Bernardo’s Story: successful treatment with Pavlik harness in baby boy with bilateral hip dislocation.
Bernardo is my third child, his two older brothers were born with healthy hips. Bernardo was in a breach position entire pregnancy and was delivered by C-section. I (his mom) was also a breach baby and had dislocated hip at birth, followed by a persistent dysplasia which required long treatment with braces, closed reduction and casting.
Considering my history and him being breach, I anticipated that Bernardo would have hip issues, although, of course, I was hoping he would not. As soon as he was delivered, his pediatrician knew that his hips were dislocated. Bernardo was referred to a pediatric orthopedist who did a physical examination of his hips, and at 6 days of age he was put in a Pavlik harness. The harness had to be worn 24 hours for a minimum of 6 weeks. Of course it was heartbreaking to see my baby boy wearing such an awkward device that restricted him from moving his legs. It also restricted me from holding him in certain positions but it did not restrict me from hugging and cuddling him. All my family members and I knew how important it was for Bernardo’s hips to continue wearing the harness at all times. We all learned to cope with the harness sooner and better than I thought we would. I learned to breastfeed him while hugging him in an upright position, laying him on my lap prompted with pillows or side laying position while only his upper body and head were turned towards me. My husband and I learned to change his diapers very quickly. As our baby grew, we learned to adjust the chest and shoulder straps of the harness ourselves. Leg straps were adjusted by an orthopedic nurse, and ankle straps were never touched. Bernardo did not seem to be bothered by the harness at all.
Bernardo was born in May, so he wore his harness during summer time. Because it was so hot the skin under his shoulder straps became irritated. I gently wiped it with moist cloth and dried thoroughly once or twice a day. There was no fabric soft enough to place under the straps, so I used baby wipes. I dried them completely in a drier and cut them into appropriate size. I changed them almost every hour and through away the used ones because they were so inexpensive. This technique really helped. Dry wipes absorbed moisture very well and Bernardo’s skin was healed completely by the next day. After that I continued using the dry wipes to prevent further skin irritation.
Bernardo’s hips became stable (in the sockets) after one week of wearing the harness, so it was apparent that the harness was an effective treatment for him. After wearing the harness for six weeks Bernardo had an ultrasound. The procedure did not take long, was not invasive and Bernardo was quite comfortable the whole time. He was laying on his side while the technologist scanned the opposite side and he continued wearing the harness during the procedure. Alpha angles of his hips were 65 degrees for the right and 62 degrees for the left. I do not recall values for beta angles, but they were normal. The very next day I was given instructions to remove Bernardo’s harness. His doctor did not think that weaning was required, but I removed the harness gradually over several hours. At first I loosened the straps a little, then a little more until the harness was very loose, and then I removed it completely. His legs had dents in them where ankle straps were, it took over a month for them to disappear. Bernardo seemed just as comfortable out of the harness as he did in it. I cuddled him a lot and carried him in a kangaroo wrap. I made sure that his legs were in a position similar to how they were when he was in a harness.
At four months of age Bernardo had his x-ray. Acetabular indexes were 23 degrees on the right hip and 26 degrees on the left. Ossification centres were not yet noted. The orthopedist said that it was within the norm. Bernardo did not require any treatment, only a follow up in four months to ensure his hips did not become dysplastic. I did not restrict any activities of my baby, but I continued keeping his legs abducted whenever possible. I carried him on my hip, never swaddled his legs, I even purchased the widest stroller and car seat I could find in order to keep his hips in a “froggy” position.
At eight months of age Bernardo had another x-ray. The doctor did not take measurements for acetabular index, he determined that his hips were not dysplastic only by looking at the x-ray. He also made sure that Shenton’s line was continuous. There was still no ossification centres noted. The orthopedist said it was still within a normal variation because they usually form between four and eight months of age. I was worried about this, though, because this was one of the problems I had with my hips as a child. In fact, it took a very long time before my cartilage turned into bones. I was also afraid that Bernardo could have developed avascular necrosis, but I knew longer monitoring was required to rule out that possibility.
Bernardo’s next x-ray was in four months, two days before he turned one year old. After looking on his x-ray his doctor said that his hips were developing very well. Acetabular indexes were within normal values (unfortunately I did not ask what they were) and I was happy to see bilateral symmetrical circles where ossification was taking place. Our next follow up is scheduled in one year, when Bernardo turns two.
Bernardo is a very active little boy, crawling, furniture walking and always trying to catch up to his older brothers. His hip development will be monitored until his adolescence. My family and I are very fortunate and very grateful to receive care from such knowledgeable and dedicated team of healthcare professionals. They provided appropriate timely treatment for Bernardo, without their expertise my baby’s outcome could have been very different.
As a mom, I would like to share with other parents some ideas that I have learned from this experience. Draw your strength from your love to your baby. I felt better when I cuddled my son, massaged his feet, his back and legs around the harness. Talk to others who you trust. I talked to my family members, my neighbour and many parents on playgrounds. I even met some moms whose babies were in similar situations. After talking about the issue it seemed less threatening, and, instead of focusing on the disorder I started to focus on how to make things more comfortable for my baby and the rest of my family. That was something I could do, so it empowered me and made me feel a lot happier. Another useful tip is to gather information. Ask your healthcare professionals questions, tell them your concerns, get second opinion when you decide it is appropriate. Ask where you can get answers to your questions when your doctor is not available. Doctors are very busy, and most of my questions came up after the appointments. A couple of days after an appointment I would formulate my most important questions and phone the orthopedic nurse, she was wonderful answering my questions. After that I felt calm instead of feeling worried and uncertain.
I hope sharing my son’s experience will help some parents feel more optimistic about their babies’ prognosis. Early treatment with Pavlik harness seems to have helped my baby’s healthy hip development. May all our children be blessed with health and happiness!