Duration of Barlow Maneuver Testing
The Barlow maneuver should be performed at every well-baby visit from birth through 3 months of age, as the test becomes unreliable after this period due to tightening of the hip capsule. 1
Age-Specific Testing Schedule
Perform the Barlow test at the following intervals:
The Barlow test is most reliable during the first 2-3 months of life, after which the hip capsule naturally tightens with age, making the test less sensitive after 3 months. 1
When to Stop Using the Barlow Test
After 3 months of age, discontinue relying on the Barlow test as the primary screening method, as it becomes less reliable due to increased tightening of the hip capsule. 1, 3
Switch to alternative examination techniques after 3 months:
- Limited hip abduction becomes the most useful clinical sign in children older than 3 months 1, 3
- Assessment for limited hip abduction should begin at 8 weeks of age, as this is the most sensitive test for DDH from this age onward 4
- Asymmetric thigh folds become more important indicators in older infants and toddlers 1, 3
- Gait assessment becomes critical in school-age children 3
Critical Clinical Pitfalls
Differentiate between a true positive Barlow test and benign "clicking" hip, which produces a click during examination but has no laxity and is not pathologic. 1
A positive Barlow test (indicating a dislocatable hip) requires immediate orthopedic referral at the time of diagnosis, as this represents hip instability that may progress to developmental dysplasia. 2, 4
If examination findings are equivocal at birth, reexamine in 2 weeks; if still equivocal, perform ultrasound or continue reexamination every few weeks through the first 6 weeks of life. 4
Persistent equivocal findings beyond 6 weeks require orthopedic evaluation, even if the hip does not demonstrate frank instability. 4