Developmental Dysplasia of the Hip and Scoliosis

Pediatrics · Musculoskeletal (Scoliosis, Hip)·Updated 2026-10-28

What it is

Developmental dysplasia of the hip (DDH) is abnormal formation of the hip joint in which the femoral head is unstable, subluxated or dislocated from a shallow acetabulum. Holding the hips flexed and abducted keeps the femoral head in the socket so the acetabulum deepens as the infant grows; that principle explains the Pavlik harness and the spica cast. Scoliosis is a lateral curvature of the spine of 10 degrees or more with vertebral rotation; adolescent idiopathic scoliosis progresses during the growth spurt, so bracing aims to stop progression until growth ends.

What the NCLEX focuses on

DDH risk factors: breech position, female sex, family history, firstborn and swaddling with the legs straight and together.
Newborn tests: Ortolani (a clunk as the hip reduces with abduction) and Barlow (the hip slides out with adduction and gentle backward pressure).
Older infant signs: asymmetric thigh and gluteal folds, limited abduction, and a shorter thigh with the knee lower on the affected side (Galeazzi sign).
Walking child: painless limp and a Trendelenburg sign (the pelvis drops on the unaffected side when standing on the affected leg).
The Pavlik harness (birth to 6 months) is worn continuously unless removal is prescribed, and only the provider adjusts the straps.
Scoliosis screening: the forward-bend test shows a rib hump; also look for uneven shoulders, scapulae, waist and hips.

Priority nursing actions

Examine the hips at every infant well visit until the child walks normally, and refer positive findings.
At each harness visit, check the skin and strap placement.
For a spica cast, assess circulation, sensation and movement of the toes and the skin at the cast edges, and reposition every 2 hours.
Screen adolescents with the forward-bend test and refer a visible rib hump for a spine x-ray (Cobb angle).
After posterior spinal fusion, check leg movement and sensation, logroll, manage pain with PCA, encourage incentive spirometry and promote early ambulation.

Numbers to know

Value	Standard	Why it matters
Pavlik harness	Birth to 6 months	Older infants need closed reduction and a spica cast
Scoliosis	Curve of 10 degrees or more (Cobb angle)	Defines scoliosis
Bracing	Curves of 25 to 40 degrees in a growing child	Stops progression; does not straighten the spine
Brace wear	Prescribed hours, often 18 or more a day	Benefit rises with hours worn
Spinal fusion	Curves above 45 to 50 degrees	Larger curves keep progressing after growth ends
Screening ages	Girls at 10 and 12 years; boys once at 13 or 14 years	Timed to the growth spurt

Common exam traps

Choosing to remove the Pavlik harness for a daily tub bath or to loosen the straps at home: wrong because the hip redislocates and strap changes belong to the provider.
Choosing double or triple diapering to treat DDH: wrong because it does not hold the hips in reliable flexion and abduction.
Choosing to wear the brace directly against the skin: wrong because a thin, seamless cotton shirt underneath prevents skin breakdown.
Choosing to lift or turn a child in a spica cast by the abduction bar: wrong because the bar can break and stress the hips.
Choosing to attribute new foot weakness after spinal fusion to positioning: wrong because it signals spinal cord or nerve injury and needs immediate reporting.

What to teach

Swaddle loosely at the hips so the legs bend up and out, and use carriers that support the thighs spread apart.
Pavlik harness: keep it on as prescribed, check the skin under the straps at least daily, put a shirt and knee socks underneath and the diaper under the straps, and avoid lotions and powders.
Spica cast: tuck a small diaper under the cast edges, keep the cast dry, check toe color and warmth, and use an adapted car seat.
Scoliosis brace: wear it the prescribed hours, inspect the skin daily, stay active and keep follow-up x-ray visits.

Try 2 NCLEX-style questions on this topic

From the NCLEXPace question bank. Pick your answers, then check them inside NCLEXPace.

Question 1 · QID 4B157B39

The nurse assists with the hip examination of a 3-week-old girl who was born in the frank breech position. Which finding is most consistent with developmental dysplasia of the left hip?

Select the best answer.

A. Asymmetric gluteal and thigh skin folds
B. The left knee rests slightly higher than the right when both hips and knees are flexed
C. Symmetric outward bowing of both lower legs noted while the infant lies supine
D. Deep lumbar lordosis with a broad-based waddling gait during assisted standing

Question 2 · QID 1469AEBB

A 13-year-old with a 28-degree curve has been prescribed a thoracolumbosacral orthosis for 18 hours daily during remaining growth. For each statement by the client, indicate whether it indicates understanding or requires reinforcement.

For each statement, identify whether it indicates understanding or requires reinforcement.

	Indicates understanding	Requires reinforcement
"The brace keeps the curve from getting worse while I grow."
"Redness that fades 10 minutes after I take it off is fine."
"I put it right against my skin so it fits more snugly."
"Once the brace straightens my spine I can stop wearing it."
"I wear it about 18 hours a day, including at school."

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Sources

Hockenberry MJ, Duffy EA, Gibbs KD. Wong's Nursing Care of Infants and Children. 12th ed. Elsevier; 2024.
Shaw BA, Segal LS; Section on Orthopaedics. Evaluation and Referral for Developmental Dysplasia of the Hip in Infants. Pediatrics. 2016;138(6):e20163107.

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