborn's hips are examined and why babies with risk factors get an ultrasound. Treated early with a harness it usually resolves. Found late it often needs surgery. 1

The numbers, up front

The biggest risk factor
Breech position in the last part of pregnancy, which is why breech babies are routinely offered hip imaging 2
How it is screened
Physical examination of every newborn, and ultrasound for babies with risk factors, because ultrasound shows cartilage that X-ray cannot 1
Why not X-ray in a newborn
A newborn hip is largely cartilage and does not show on X-ray. Ultrasound is used in the early months and X-ray becomes useful later 1
The usual treatment
A soft harness that holds the hips in a flexed, spread position so the socket deepens around the ball 1
Why early matters
Treatment with a harness in the first months is usually successful. A hip found later more often needs surgery 1
What travels with it
Torticollis and foot positional problems occur more often alongside hip dysplasia, so babies with one are checked for the others 1

How does this happen?

The hip is a ball on the top of the thigh bone sitting in a socket in the pelvis. In a baby, both are largely cartilage and both are still forming. The socket deepens in response to the ball sitting in it correctly. That is the key fact: the joint shapes itself through use. 1

If the ball sits out of position, the socket does not deepen properly. Over time the two grow further apart in shape as well as in position, which is why a hip that is easy to correct at 6 weeks can need surgery at 18 months.

The main influences are position and hormones. A baby who spent the last weeks folded bottom-first has had the hips held in an unusual position, which is the strongest single risk factor. 2 Hormones that soften the mother's ligaments before birth also reach the baby and loosen theirs.

Swaddling matters after birth. Wrapping a baby with the legs held straight and pressed together holds the hips in the position that encourages dislocation. Swaddling that leaves the hips free to bend and spread does not carry that risk. 1

What causes it?

Two different questions get mixed together here. The first is what leads to this injury in the body. The second is whether anyone could have prevented it. They are not the same question, and the answer to the first does not settle the second.

Happens even with perfect care

  • breech position, especially in the last weeks of pregnancy. This is the strongest risk factor and it is not caused by anything anyone did. 2
  • Family history of hip dysplasia.
  • Being a first baby, where the uterus is less stretched.
  • Low fluid around the baby, limiting movement.
  • Twin or multiple pregnancy.
  • A large baby. 3
  • torticollis or foot positional differences, which travel with it. 1
  • Being female, which carries a higher rate, and having no identified risk factor at all, which is common. 4

Associated with gaps in care

These are situations where published standards say what the care team should watch for and do. A gap here does not prove anyone caused your child's injury. It points to where the medical records will have an answer.

  • Hips not examined at the newborn check or at well-child visits, where hip examination is part of standard newborn and infant care. 5
  • A breech baby not offered hip imaging, when breech position is the strongest risk factor. 2
  • An abnormal examination not followed up with imaging or referral.
  • Imaging done with X-ray in a very young baby, where cartilage does not show and a normal result can be falsely reassuring. 1
  • Advice about swaddling not given, where tight leg-straight swaddling is a known risk. 1
  • Hips not checked in a baby with torticollis. 1
  • A limp or a difference in leg length in a toddler not investigated.

Whether any of this amounts to a departure from the standard of care takes a physician expert reading the whole record.

What are the signs, by age?

Signs change as a child grows. A newborn cannot show you a walking problem. Some children look fine at first and show differences months later.

At birth and the first hours

  • Often nothing that a parent would notice. This is why examination and screening exist.
  • On examination, a clunk or a slip as the hip is moved, which is what the newborn hip tests are looking for.
  • Uneven thigh or buttock skin creases.
  • One leg appearing shorter.
  • Limited spreading of one hip during a diaper change.

The first week

  • The same findings. Examination is repeated at well-child visits because some hips become detectable later.

Around 3 months

  • Limited spreading of one hip, which becomes a more reliable sign than the newborn clunk tests as a baby grows.
  • Asymmetric creases.
  • A leg length difference.

Around 6 months

  • Reduced hip spreading.
  • Difficulty with diaper changes on one side.
  • Asymmetry when the knees are held together with hips and knees bent.

