Practice Guidelines

Developmental Dysplasia of the Hip in Infants: A Clinical Report from the AAP on Evaluation and Referral


Am Fam Physician. 2017 Aug 1;96(3):196-197.

Author disclosure: No relevant financial affiliation

Key Points for Practice

• The AAP recommends against universally screening for DDH with ultrasonography.

• Imaging can be performed in infants considered high risk from six weeks to six months of age who have normal findings on physical examination.

• Radiography can be an option for children older than four months who have normal findings on physical examination.

• A child's legs should not be tightly swaddled with the hips extended and adducted.

From the AFP Editors

Developmental dysplasia of the hip (DDH) can range from a mild abnormality to dislocation. In infants and young children, it is asymptomatic; therefore, screening is required to diagnose it in otherwise healthy children. There are no agreed upon best screening techniques and important clinical findings because of a lack of quality evidence. In addition, there is no standardized definition of DDH, including what measurable criteria at what age can be considered differences in development and what indicates DDH.

It should be noted that, although there are different definitions of DDH, there is still an overall consensus from expert groups that prognosis is poor for hips that remain unstable or abnormal until two to three years of age. The American Academy of Pediatrics (AAP) has published this clinical report to provide updated information since the release of their practice guideline in 2000. The AAP indicates that screening for DDH is useful to prevent subluxated or dislocated hips in the first year of an infant's life. It should be noted that no method of screening has been determined to entirely remove the risk of DDH occurring late, and no high-quality evidence supports the idea that screening combined with early treatment will prevent mild DDH.

Physical Examination

DDH is most often diagnosed in children without risk factors; therefore, physical examination is the main screening method. Using occasional physical examination, physicians should aim to diagnose hip subluxation or dislocation by six

Author disclosure: No relevant financial affiliation

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



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Aug 1, 2018

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