The Pavlik Harness is specially designed to gently position your baby’s hips so they are aligned in the joint and to keep the hip joint secure. Since it is almost impossible to secure one hip by itself in the harness, both hips need to be positioned in the harness. This does not mean that your baby has problems with both hips. By positioning your baby’s hips in such a way that the hip joint is aligned and stable, it will help normal growth and development of the hip joint. There are several reasons why the harness needs to be used and the doctor will explain to you why it is necessary for your baby to be in one.
The video below was developed by Dr. Mubarak from the IHDI Medical Advisory board that covers taking the harness on and off, and some basic tips for parents when dealing with a Pavlik Harness.
General Pavlik Harnes Tips
It’s best to allow the knees and thighs to spread apart so the hips point towards the middle of the child’s body. Anything that presses the legs together should be minimized but the child should have freedom to pull his or her own knees together. You should encourage positions that allow the legs to spread apart like a wide V naturally. They should not be forced apart.
Avoid swaddling with the legs together, and also avoid sling carriers. Avoid anything that holds the legs together. The breastfeeding position should be fine. Pant sleepers are OK if you unsnap the snaps across the crotch area plus one or two snaps down the legs and up the bodice.
- The Pavilk harness is designed to keep your baby’s hips in a specific position. The harness should not be removed in the early stages of treatment, even if it is soiled unless directed by a doctor.
- Each week or two at the beginning of treatment, the position of the harness will be checked by the doctor or nurse practitioner and probably adjusted. This will allow for natural growth, keeping the hip joint in the best position.
- Soft, thin clothing (preferably a shirt or vest with a collar) may be worn under the harness. Occasionally the shoulder straps may rub against the neck. If they do, some soft padding can be added to cover the straps. This will prevent any harmful rubbing.
- Each day: it is important to check the knee creases, groin creases and sides of the neck for skin rubbing.
- Important: You should never unfasten straps (#3,4,7,8), these are the hip flexor and hip abduction straps. When the hip joint becomes normal, as it does in most cases, the doctor will start allowing you to remove the harness for certain periods of time.
- For additional information on breastfeeding please see Healthy Hips Australia’s brochure on Breastfeeding Tips.
Onesies under the harness, or body suits with snaps below for easy diaper changes work well for most babies. Collared body suits are often recommended, but the regular ones are usually all that’s needed unless the straps are rubbing the neck. Clothing should be loose around the legs as much as possible.
When changing clothing it is important to remove only one section of the harness at a time to keep the hips in the proper position as much as possible. It may be a good idea to have someone help you for the first few times. To change tops:
- Lie your baby down and first loosen (do not take off) the chest band that attaches with Velcro in front.
- Undo the shoulder strap (#1) and take the right arm out of the clothing.
- Take the clothing over the baby’s head and re-attach the shoulder strap (#1)
- Undo the other shoulder strap (#2) and remove the old clothing.
- Put on the new clothing over your baby’s left arm then over his/her head, and re-attach strap (#2)
- Undo strap (#1), take the clothing over the right arm and re-attach strap (#1)
- Tuck the clothing down through the (loosened) chest band.
CHECKPOINT: Strap (#1) and (#2) should be re-attached over top of the baby’s clothing.
- Check that the shoulder straps are back on their markers (readjust the straps if needed)
- Retighten the chest band so that you can get four fingers between your baby’s chest and the chest band
The following video provides instructions for fitting by a physician or orthopedist.
Knee length socks are normally worn beneath the lower leg straps and booties to help prevent chaffing. To change the socks:
- Undo both (#5) straps and remove only one leg from the harness
- Replace the sock, put leg back into harness and retighten the straps
- Repeat for the other leg with straps (#6). Cotton socks are usually best.
IHDI Medical Advisory Board Member, Dr. Pablo Castañeda explains how to properly change a diaper while wearing a Pavlik Harness.
The diaper (nappy) should be worn in the normal way but MUST be worn beneath the abduction straps (Image reference above: #3,4,7,8). If the diaper is worn outside the harness then urine will soak the harness. Urine burns may occur and the harness will not function properly. Do not pick your baby up by his or her feet when changing the diaper (nappy).
