Natalie Trice is a UK based hip dysplasia advocate, author, member of the IHDI International Advisory Committee and PR Guru. Her son, Lucas, was born with Developmental Dysplasia of the Hip (DDH) which inspired Natalie to write ‘Cast Life – A Parent’s Guid to Hip Dysplasia’.
Natalie has a wealth of experience with hip dysplasia and is sharing her tips on “Living with a Pavlik Harness”.
To learn more about a Pavlik Harness, please visit:
The Pavlik Harness (also referred to as a splint) is soft and lightweight and offers a non-invasive treatment for babies who start treatment before the age of six months. The Pavlik harness keeps the hips in a position to allow normal growth of the hip joint and can be extremely successful
A Pavlik harness might seem very medical and constricting at first but once your baby is used to it they really won’t know anything else and will settle into it.
For you, the harness can be a challenge in the early days but once you are armed with the facts and have the practical strategies under control, life can go on as normal.
How does the Pavlik harness work?
The harness is made up of fabric straps that fasten around a baby’s legs and are held in the correct position by correlating shoulder and chest straps.
Whilst a Pavlik harness is meticulously constructed and meets orthopaedic standards, unlike a cast, it does not rigidly immobilise the hips but instead allows controlled movement by the child as it kicks.
The idea is that your baby will be encouraged to rest in a position where the hips are bent (flexed) up to 90 per cent and relaxed out to the side (abduction). In this position the head of the ball (femur) can hopefully deeply mold into the socket (acetabulum), thus stabilising the hip in the correct position for healthy development.
What happens to my baby’s feet, will they be left dangling?
The harness comes with specially designed ‘booties’ that prevent little feet from slipping out of the harness. Socks can be worn beneath the lower leg straps and booties.
My baby only has DDH in one hip, why do both legs need to be in the harness?
Both legs need to be in the harness as the pelvis is a ring of connected bones; so one hip cannot be correctly positioned on its own.
How long will it take my baby to get used to the harness?
There is no magic number here I am afraid, it differs from baby to baby.
Some babies settle straight away, for others it can take between seven to ten days.
Whilst it is hard for us to watch our children struggle and accept that our little bundles of joy look ‘different’, they are amazingly resilient and adaptable and will never remember any of this.
If you do have any concerns or if they simply don’t settle, contact your nurse or consultant.
If caught early enough, will a Pavlik harness correct DHH?
There is no guarantee of success using the Pavlik harness but the earlier treatment starts, the better.
How long will my baby have to wear the harness?
There is no set time for a baby to wear this harness. Every single case is different and will depend on your child, their hips and the age at which DDH was diagnosed. In many cases, babies wear a harness for 24 hours a day for six to twelve weeks with regular checks and follow-up scans.
If these checks show the ball is being held in the right position, there will be a ‘weaning’ off period when you baby wears the harness for less time each week depending on progress.
If this happens, you will be shown how to take the harness on and off correctly. It is a good idea to take someone
During these periods of ‘freedom’, let your baby enjoy baths, swimming (age and time permitting) as well as movement and harness free cuddles.
It will be up to your consultant to decide a plan of treatment for your baby and it is vital you follow it.
How do I know the harness is properly fitted?
The chest strap should be firm but you should be able to fit four fingers between your baby’s chest and the chest band so their chest can expand properly when they are breathing.
The ankle and lower leg straps need to gently secure or hold the legs but they must not be too tight.
What follow-up appointments will we have once the harness is fitted?
Each case is different but initially you will most likely have weekly appointments during which there will be regular ultrasounds as well as checks to ensure the harness is still correctly fitted and is providing the right amount of support.
If you have any questions or concerns between meetings, get in touch with your surgeon or nurse and they will answers questions and make another appointment if necessary.
How will I bath my baby whilst they are in a harness?
If your doctor has said the harness is to be worn 24 hours a day, then washing your baby in the bath isn’t possible, but you still need to keep them clean, hygienic and fresh.
Give them a gentle sponge bath with a soft cloth, paying close attention to their neck, shoulders, groin and behind the knees as this is where their skin comes into contact with the straps. It is also worth paying attention to the hips creases too.
Use a clean towel every time and ensure the skin is 100% dry afterwards.
Keep an eye out for any soreness and whilst it is tempting to apply talcum powder or cream, check with your nurse or surgeon first, as this can sometimes cause further irritation and clogging.
If your baby is allowed out of their harness for a bath, the steps to follow are:
- When bathing your baby pay particular attention to the skin behind the knees, hip creases as well as the neck and shoulders
- Dry the skin well with a clean towel before re-applying the harness
- In both cases, it is a good idea to keep an eye on your baby’s skin daily and if you notice any irritation, sores or redness, contact your nurse. The main areas to check are the groin and behind the knees.
Can my baby wear a normal nappy?
Yes, it is perfectly fine for normal nappies to be worn whilst your baby is in a harness. Many people find disposable are easier and less fiddly to use than cloth ones and this also means there is less chance of disturbing the set up of the harness.
