Nursing care
Developmental Dysplasia of the Hip nursing care: what to assess and what to do first
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Developmental dysplasia of the hip is an abnormal formation of the hip joint present from birth or developing in infancy, where the femoral head sits loosely or dislocates from a shallow acetabulum. Nurses assess for asymmetric skin folds, limited hip abduction and a positive Ortolani or Barlow sign, then support Pavlik harness treatment and family teaching.
What it is and why it happens
Developmental dysplasia of the hip covers a spectrum from mild acetabular shallowness to a fully dislocated femoral head. The acetabulum fails to develop a deep enough socket to hold the head of the femur securely, so the joint is unstable and prone to subluxation or dislocation during normal movement.
Risk factors cluster around anything that restricts fetal hip movement or loosens the joint capsule before birth: breech presentation, first pregnancy, oligohydramnios, a family history of the condition, and female sex, which accounts for most cases. Firstborn girls delivered breech carry the highest combined risk. Swaddling that forces the legs straight and together after birth adds further mechanical risk, which is why hip-healthy swaddling technique matters on the postnatal ward as much as it does at home.
How it presents — what you will actually see
The hallmark findings are asymmetric skin folds on the posterior thigh or buttock and a positive Ortolani sign, felt as a palpable clunk as the examiner abducts the hip and the femoral head reduces back into the acetabulum. A positive Barlow sign, where gentle adduction and posterior pressure displaces an unstable hip out of the socket, often accompanies it.
Beyond the folds and the clunk, look for limited hip abduction on the affected side, apparent shortening of the femur (a positive Galeazzi sign when the knees are compared in flexion), and asymmetric leg length. In an older infant who has started weight-bearing, a Trendelenburg gait or waddle may be the presenting complaint instead. The Ortolani and Barlow signs lose reliability after about three months as the hip stiffens, so imaging carries more weight in older infants.
Nursing assessment priorities
Perform the hip exam with the infant relaxed, ideally feeding or settled, since a crying or tense baby will mask subtle findings. Compare both hips side by side for skin fold symmetry, range of abduction, and leg length before attempting the Ortolani and Barlow manoeuvres, and document findings precisely rather than simply charting 'hips normal.'
Review the birth and family history for breech presentation, oligohydramnios and any relative with hip dysplasia, since these raise the index of suspicion even when the exam is equivocal. Confirm that ultrasound has been arranged for infants under six months with risk factors or positive findings, since ultrasound visualises the still-cartilaginous femoral head better than X-ray at this age. Reassess hip stability at each well-child check through the first year, because a hip that was stable at birth can still loosen.
Interventions and what to do first
For infants under six months, the Pavlik harness is first-line treatment, and the priority intervention is fitting it correctly and keeping it on as instructed, typically 23 hours a day for several weeks before a weaning schedule begins. The harness holds the hips flexed and abducted so the femoral head stays seated in the acetabulum while it deepens around it.
Check skin integrity under the straps at every nappy change, since the harness sits directly against skin for most of the day and pressure areas develop quickly on an infant's soft skin. Confirm strap position and tension at each follow-up rather than adjusting them at home, and never remove the harness for bathing or play unless the treating team has explicitly said it is permitted. For dysplasia diagnosed later or unresponsive to bracing, closed or open reduction followed by spica casting is the next step, and the same skin and neurovascular vigilance applies to cast care.
Complications to watch for
Avascular necrosis of the femoral head is the complication that most concerns clinicians, caused by excessive forced abduction compressing the blood supply to the femoral head. It is a direct argument for using the harness exactly as prescribed rather than tightening it further to 'get a better result.'
Watch for skin breakdown under the harness or cast, particularly at the groin and behind the knees, and for signs of neurovascular compromise distal to any cast: pallor, coolness, delayed capillary refill or reduced movement in the toes. Left untreated or treated inadequately, dysplasia progresses to a permanently shallow, unstable hip that causes early degenerative joint disease and a limp that becomes obvious once the child is walking.
Patient teaching before discharge
Teach parents that the harness stays on as instructed, including through nappy changes, feeding and sleep, and that they should not loosen or remove it to 'give the hips a rest' without direction from the orthopaedic team. Show them how to check for redness or rubbing at each nappy change and to layer a vest and babygrow under the straps rather than dressing over them.
Explain the follow-up schedule clearly, since ultrasound or X-ray checks track how the hip is developing and determine when weaning from the harness can begin. Cover safe positioning for car seats and carriers with the harness in place, and reassure parents that most infants treated in the first few months of life go on to have a normally functioning hip, provided the harness protocol is followed consistently.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our pediatrics practice questions are the closest set to what this page covers.
Common questions
Can a baby be swaddled normally with hip dysplasia risk factors?
No — swaddling should keep the hips free to flex and abduct rather than forcing the legs straight and together. Hip-healthy swaddles wrap the arms and upper body while leaving room at the hips and knees for natural frog-leg positioning.
Why does the Ortolani sign disappear in older infants?
The Ortolani and Barlow tests rely on being able to manually reduce or dislocate an unstable hip, which becomes harder as periarticular soft tissue tightens with age. After about three months, a shortened limb, limited abduction or an abnormal gait become more reliable clues, and imaging takes over as the main diagnostic tool.
Is Pavlik harness treatment painful for the infant?
The harness itself does not cause pain when correctly fitted, though infants may fuss during the initial adjustment period as they get used to restricted leg movement. Persistent crying, especially with feeding or nappy changes, warrants a check for strap rubbing or incorrect positioning rather than being dismissed as normal fussiness.
What happens if the Pavlik harness fails to correct the hip?
If the hip remains unstable or dislocated after several weeks of harness treatment, the next step is usually closed reduction under anaesthesia followed by a spica cast, or open surgical reduction if closed reduction cannot achieve a stable position. Failure rates rise with later diagnosis, which is part of why early newborn hip screening matters.
How is developmental dysplasia of the hip likely to appear on the NCLEX?
Expect a scenario describing a newborn with asymmetric thigh folds and a hip clunk on exam, asking you to identify the finding as a positive Ortolani sign or to prioritise the next nursing action. Harness care questions typically test skin assessment frequency and the instruction to keep the harness on continuously rather than removing it for comfort.