The Ortolani and Barlow tests, explained for parents
Written by Dr. Mutasem Aldhoon, pediatric orthopedic consultant · Medically reviewed by the Baby Hip Center pediatric orthopedic team · Last reviewed September 1, 2026
The Ortolani test tries to slide a dislocated hip back into the socket; the Barlow test tries to push a loose hip out of it. A clear clunk on either test means the hip is unstable and needs an ultrasound. Both tests stop being reliable after about 3 months, when a dislocated hip becomes stiff rather than loose.
Every newborn examination includes these two hip manoeuvres, usually described to parents as "checking the hips clicked". Here is what the examiner is really feeling for.
The Ortolani test — putting a hip back in
Your baby lies on their back with hips and knees bent. The examiner holds the thigh, gently swings the knee outwards and lifts forwards. If the head of the femur is sitting outside the socket, this movement slides it back in, and the examiner feels a deep, palpable clunk — not a sound so much as a sensation. A positive Ortolani means the hip is dislocated but reducible.
The Barlow test — pushing a hip out
From the same position the examiner brings the knee inwards and presses gently backwards. If the hip slips out of the socket, the test is positive: the hip is in place, but dislocatable. This is instability rather than dislocation, and it is the finding most often described to parents as "a loose hip".
| Finding | What it means | What usually follows |
|---|---|---|
| Ortolani positive | Hip is dislocated but goes back in | Urgent ultrasound and specialist referral |
| Barlow positive | Hip is in place but can be pushed out | Ultrasound; often treated, sometimes rechecked |
| High-pitched click only | Usually ligaments or soft tissue moving | Often benign; scan if risk factors exist |
| Both negative, but breech or family history | Examination cannot exclude dysplasia | Ultrasound at around 6 weeks regardless |
A normal examination does not rule out hip dysplasia
This is the most important thing on this page. A shallow but stable socket — the commonest form of dysplasia — produces a completely normal Ortolani and Barlow. That is precisely why babies with breech presentation or a family history are scanned even when the examination is reported as normal.
Why the tests expire at around three months
In the first weeks a dislocated hip is loose and can be slid in and out, which is what these tests detect. By three to four months the soft tissues around a hip that has been out of place tighten. The hip stops moving in and out and instead becomes stiff — so the clunk vanishes. From then on the useful signs are different: limited spread of one leg, uneven thigh creases, an apparently shorter leg, and later a limp or waddle.
What to ask if you were told the hips were fine
- Were both hips examined, and was the finding recorded as normal or as an uncertain click?
- Does my baby have any risk factor — breech position, family history, firstborn girl, oligohydramnios, foot deformity — that means a scan is recommended anyway?
- Will the hips be checked again at the later routine reviews, and at what ages?
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This page is general information about developmental dysplasia of the hip, not a diagnosis of your own baby. It does not replace examination by your baby's doctor, and it is not for emergencies.