Breech Babies: What Parents Should Know About Hip Follow-Up

What does “breech” mean?

A baby is normally born head-first. A breech baby is positioned bottom-first or feet-first instead.

Breech positioning is common earlier in pregnancy and becomes less common as the due date approaches. By full term, about 3 to 4 out of every 100 babies are still breech.

There are a few types:

• Frank breech: Bottom down, with the legs straight up and the feet near the head. This is the most common type.
• Complete breech: Bottom down, with the hips and knees bent.
• Footling breech: One or both feet are pointing downward.

Most of the time, there is no clear reason why a baby is breech. It is more common with premature birth, twins or multiples, differences in the shape of the uterus, too much or too little amniotic fluid, first pregnancies, and baby girls.

What happens before delivery?

If a baby is still breech near term, the obstetric team may offer external cephalic version (ECV)—a procedure in which pressure is applied to the mother's abdomen to try to turn the baby head-down.

ECV is usually offered late in pregnancy and succeeds in roughly half of attempts.

If the baby remains breech, many are delivered by planned cesarean. In carefully selected situations, vaginal breech birth may also be considered with an experienced obstetric team.

The delivery plan depends on the pregnancy, the baby's position, the experience of the birth team, and the family's preferences.

The most important thing afterward: your baby's hips

Babies who were breech at any point during the third trimester have a higher risk of developmental dysplasia of the hip (DDH).

DDH means the hip joint is looser, shallower, or more unstable than it should be. In some babies, the ball of the hip joint may partially or completely move out of the socket.

Breech positioning is one of the strongest known risk factors for DDH.

Other risk factors include:

• Being a girl
• Having a parent or sibling who had hip dysplasia
• Certain conditions that restrict movement in the womb

The increased risk applies whether your baby was ultimately born vaginally or by cesarean.

Why does hip dysplasia matter?

DDH usually does not cause pain in a newborn, and a baby may look completely normal.

If significant hip dysplasia is missed, however, it can eventually affect walking and contribute to hip problems later in life.

The good news is that when clinically significant DDH is found early, treatment is often much simpler and may involve a soft brace such as a Pavlik harness rather than surgery.

Some mild abnormalities seen on early ultrasound improve on their own and may only need observation.

What hip checks should my baby have?

Every newborn has their hips examined after birth, and the pediatrician should continue checking the hips during routine well-child visits.

Because breech positioning itself increases the risk of DDH, a normal newborn examination does not eliminate the need for imaging.

For babies who were breech at any point during the third trimester, the current Seattle Children's screening recommendation is:

• Hip ultrasound at about 6 weeks of age
• A single pelvis X-ray at about 6 months of age

This recommendation applies to both boys and girls.

Ultrasound is used early because a young baby's hip is still largely made of cartilage, which does not show well on an X-ray. As the hip becomes more bony, an X-ray becomes more useful.

Your pediatrician may adjust the timing or recommend additional evaluation depending on your baby's examination or other risk factors.

Hip-healthy habits at home

Swaddle safely

Swaddling the upper body snugly is fine, but your baby's hips and knees should still be able to bend and move freely.

Avoid wrapping the legs tightly together in a straight position.

Your baby's legs should have room to bend naturally at the hips and knees.

Use hip-friendly carriers

Carriers that support the thighs and allow the legs to spread naturally—with the hips bent and the knees slightly higher than the bottom—are generally considered hip-friendly.

What should parents watch for?

Most babies with DDH do not have obvious symptoms, which is why scheduled examinations and imaging are important.

Contact your baby's pediatrician if you notice:

• A noticeable clunk or sensation that the hip seems to slip in or out during movement
• One leg appearing shorter than the other
• One hip not spreading outward as far as the other during diaper changes
• A persistent difference in the way the two legs move

Simple clicking sounds by themselves are common in babies and usually do not mean that the hip is dislocated.

Uneven thigh or buttock creases can sometimes occur with DDH, but they are also common in babies with normal hips and do not necessarily mean anything is wrong by themselves.

In older babies or toddlers, signs may include:

• Limping
• Walking on the toes on one side
• A waddling walk
• A noticeable difference in leg length

What if the imaging shows hip dysplasia?

The next step depends on your baby's age and how abnormal the hip appears.

Some mild findings improve naturally and may simply be watched with repeat examinations or imaging.

When treatment is needed in a young infant, a Pavlik harness is commonly used. This soft brace holds the hips in a position that helps the hip socket develop normally.

Babies diagnosed later, or babies whose hips do not improve with bracing, may need other treatments.

Your pediatrician or pediatric orthopedic specialist will explain what is appropriate for your baby.

The bottom line

Being breech does not mean something is wrong with your baby.

The important thing is remembering that breech positioning during the third trimester increases the risk of developmental hip dysplasia—even if your baby's hip examination after birth is normal.

For babies with a third-trimester breech history, make sure the follow-up plan includes:

• Routine hip examinations
• A hip ultrasound at about 6 weeks
• A pelvis X-ray at about 6 months

Early detection makes treatment easier when hip dysplasia is present and helps protect your child's hip development as they grow.