Hip health is an essential part of caring for children with cerebral palsy (CP). Many hip problems in CP develop slowly and without obvious early pain, therefore regular monitoring is one of the most effective ways to protect movement, comfort, and long-term function.
This blog explains what hip surveillance is, why it matters, and what families should expect at each stage of their child’s growth
What Is Hip Surveillance?
Hip surveillance simply means regular check-ups to monitor how your child’s hip joints are growing and whether they are staying in a healthy, stable position. The purpose is early detection: catching hip changes before they become painful or harder to treat.
A surveillance plan usually includes:
- A physical assessment by a physiotherapist or paediatric doctor
- Hip X-rays at recommended ages
- Tracking hip position over time (called migration percentage)
- Monitoring muscle tightness, posture, and gait changes
Why Are Hips at Risk in Cerebral Palsy?
Children with CP have a higher risk of hip displacement because of differences in muscle tone, posture, and motor control.
Common contributing factors include:
- Tight hip muscles – Especially the hip flexors and adductors, which can pull the ball of the hip joint inward or upward.
- Asymmetrical movement – If one side of the body is stronger or more active, the hip on the less active side may be at greater risk.
- Less standing or walking time – Weight-bearing helps shape and stabilise the hip joint. Kids who stand or walk less often may not get enough consistent load through their hips.
These changes usually happen quietly and slowly, which is why regular checks are essential even if your child isn’t showing signs of pain.
Who Needs Hip Surveillance?
The short answer: every child with cerebral palsy. However, some children are at higher risk and need more frequent monitoring. Kids with the following should be checked more frequently:
- GMFCS Levels III, IV, V
- Children with significant muscle tightness
- Children who don’t weight-bear regularly
- Kids with hemiplegia where one side is much weaker or tighter
Your physiotherapist can help determine your child’s risk level and create a tailored surveillance plan.
How Often Should Hips Be Checked?
The frequency depends on your child’s age, GMFCS level, and stage of development. Most children get their first hip X-ray between 12–24 months old, then follow a structured schedule based on risk. Even if a child is walking independently, hip displacement can still happen, so ongoing monitoring is important for everyone.
The general guidelines, based on the GMFCS, are as follows:
- GMFCS I–II: X-rays and assessments every 12–24 months
- GMFCS III–V: X-rays and assessments every 6–12 months
What Do Clinicians Look For?
At each appointment, your physio or doctor will check
- Range of motion: Are the hips becoming tighter or harder to move
- Hip alignment: Is one hip sitting higher or rotating inward?
- Sitting/standing symmetry: Is the child leaning to one side or favouring one leg?
- Pain or stiffness: Any new discomfort, even subtle, is important to note.
- X-ray results: The X-ray measures the migration percentage (how much of the hip joint is sitting outside its normal position).
Tracking these changes early allows for timely treatment.
What Parents Might Notice
Most early hip changes don’t cause obvious symptoms. However, some signs to keep an eye on include:
- New or increasing limp
- Pain or reluctance to weight-bear
- More tightness in the legs than usual
- Discomfort during dressing, toileting, or nappy changes
- One leg kicking or sitting differently
- Changes in walking pattern
If you notice anything new, a review is always a good idea.
Why Hip Surveillance Matters
Hip surveillance is one of the most effective ways to prevent complications for children with CP. Early detection helps prevent:
- Hip pain
- Hip dislocation
- Loss of mobility
- Need for major surgical intervention
Keeping the hips healthy supports better movement, comfort, and participation in the activities children love, from playing at the park to engaging in school and sport. If you are concerned about your child’s hips or want to begin monitoring your child’s hip health, please make an appointment with our Children’s Physiotherapist, Bec.