At what age should I refer a child for further assessment if DDH is suspected based on clinical examination?

Refer a child for further assessment of suspected developmental dysplasia of the hip (DDH) if clinical examination findings are present beyond the newborn period, particularly if abnormalities persist or are detected after 4 weeks of age. Early clinical screening is typically performed at birth and during the neonatal period; however, if DDH is suspected on clinical examination after this time, referral should not be delayed beyond the first few weeks of life to optimise outcomes.

UK guidance emphasises that referral is warranted if there are red flag features, functional impairment, or persistent asymmetry in hip examination findings, especially if these persist beyond 4 weeks of age. While routine referral is not usually required for children younger than 4 years without red flags or functional impairment, suspicion of hip disease—including DDH—should prompt specialist assessment earlier to prevent long-term complications ¹.

Supporting this, the literature highlights that early identification and referral, ideally within the first 4 to 6 weeks of life, is critical for effective management of DDH, as delayed diagnosis can lead to more complex treatment and poorer outcomes (Jackson et al., 2014; Shaw et al., 2016).

Therefore, if DDH is suspected on clinical examination, especially if abnormal hip stability, limited abduction, or leg length discrepancy is noted, referral to paediatric orthopaedics or specialist services should be made promptly, ideally within the first month of life. If the child is older than this and symptoms or signs persist, urgent referral remains indicated to exclude other hip pathologies and initiate appropriate management ¹ (Jackson et al., 2014; Shaw et al., 2016).