Around 12 months

  • Late walking, judged against the standard milestones. 6
  • A limp when walking begins.
  • Walking on the toes on one side.
  • Waddling, if both hips are affected.

Toddler years

  • A limp.
  • An increased curve in the lower back.
  • A leg length difference.
  • Usually still no pain, which is why it can go unnoticed.

School age

  • Pain begins to appear in untreated hips.
  • Reduced activity and tiring quickly.
  • Long-term, untreated dysplasia leads to early arthritis of the hip.

None of this is a diagnosis. Children develop at different speeds and one late skill on its own usually means nothing. Bring what you see to your pediatrician, and ask for a referral to early intervention if you are worried. You do not need a diagnosis to be referred.

How is it diagnosed?

Physical examination of every newborn, repeated at well-child visits. The newborn tests look for a hip that slips in or out of place. As babies grow past a few months, limited spreading of the hip becomes the more reliable sign. 1

Ultrasound for babies with risk factors or an abnormal examination, generally in the first months. It shows the cartilage that an X-ray cannot. 1

X-ray becomes useful from around 4 to 6 months, once enough bone has formed.

Who should be imaged typically includes babies who were breech, babies with a family history, and babies with an abnormal or uncertain examination. Ask directly whether your baby's risk factors mean imaging is indicated. 2

Check what travels with it. Babies with torticollis or foot positional differences should have their hips examined, and the reverse. 1

If your baby was breech and nobody has mentioned a hip ultrasound, ask about it.

What is the treatment?

A harness, usually a Pavlik harness, is the standard first treatment in young babies. It holds the hips bent and spread so the ball sits in the socket and the socket deepens around it. It is worn for weeks, usually full time at first. 1

The harness works because the joint shapes itself. That is also why time matters: the younger the baby, the more shaping is still to come.

Follow-up ultrasound during treatment to confirm the hip is staying located.

Closed reduction and a cast, where a harness has not worked or where the child is older. The hip is placed under anesthetic and held in a cast.

Open surgery, where the hip cannot be placed otherwise or where the child is older still. This may include reshaping the socket or the thigh bone.

Swaddling advice. Hips should be free to bend and spread. Tight leg-straight swaddling should be avoided. 1

Referral to early intervention where treatment affects motor development, which is free to evaluate for a child under 3. 7

Follow-up for years. Hips are watched as the child grows, because a hip that was treated successfully can still develop shallow socket problems later.

What is the long-term outlook?

Excellent when found and treated early. Most babies treated with a harness in the first months develop normal hips. 1

Outcomes are progressively less straightforward the later it is found. A hip treated at 6 weeks, at 8 months, and at 2 years involves increasingly invasive treatment.

Untreated hip dysplasia leads to pain, a limp, and early arthritis of the hip in adult life.

Long-term follow-up matters even after successful treatment, because a shallow socket can become apparent later in childhood.

What does daily life look like?

A harness changes daily life for a few weeks. Diaper changes, clothing, car seats and carrying all need adjusting, and the harness usually stays on for bathing arrangements your team will explain.

Most families find the first week hardest and then adapt.

Babies are generally not distressed by the harness, which surprises parents.

After treatment, ordinary life, with follow-up appointments and X-rays over the years.

What does care cost over a lifetime?

Harness treatment is inexpensive relative to surgery, which is the practical argument for early detection alongside the clinical one.

No agency publishes a lifetime cost estimate for hip dysplasia and this site does not invent one.

Where surgery and long-term follow-up are needed the cost is substantially higher. See paying for care.

What can you do this week?

  1. If your baby was breech, ask whether a hip ultrasound is indicated. 2
  2. Ask whether the hips were examined at the newborn check and at each visit since.
  3. Ask about family history of hip problems and tell your team if there is one.
  4. Check your swaddling technique. The legs should be free to bend and spread.
  5. If your baby has torticollis, ask for the hips to be checked.
  6. Ask when the next hip check is and what they will be looking for.

What should you ask each specialist?

