Why does my baby need a Pavlik harness?
The health-care team may recommend the Pavlik harness for your baby when either one or both hips are dysplastic or even dislocated. Even if only one hip is affected, it is important to have both legs in the harness to ensure that the affected hip is stabilized.
What is the Pavlik harness?
The Pavlik harness orthosis is used to correct developmental dysplasia of the hip (DDH). It is a set of soft straps that help to keep your baby’s legs in a hip-healthy position with the legs bent up and apart and gently falling out to the sides. This helps to keep your baby’s hip in the socket to allow for normal hip development. It is usually used to treat newborn babies as old as six months.
Application
The Pavlik harness is applied by the orthotist at your appointment and the straps are adjusted and marked at the correct length. Your baby will be required to wear the Pavlik harness 24 hours per day at the beginning of treatment. Once the health-care team confirms your baby’s hips have been stable in the harness for a certain amount of time, you can remove the harness for one hour a day until the end of treatment.
How to correctly put a Pavlik harness on your baby:
- Open all the straps and lay your baby face up on the harness with the chest strap across the chest.
- Fasten the chest strap. The top of the chest strap should be at the nipple line.
- You should be able to fit two of your fingers underneath the chest strap when it is fastened. This will ensure your baby can breathe properly in the harness.
- Fasten the shoulder straps to the chest strap. You should be able to fit one of your fingers underneath the shoulder straps when they are fastened.
- Place your baby's legs into the leg portion of the harness (booties) so that the toes are in the "socks."
- Secure the leg straps snugly, but not too tightly.
- Thread the front and back straps through the leg portion of the harness and secure them. The leg straps have colour-coded tabs: Red-Red, Blue-Blue. The blue tabs will be on the left leg and the red tabs will be on the right leg.
The straps on the harness will be marked to help you fasten them. As your baby grows, the tightness of the leg straps can be adjusted when needed. Your orthotist will help with adjustments when necessary. Do not adjust any of the straps on the harness without first speaking with your health-care team. A video showing the correct procedure to apply the Pavlik harness is shown below.
A video showing the correct procedure to apply the Pavlik harness is shown below.
What are the risks of Pavlik harness treatment?
Femoral nerve palsy is a rare condition caused by a trapped nerve at the hip. A trapped nerve occurs when too much pressure is placed on the nerve by surrounding tissue. This can occur in up to 1 in 50 babies who use a Pavlik harness. If this happens, your baby will not kick their leg out straight, even when their toes are tickled. It will look as if your baby's leg has fallen asleep.
If you notice that your baby has reduced movement of their leg, and stops kicking, this may mean that your baby has a femoral nerve palsy. It is advised that you take off the harness and contact your health-care team as soon as possible.
Skin irritation can occur with the Pavlik harness as it is designed to be worn directly next to the baby’s skin. If skin irritation occurs, please contact your health-care team for suggestions. Note that clothing worn over the top of the harness should be very loose and you should never change the position of the harness straps or the baby’s legs.
General Pavlik harness tips
The Pavlik harness helps to keep the legs in a hip-healthy position with the legs bent up and gently falling out to the sides. In general, when wearing a Pavlik harness, you should avoid anything that pushes the legs together, such as car seats that are too narrow or swaddling. The legs should also not be forced apart but should fall naturally apart within the harness.
- You should never remove the harness unless instructed by your baby’s health-care team. At a certain point in the treatment, your baby will be allowed to come out of the harness for one hour per day, but it is important to wait for the team to tell you when this is OK.
- The position of the harness will be checked periodically by your team and the straps will be adjusted if needed.
- It is important that you never unfasten the straps that hold your baby’s legs in place. The chest strap at the nipple line may be adjusted as the baby grows. You should be able to fit two fingers between the baby’s chest and the chest strap. The bootie straps may also be adjusted and you should be able to fit one finger between the baby’s legs and the bootie straps.
Clothing
Once you have been told by the health-care team that your baby can come out of the harness for one hour per day, a t-shirt or onesie can then be worn under the harness. To change your baby, it is important to remove only one part of the harness at a time, starting with one arm and then the next.
Diaper
The diaper must be worn under the straps to ensure that urine and stool do not soil the harness. When changing your baby, do not pick them up by their legs.
Dirty harness
A dirty harness must not be removed. While the harness is still on the baby, you can clean it by dampening it with warm water, then applying some detergent and scrubbing it with a toothbrush.
Travelling
When travelling with a baby in a Pavlik harness, it is important that the baby is in a car seat that is wide enough for the legs to fall out to the sides and not be pushed together. The harness must not be removed, even for travel. Prolonged travel on a weekly basis is not recommended. If a long car trip is required, it is important to take breaks to allow the legs to fall out to the sides maximally.
Play time/tummy time
Play time in the harness is encouraged, including floor activities and sitting activities. Supervised tummy time is also encouraged.
Time out of the harness
At a certain point in your treatment plan, the health-care team will inform you that you can take your baby out of the harness for one hour a day. During this hour, you may choose to bathe your baby, have play time or wash the harness. You do not need to release all of the straps to remove your baby from the harness. Remove the harness in the following way:
- Lie your baby down on their back and first undo the chest band that attaches with Velcro in front.
- Take both arms out of the harness.
- Undo the two Velcro straps that go around the lower leg on each side.
- Take both legs out of the built-in socks.
- Lift baby from the harness.
- Bathe baby.
- Once baby is dry, put the harness back on.
- Place harness flat on a dry surface.
- Place baby onto the harness.
- Place both arms through the shoulder straps.
- Secure the chest band around your baby’s chest, ensuring there is plenty of space to insert two fingers comfortably under the chest strap.
- Reattach the leg section by placing the feet back into the leg section of the harness and gently securing the two leg straps.
- Check that your baby can kick freely within the harness.
- Note: throughout this process you should not have needed to adjust the flexion and abduction straps.
When treatment is finished
When treatment is complete, your baby will no longer need to wear the harness. Even with the harness removed, your baby may continue to hold their legs in a "frog leg" position for a short time and this is completely normal. Do not try to stretch the legs in any way; your baby will move their legs as they see fit. It is important to maintain hip healthy practices following DDH treatment which can be found in the article Preventing developmental dysplasia of the hip.