Checking Newborn Babies' Hips: Why Early Scans and Early Treatment Matter

What four 2025 studies from the Netherlands, Taiwan, Germany and Italy tell families about hip checks, ultrasound scans, risk factors and soft braces for developmental dysplasia of the hip

Some babies are born with a hip joint that is shallow or loose, a condition called developmental dysplasia of the hip. Four studies from 2025 show that European countries check babies' hips in very different ways, that early scanning found cases in time in one hospital, and that treatment started before three months of age is linked to fewer problems. Most babies with a loose hip at birth do very well.

Four studies, one journey from checking to treatment

The hip is a ball-and-socket joint: the rounded top of the thigh bone (the ball) sits in a cup in the pelvis (the socket). In developmental dysplasia of the hip, usually shortened to DDH, the socket is too shallow or the ball can slip partly or fully out. Doctors look for it soon after birth because it is much easier to treat in the first weeks of life.

The four studies in this article fit together like steps on a path. A team from Maastricht University and Leiden University Medical Center in the Netherlands, led by Mulder, looked at the official rules (guidelines) that European countries use to check and treat babies' hips ^[1]. They found only nine national guidelines, and they disagreed on who should have a scan and when. Two hospital studies then looked at scanning babies very early. Wang and colleagues checked the hips of nearly every newborn in a hospital in Taiwan, usually on the third day of life ^[2]. Vogt and colleagues at Muenster University Hospital in Germany worked out what normal hips look like on a scan in the first 10 days ^[3]. Finally, a team from the University of Messina in Italy, led by Marletta, combined earlier studies to ask whether starting treatment earlier makes a difference ^[4].

How doctors have looked for loose hips over the years

For many years, the only way to check a baby's hip was by hand. A doctor or midwife gently bends the baby's legs and moves the hips to feel whether the ball slips out of the socket or clunks back in. These moves are named after the doctors who described them, Ortolani and Barlow. They are quick and painless, but they can miss hips that are shallow without being loose. A large review found that these hand checks picked up fewer than half of truly dislocated hips (46%) ^[5].

In 1980, a doctor named Graf described a way to look at a baby's hip with ultrasound, the same safe, painless sound-wave scanning used during pregnancy ^[6]. A scan shows the shape of the socket and gives it a "type": type I is a mature, normal hip, while other types range from "immature" to dislocated. Austria began scanning every baby in 1992, and afterwards fewer children needed hip operations ^[7]. Germany started scanning all babies in their first six weeks in 1996 ^[8].

Other countries, such as the United Kingdom, chose instead to scan only babies with a higher chance of DDH ^[1]. Norway ran a large fair comparison: 11,925 newborns were placed by chance into three groups, scanning everyone, scanning only babies at higher risk, or hand checks alone. When the young people were checked again at 18 to 20 years of age, their hips looked much the same whichever group they had been in ^[9]. Researchers also noticed a trade-off. Scanning everyone finds many more babies with hip changes, but a review of 76 studies found it did not clearly reduce the number of operations ^[10]. In one Norwegian town, adding early scans for all babies more than doubled how many were treated, from 0.9% to 2.1% ^[11]. That is why experts still disagree about whether every baby should have a scan.

What the four studies found

The European review found that only 9 of 46 countries had national guidelines, and only two, Germany and the Netherlands, were judged to be good quality ^[1]. Three countries scan every baby, five scan only babies with risk factors (things that make DDH more likely) or a worrying hand check, and the recommended age for a first scan ranges from the first week to three months.

In the Taiwanese hospital, 4,667 babies had their hips scanned, usually on day three ^[2]; babies born early and babies with other birth differences were not included in this study. DDH was found in 27 of the 4,667 babies, fewer than 1 in 100, affecting 35 of the 9,334 hips scanned. All 27 babies started treatment before 12 weeks of age, and no baby was found to have DDH late. Most hips (31 of 35) developed normally with a soft brace; only four needed further procedures. Every hip that looked slightly "immature" on the first scan had become normal by the four-week scan.

The German study compared two groups of newborns scanned in their first days: 967 babies scanned whatever their risk, and 1,900 scanned because they had a risk factor ^[3]. DDH turned up about as often in both groups, 2.5% and 3.2%. The researchers concluded that a hip angle that would count as "immature" at six weeks of age is often completely normal for a two-day-old. In a small follow-up group of 20 with borderline angles, all matured on their own within a few weeks.

The Italian review combined 22 studies of babies treated with braces ^[4]. Babies who started treatment before three months had fewer problems later, such as a socket that stayed shallow, than babies who started between three and six months. For example, fewer than 2 in 100 babies treated early still had a shallow socket afterwards, compared with about 1 in 5 of those who started later, according to the authors' calculations. The review had weaknesses in how it grouped and reported studies, and babies who start later may have had more serious hip problems to begin with, so the exact numbers are uncertain. Still, the general message, earlier treatment is linked to fewer problems, matches what doctors have long believed.

