Hip Surveillance for Children with Cerebral Palsy: A Guide for Families

If your child has cerebral palsy, you may have heard the term “hip surveillance” mentioned by your physiotherapist or paediatrician - and it can sound more alarming than it needs to. In simple terms, hip surveillance is a way of keeping a close eye on your child’s hips over time, so that any changes are picked up early when they’re easiest to manage. It’s one of the most valuable things we can do to protect a child’s comfort and mobility for the years ahead. In this guide we’ll explain what hip surveillance is, why it matters for children with cerebral palsy, how it works, and the part families and physiotherapists play together.

Why are the hips a focus in cerebral palsy?

Almost all children with cerebral palsy are born with normal hips. The challenge is that cerebral palsy affects muscle tone and the balance of pull around the hip joint. Over time, uneven muscle forces can gradually draw the top of the thigh bone away from its socket - a process called hip displacement (you may also hear the words subluxation, meaning partly out, or dislocation, meaning fully out).

Hip displacement usually happens slowly and, importantly, often without obvious signs in the early stages - a child may not appear to be in pain even as changes begin. That’s exactly why a watchful, structured approach matters: it lets us notice small changes long before they become a problem. When hip displacement is found early, there are more options to manage it gently. When it’s found late, it can become painful and much harder to treat, affecting a child’s ability to sit comfortably, stand, be positioned, and take part in daily life.

What is hip surveillance?

Hip surveillance is a planned program of regular checks that monitor how a child’s hips are developing. It usually combines two things: a clinical review by a health professional (looking at things like hip movement and range, posture, and comfort) and, at appropriate times, a hip X-ray to measure what’s happening inside the joint.

On an X-ray, clinicians often use a measurement called the migration percentage - essentially, how much of the head of the thigh bone sits outside the socket. Tracking this number over time is a reliable way to spot whether a hip is stable or starting to move, so the care team can act early if needed. A single measurement matters less than the trend across time, which is why regular, consistent monitoring is so useful.

How often does my child need to be checked?

This is where a child’s individual situation really matters. The risk of hip displacement is closely linked to a child’s gross motor function - how they move and get around - which clinicians describe using a tool called the GMFCS (Gross Motor Function Classification System), levels I to V. Generally speaking, children who walk independently are at lower risk, while children who use more support to move are at higher risk.

Because of this, the recommended frequency of clinical reviews and X-rays is tailored to each child, based on their GMFCS level and age. In Australia, this is guided by the Australian Hip Surveillance Guidelines for Children with Cerebral Palsy, which set out how often checks should happen for each level. For some children this might mean occasional monitoring, while for others it means more regular X-rays through the growing years. Your child’s physiotherapist, paediatrician or specialist will map out the right schedule for your child and explain it to you.

What happens if a change is picked up?

Finding an early change is exactly what surveillance is for - it’s good news, not bad, because it opens the door to timely, less invasive options. Depending on what’s found, a child’s team might adjust their management in a number of ways, which can include physiotherapy and postural care (such as positioning, supported standing, and seating), tone management, or referral to an orthopaedic specialist for further advice. In some cases, surgery may be recommended, and detecting displacement early can make that surgery simpler and more successful if it’s needed.

The key message is that hip surveillance doesn’t cause interventions - it gives your child’s team the information to make good, timely decisions with you.

What part do physiotherapists and families play?

Physiotherapists are often closely involved in hip surveillance. That can include helping determine a child’s GMFCS level, carrying out clinical hip checks, keeping track of the surveillance schedule, supporting postural management at home and school, and working alongside your paediatrician, GP and specialists so everyone stays coordinated. Families are central - you know your child best, and your observations, along with keeping up with scheduled reviews, are a vital part of the picture.

At Outreach Physiotherapy, we’re experienced in supporting children with cerebral palsy and their families, and we’re NDIS registered. We can see your child at home, at school, in the community, or by telehealth, and help you feel confident about what surveillance means for your child.

When should I speak to a health professional?

If your child has cerebral palsy and hip surveillance hasn’t been discussed with you, it’s well worth raising with your physiotherapist, paediatrician or GP — every child with cerebral palsy can benefit from a surveillance plan suited to them. It’s also worth reaching out if you notice changes such as new or increasing stiffness around the hips, a reduced range of movement, difficulty with positioning, nappy changes or seating, a change in how your child sits or stands, a difference between the two legs, or any signs of hip discomfort or pain.

If your child appears to be in significant pain, is very unsettled, or has had a fall or injury affecting the hip or leg, please seek prompt medical care through your GP or the nearest emergency department.

Summary

Hip surveillance is a gentle, proactive way of protecting the hips of children with cerebral palsy. Because hip displacement can develop slowly and quietly, regular monitoring - tailored to your child’s GMFCS level and age - helps catch changes early, when the kindest and most effective options are available. It’s a team effort between your family and your child’s health professionals, and it’s one of the most worthwhile things we can do for your child’s long-term comfort and mobility.

We’re here to help

If you’d like to understand hip surveillance for your child, we’d love to help.

Darwin, NT — Unit 5, 396 Stuart Highway, Winnellie. Call (08) 7918 0879 or email reception@outreachphysiotherapy.com

Adelaide, SA — mobile physiotherapy across Adelaide, the Fleurieu Peninsula, and remote SA. Call 0475 921 397 or email reception@outreachphysiotherapysa.com