The nappy should be worn as normal but needs to be worn under the leg straps for the harness to work properly.
When changing your baby’s nappy, never lift them up by their legs as you may have done in the past. Instead support them under their bottom and gently hold their feet together and carefully change them ensuring you keep the hips secure and in place.
This might seem tricky at the start, but once you have done it a few times you will find it becomes second nature and you will probably continue to do it this way even after their treatment.
Remember, the nappy is worn underneath the harness so take care not to move the straps whilst changing your child.
What clothes can my baby wear if they have a harness on?
Clothes are one of the concerns that spring to mind when parents think about this condition. With many little outfits waiting to be worn, it can be really upsetting to think that none of them can be used and that your baby is different for all the others. This is a natural part of your journey so don’t worry or feel guilty.
The main thing to remember is that your baby can wear ‘normal’ clothes and with a few easy alterations, they will be comfortable and happy. If you need to, pop a soft blanket over them when you are out and about to avoid people staring or commenting and keep them warm at the same time.
Can I breastfeed my baby whilst they are in their Pavlik harness?
Yes, there is absolutely no reason why you cannot continue to breastfeed your baby whilst they are in a Pavlik harness.
You might need to spend a while finding positions you both find comfortable and where your baby’s legs are in the correct position, but otherwise continue breastfeeding as if nothing had changed.
How should I hold my baby, I don’t want to hurt him/her?
Simply support your baby as normal and place your hand between his/her legs. Don’t be scared, they are still your baby and they need you to be strong and confident when caring for them.
Will my baby be able to sleep in their harness?
This is something many parents are concerned about but again your baby will adapt and they will sleep.
As with current thinking, babies should still sleep on their backs and if you can, do your best not to let them lie on their sides, as this isn’t the best position for healthy hip development.
To keep your baby warm, especially at night, you can use sleeping bags but go for a size or two bigger in order to maintain the correct leg and hip position and ensure no restrictions or chance of the legs being brought together.
Can I clean a Pavlik harness?
Babies make a mess and get dirty by nature, so do make sure you still use bibs and muslins whilst they are in their harness.
There will be times when your harness needs to be cleaned but if your baby has to be in their harness 24/7, do not take them out due to spillages. Instead spot wash the dirty area with cooled boiled water, then using a gentle washing powder or liquid either scrub the affected area with a cloth or small brush, I found a nailbrush really effective.
Blot the damp area dry with a towel and it should be clean (or clean enough) once again.
Once your baby is being weaned out of the harness, it is possible to wash it by hand in warm water. If you do use your washing machine, put the harness inside a pillowcase to protect the Velcro and use a very mild powder. Low heat tumble drying can be used but preferably dry in the sunshine and fresh air or put on a towel on top of a warm radiator.
How do I know if the harness needs checking?
Most of the time the harness will be absolutely fine and your baby will be happy.
Signs that things aren’t quite right include:
- Your baby has been growing and their harness is getting too tight
- Your baby’s feet start sliding in and out of the booties freely
- Red marks appear around the shoulders or chest straps and don’t fade or get better
- Your baby has blue or cold feet or swollen toes
- Feel free to contact your nurse or consultant if you are worried about any of the above and they will advise you or make you an appointment.
Are there any side effects connected to the Pavlik harness?
The Pavlik harness is a very safe piece of medical equipment but one thing to be mindful of is Femoral Nerve Palsy. This is a rare condition that sometimes occurs in babies who are in a Pavlik harness.
If your baby has this, they will not be able to kick their leg or move their toes when tickled and it will almost be like their leg has gone to sleep.
If you think your child might have this condition seek medical attention as soon as possible.
What happens when my baby grows?
Just like clothes, Pavlik harnesses come in different sizes therefore as your child grows, the harness may be adjusted or changed.
KEY POINTS TO REMEMBER
- A Pavlik harness is used to correct DDH and works by keeping your baby’s hip joints in the correct position.
- It may take a few days for your baby to adjust to the harness but they will get there and so will you.
- The harness should be adjusted as your baby grows.
- Clean your baby’s skin and keep an eye out for irritation and soreness.
- Be aware of Femoral Nerve Palsy.
- Be kind to yourself and know you are doing the best for your child.
Natalie is a PR Director based in Devon, England. From CEOs of international TV channels and the finance directors of IT companies to entrepreneurs at the forefront of their industry and ambitious start-ups, Natalie has worked with them all and many more.
Cast Life – A Parent’s Guide to DDH, was Natalie’s first book and sits alongside her charity, DDH UK which supports thousands of people around the world dealing the hip dysplasia, a condition one of her sons has been treated for over the past decade. This December will see the launch of ‘PR School – Your Time to Shine’ Natale’s second book and one which promises to take readers from zero to hero so they can do their own PR and feel as if they have their very own PR ninja sitting alongside them.