Donald Trump has been caught in one of the most awkward moments of his presidency so far during a 'family' photo at the start of a regional summit in the Philippines.

President Trump was left confused by a communal handshake that took place between some of the world's most powerful leaders during the opening ceremony of the 31st Association of South East Asian Nations in November.

President Trump looked slightly ill at ease at first but then appeared to enjoy himself during the unusual handshake with Prime Minister Malcolm Turnbull, Russian Prime Minister Dmitry Medvedev, Vietnam's Prime Minister Nguyen Xuan Phuc, Thailand's Prime Minister Prayut Chan-O-Cha, Philippine President Rodrigo Duterte, Singapore's Prime Minister Lee Hsien Loong.

It provided a lighthearted introduction to the ASEAN meeting where rogue state North Korea and its leader Kim Jong-un, Philippines' bloody drug war and its fight against ISIS is set to be high on the agenda.

President Trump is winding down his lengthy Asian trip at the international summit and a trio of meetings with Pacific Rim allies.

The opening ceremony began with pageantry before the summit's traditional handshake.

The cross-body shake, during which each leader shakes the opposite hands of those next to him, briefly baffled Trump, who then laughed as he figured out where to place his arms.

One of the leaders on his flank was President Duterte, who has overseen a bloody drug war that has featured extrajudicial killings.

The two men are also slated to hold longer, formal talks later today and White House aides signalled that Trump is not expected to publicly bring up human rights in their discussions.

Trump will also meet with Prime Minister Narendra Modi of India, which plays a key role in the U.S. vision of an Indo-Pacific region that attempts to de- emphasise China's influence.

And he will meet with Prime Minister Turnbull, with whom he had a contentious phone call in January.

The handshake brought back memories of earlier awkward exchanges between Trump and his presidential predecessor Barack Obama and with Prime Minister Turnbull following their controversial phone call.

Riot police used water cannon and sonic alarms to repel hundreds of protesters shouting anti-Trump slogans on the sidelines of the summit.

Colourful effigies of the US president, including one with four arms in the shape of a Nazi swastika, were carried through the streets of the Philippine capital.

A likeness of President Duterte peeked out from behind the figure, as the two leaders sat down for formal talks less than three kilometres away.

Protesters carried placards that read "Trump Go Home" and "Ban Trump #1 terrorist".

Police said there were nearly 2,000 people at the rallies.

Rights groups have called on Trump to speak out over Duterte's drugs war, which has seen police and suspected vigilantes kill thousands of people during his 16 months in power.

But the one-time property magnate, who is on the final stop of a tour of Asia, has so far shown nothing but warmth for a strongman leader who has boasted of personally killing people.

Trump also spoke about trade and the menace of North Korea with Australian Prime Mnister Malcolm Turnbull in a three-way chat with Japanese leader Shinzo Abe. The trio caught up on the sidelines of the summit, after Turnbull's one-on-one meeting with Trump was cancelled.

Trump raved about his accomplishments on his five-nation journey, including on trade and North Korea, but said he would wait until his return to Washington on Wednesday to elaborate with a "major statement."

"We've made some very big steps with regard to trade - far bigger than anything you know," Trump told reporters at the beginning of the meeting in Manila, touting business deals forged between US and foreign companies.

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