Congenital dislocation may be noted before the baby starts to walk. An observant mother may note asymmetry - with a different number of of skin folds - difficulty in applying a nappy because of limitation of abduction, or that one of the baby's hips clicks.
Once the baby has started walking then the asymmetry becomes more obvious. A unilateral dislocation may exhibit a difference in level of skin creases between the two legs: this is unreliable. The dislocated leg will appear shorter and may be externally rotated.
If there is bilateral dislocation then DDH may be difficult to pick up, since there is no asymmetry. Instead the signs here are of lordosis, waddling gait and increased perineal gap.
In the older child, Trendelenburg's test is positive, gait is abnormal, and there is excessive shoulder sway.
Last reviewed 01/2018