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the pediatrician

  • Were the hips examined, and what were the findings?
  • Do my baby's risk factors mean an ultrasound is indicated?
  • Is one leg shorter, or are the creases uneven?
  • When is the next hip check?

For the orthopedic team

  • Is the hip dislocated, partly out, or just loose?
  • How long in the harness, and how will we know it is working?
  • What happens if the harness does not work?
  • How long will we be followed up, and what are you watching for?

You can also build a printable list with the question generator.

Codes you may see on paperwork

These are ICD-10-CM codes. They are how hospitals and insurers label a diagnosis. Seeing one on a bill or a chart tells you what was recorded, not how severe it is. 8

CodeWhat it means
Q65.00Congenital dislocation of unspecified hip
Q65.6Congenital unstable hip
Q65.89Other specified congenital deformities of hip
P13.8Birth injuries to other parts of skeleton

Questions parents ask

My baby was breech. Do the hips need checking?

Ask about it. Breech position in the last weeks of pregnancy is the strongest risk factor for hip dysplasia, and breech babies are routinely offered hip imaging in addition to examination. 2 1 If it has not been mentioned, raise it.

Is hip dysplasia painful for a baby?

Usually not, which is exactly why it is screened for rather than waited for. A baby with a dislocated hip is generally comfortable and behaves normally. Pain tends to appear years later in untreated hips. 1

Does swaddling cause hip problems?

Swaddling that holds the legs straight and pressed together holds the hips in the position that encourages dislocation. Swaddling that leaves the hips free to bend and spread does not carry that risk. 1 The upper body can be wrapped snugly; the legs need room.

The clunk test was normal at birth. Are we clear?

Not entirely. Some hips become detectable later, which is why hip examination is repeated at well-child visits through the first year. As a baby grows, limited spreading of the hip becomes a more useful sign than the newborn tests. 1 If your baby has risk factors, imaging matters more than a single normal examination.

Words on this page, in plain English

breech
The baby is positioned bottom or feet first instead of head first.
macrosomia
A baby who is much larger than average, usually defined as more than 4,000 or 4,500 grams at birth.
torticollis
A tight neck muscle that holds the head tilted to one side and turned to the other.
standard of care
What a reasonably careful provider would have done in the same situation. It is proven with expert testimony, not with a guideline alone.
early intervention
The public program that provides therapy and support to children under 3 with delays or diagnosed conditions. It is required by federal law.

See the full glossary and records decoder

Where these facts come from

  1. U.S. National Library of Medicine. MedlinePlus Medical Encyclopedia. 2025. medlineplus.gov/encyclopedia.html. Link checked September 3, 2026.
  2. American College of Obstetricians and Gynecologists. Committee Opinion 745, Mode of Term Singleton Breech Delivery. 2018. www.acog.org/clinical/clinical-guidance/committee-opinion. Link checked September 3, 2026.
  3. American College of Obstetricians and Gynecologists. Practice Bulletin 216, Macrosomia. 2020. www.acog.org/clinical/clinical-guidance/practice-bulletin. Link checked September 3, 2026.
  4. CDC. Data and Statistics on Birth Defects. 2024. www.cdc.gov/birth-defects/data-research/index.html. Link checked September 3, 2026.
  5. American Academy of Pediatrics, Pediatrics. Hospital Discharge of the High-Risk Neonate. 2008. publications.aap.org/pediatrics/article/122/5/1119. Link checked September 3, 2026.
  6. American Academy of Pediatrics and CDC, Pediatrics. Evidence-Informed Milestones for Developmental Surveillance Tools. 2022. publications.aap.org/pediatrics/article/149/3/e2021052138. Link checked September 3, 2026.
  7. U.S. Government Publishing Office, Electronic Code of Federal Regulations. 34 CFR Part 303, Early Intervention Program for Infants and Toddlers with Disabilities. 2025. www.ecfr.gov/current/title-34/subtitle-B/chapter-III/part-30. Link checked September 3, 2026.
  8. Centers for Medicare and Medicaid Services. ICD-10-CM Files. 2025. www.cms.gov/medicare/coding-billing/icd-10-codes. Link checked September 3, 2026.