Which babies are more likely to have loose hips

Both the Taiwanese and German studies found that girls and babies who lay bottom-first (breech) in the womb were more likely to have DDH ^[2], ^[3]. In the German study, having a parent or sibling with DDH, or being born by Caesarean section (an operation to deliver the baby), did not make DDH more likely in the first days, although many guidelines still list family history as a reason for a scan ^[1]. Across many countries, about 1.4% of babies are found to have DDH, and girls are affected more often ^[12].

What this means for families

If your baby was breech or has a close relative with DDH, your team may suggest a hip scan, often at around four to six weeks or earlier depending on where you live. In the United Kingdom, for example, babies who were breech late in pregnancy or who have a parent, brother or sister with DDH are offered a scan by four to six weeks, and babies born well before their due date who also have a risk factor or a worrying hand check may be scanned around the time they would have been born ^[1]. If your baby has been in the neonatal intensive care unit (the hospital unit that cares for sick or premature newborns), ask before going home whether a hip scan has been arranged, because it can be overlooked among other appointments. This does not mean something is wrong; it is simply a closer look. A normal hand check at birth is reassuring, but it cannot rule out every problem, so keep scan appointments even if your baby seems perfectly well.

If a scan shows an "immature" hip, try not to worry. Many hips that look immature in the first days or weeks become normal on their own, which is why doctors often repeat the scan rather than starting treatment straight away ^[3], ^[13]. The German researchers suggested new, age-specific measurements for very young babies, but these still need to be tested in other hospitals.

If treatment is needed, it is usually a Pavlik harness: a soft fabric brace with straps that holds the baby's legs bent up and apart, like a frog, so the ball sits snugly in the socket while it grows. Babies can still move, feed and be cuddled, and the harness is adjusted at regular check-ups. Occasionally the harness does not hold the hip in place and the hip team changes plan; in the Taiwanese study this happened for two hips, which were then gently put back in place and held in a cast ^[2]. This is why regular check-ups during treatment matter.

Everyday handling helps too. The Taiwanese team taught parents "healthy hip swaddling" before going home: wrapping the upper body snugly while leaving the legs loose, so they can bend up and fall apart naturally, rather than wrapping them straight and tight ^[2]. Ask your midwife or nurse to show you how.

What researchers are working on next

The European review calls for countries to work together on clearer, better-quality guidelines ^[1]. The big open questions are whether every baby should be scanned or only those at higher risk, the best age for a first scan, and the best time to start treatment. Researchers also want to test the new "normal" measurements for very young babies in more hospitals, check how much scan results differ between the people doing them, and follow children for many years to see how their hips do as adults. Another important question is balance: finding every loose hip early is valuable, but so is avoiding braces for hips that would have settled by themselves.

The main message for parents

Checking babies' hips is a routine part of newborn care, but countries still do it differently. Recent studies suggest that early scans found loose hips in time in at least one hospital, that many early "immature" hips settle on their own, and that when treatment is needed, starting in the first few months is linked to better results. Your baby's team is there to guide you through each step.

References

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2. Wang JH, Yao SH, Wang TM, Lin CJ, Lin CH, Chen CH. Effectiveness of incorporating the Graf method into a universal neonatal ultrasound screening program for early diagnosis of developmental dysplasia of the hip in the Taiwanese population. BMC Musculoskelet Disord. 2025;26(1):551. doi:10.1186/s12891-025-08740-7 ↩
3. Vogt B, Tureck SS, Gosheger G, Frommer A, Laufer A, Tretow H, et al. Early screening for developmental dysplasia of the hip: sonographic reference values, risk factors, and treatment considerations. Int J Neonatal Screen. 2025;11(3):81. doi:10.3390/ijns11030081 ↩
4. Marletta DA, Zampogna B, Giuca G, Nanni M, Sanzarello I, Leonetti D. Impact of age and timing of hip orthosis on treatment outcomes in infants with developmental dysplasia of the hip: a systematic review and meta-analysis. J Clin Orthop Trauma. 2025;64:102944. doi:10.1016/j.jcot.2025.102944 ↩
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13. Biedermann R, Riccabona J, Giesinger JM, Brunner A, Liebensteiner M, Wansch J, et al. Results of universal ultrasound screening for developmental dysplasia of the hip: a prospective follow-up of 28 092 consecutive infants. Bone Joint J. 2018;100-B(10):1399-1404. doi:10.1302/0301-620X.100B10.BJJ-2017-1539.R2 ↩