Staff on post-natal ward to refer for hip USS on Epic and reassure parents following NIPE if:

• Positive Ortolani or Barlow test

• All babies from a multiple pregnancy should be referred for hip ultrasound if at least one of the babies has a screen positive result from clinical examination of the hips.

and / or

• One or more risk factors present including:

  • First-degree family history of DDH requiring treatment

  • Breech presentation at or after 36 weeks gestation

  • Breech presentation at time of birth between 28 weeks gestation and term

  • Baby presents with Congenital Talipes Equinovarus, Metatarsus Adductus, Positional Calcaneovalgus talipes or Congenital Vertical Talus

  • All babies from a multiple pregnancy where any of the NIPE hip risk factors listed above are present should have a hip ultrasound.

Radiology admin team will process Hip USS Epic order and contact parents with an appointment.

• Preterm babies born before 34 weeks gestation should be scanned between 38 weeks and 40 weeks corrected age. (see NIPE guidelines)

• Preterm babies born after 34 weeks gestation should be scanned at 4-6 weeks of age. (see NIPE guidelines)

• Term babies should be scanned at 4-6 weeks of age. (see NIPE guidelines)

In the event of a baby still being an inpatient on NNU when their hip scan is due, NNU team to discuss clinical case with Paediatric Orthopaedic Team.

Radiology team to classify hip USS using Graf classification.

Discharge – normal hip ultrasound (Graf I)

Re-scan required - Can conduct repeat scan for Graf II but should start treatment within 8 weeks ideally. Liaise with Paediatric Ortho Team if unsure via Epic secure message

MDT opinion required – Contact Paediatric Ortho Team via Epic secure message for severely dysplastic hips (Graf III or above) or those that have not normalised on second hip USS

Radiology input once Pavlik harness treatment commenced

Ultrasound scans 2-4 weekly whilst in harness until Graf I achieved bilaterally

For babies with hip dysplasia the Paediatric Orthopaedic Team are responsible for deciding initial treatment plan and will advise on if Pavlik harness treatment is required.

First appointment

• Patient measured and fitted with Pavlik harness.

• Parents informed about rationale for treatment, dressing, washing, nappy changes.

• Parents informed about potential risks (AVN and femoral nerve palsy)

• Contact details, information leaflet and appointment for 1 week given

Follow-Up

Baby reviewed by physio/plaster room every subsequent 2 weeks to monitor position until end of weaning process.

Weaning

• Once hips are Graf I on scan (alpha angle 60 degrees or over) and baby has completed 6/52 full time in harness for Graf II or 8/52 for Graf III/IV weaning can commence.

• Parents taught how to remove / re-apply harness.

• Continue to review every 2/52 to adjust harness as required.

• Week 1 - Out of harness 1 hr / day.

• Week 2 - Out of harness 2 hrs / day.

• Week 3 - Out of harness 3 hrs / day.

• Week 4 - Out of harness 4 hrs / day.

• Week 5 - Out of harness 8 hrs / day.

• Week 6 - Out of harness 12 hrs / day.

Once weaning completed parents can remove harness and baby is discharged from physiotherapy/plaster room

Department of Health and Social Care - Gov.uk (2016) Newborn and infant physical examination (NIPE) screening programme handbook. Available at: https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook. (Accessed: 18 September 2025).

British Society for Children's Orthopaedic Surgery (2019) Regarding the management of developmental dysplasia of the hip (DDH) in the first three months of life. Available at: https://www.bscos.org.uk/public/guidelines-consensus-projects/consensus-project/ddh-consensus-steering-group (Accessed: 18 September 2025).

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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