If a child has a soft click during hip dysplasia screening, what is the next step in management?

When a child presents with a soft click during hip dysplasia screening, the next appropriate step in management is to obtain imaging studies, specifically an ultrasound or x-rays, depending on the child's age. This is because the presence of a click can indicate hip instability or developmental dysplasia of the hip (DDH), but it is not definitive on its own.

Ultrasound is typically the preferred initial imaging modality for infants under 6 months old, as it can effectively visualize the cartilage and assess the hip joint's stability. For older infants and children, x-rays may be utilized to evaluate the bony structures of the hip. Depending on the results of these imaging studies, further management can be determined, which may include monitoring or specific interventions.

In contrast, immediate referral for surgery is not warranted unless there are definite findings indicative of severe dysplasia or dislocation, which is not established with just a soft click. Normal follow-up visits alone would also not adequately address the potential risk of hip dysplasia; some form of imaging is essential for proper diagnosis. Cast application is typically reserved for cases with confirmed dysplasia or dislocation rather than merely a click during screening. Therefore, further imaging is necessary to guide the management appropriately.