There are numerous options available for covering the harness:
- Starfish Babes
- Love to Dream – Swaddle Up Hip Harness Swaddle
- Hipsleepers – Hip Dysplasia sleeping bags, clothes & accessories
For additional information on clothing please see the Healthy Hips Australia’s brochure by clicking here.
Should the harness become soiled you can clean it by dampening it with plain water then applying some detergent and scrubbing with an old toothbrush. Do not take the harness off the baby.
Travel is usually normal in the harness. Monitor the amount of time the legs are not in the maximum wide position to avoid the legs being pushed together for long periods of time. If trips are longer than 4 hours just do your best to keep the legs as wide as possible and don’t worry too much about it. A few hours once in a while is OK, but prolonged travel on a weekly basis should be avoided as much as possible. If routine long car travel is required, then consider purchasing a wide car seat to allow the legs to spread apart.
What about slings?
Slings are not recommended because the legs can dangle together. Baby carriers should support the entire thigh with the legs apart like a jockey riding a horse. Front carriers are preferred and sling carriers should be avoided.
Babies usually fit in an umbrella stroller but keep the legs apart as much as possible. Sometimes a jogging stroller works better. Try to limit the time that the legs are pressed towards each other. For additional information please see the Healthy Hips Australia brochure on Prams by clicking here.
Use a regular car seat for short trips. Try to avoid long journeys because the car seats usually hold the thighs close together and limit the effectiveness of the Pavlik Harness. If your car seat feels tight on the legs, then consider using something different such as the Britax Marathon car seat.
Regular playtime is encouraged. Older infants sometimes learn to crawl while wearing the Pavlik Harness. This is not harmful. Floor activities, sitting activities and high chairs are all encouraged with the Pavlik Harness. Some high chairs work better than others. Look at the Keekaroo High Chair if your’s doesn’t fit very well. Propped sitting activities are also encouraged. The Bumbo chair can be used if the sides are cut out to avoid pressing the thighs together.
For playing, lay your baby on his/her tummy, back, or in a sitting position. Do not lay your baby on their side as it is not good for your baby’s hips at this stage.
If your doctor says the harness should be worn full time then you’ll need to wash with a wash cloth and basin. Sometimes the hips are more stable and the child is allowed out of the harness for an hour each day. If time out of harness is allowed, then combine bathing time, play time and harness washing time all together.
Sleeping on the back is always encouraged for the hips and to reduce the risk of Sudden Infant Death Syndrome (SIDS). A large size HALO SleepSack can be used as long as there is plenty of room for the legs and the neck fits appropriately. Avoid rolled up supports under the thighs and allow the legs room to spread apart.
Prescribed Time Out of the Harness
Once it has been decided that the harness can be removed by your doctor, the Doctor or Nurse Practitioner will show you how to take the harness on and off.
Taking the Harness Off:
- Lay your baby on his/her back.
- Take the feet out of the foot straps (#5,6).
- Then undo the chest band and shoulder straps (#1,2).
Putting the Harness On:
- Stretch the harness out on a flat surface.
- Place your baby so that he/she is lying down with their back on the back half of the chest piece.
- Attach the chest straps in front and then attach shoulder straps (#1,2) to the markers.
- Finally attach the feet in the foot straps (#5,6).
While Your Baby Is Out of the Harness
- While your baby is out of the harness encourage him/her to kick. An ideal time to do this is when your baby is in the bath.
- Swimming is good exercise once your baby is allowed out of the harness during the day. The doctor will advise you on activities at your clinic visit.
- Do not be worried about allowing your baby to move freely when he/she is out of the harness. Treat him/her as you normally would. There are no movements which you should prevent your baby from doing although adults should not push or pull the child’s hips.
- Once your baby’s harness is prescribed to be off for 4 or more hours, it is possible to wash it by hand in warm water or on a wool setting if using a washing machine. Use non-irritant soap flakes/powder. If you are using a washing machine place the harness in a pillow case and tie it up to prevent the Velcro damaging other clothes. If you have a tumble dryer keep it in the pillow case for drying or place it on a towel over a radiator. Sunshine however, is best of all!
When Treatment Is Finished
- Because your baby has been in the harness for some time, it may slow his/her rate of development relative to other children. This is only a temporary phase and he/she will soon catch up.
- Baby walkers or baby bouncers are not recommended for 4-6 months after finishing treatment for Hip Dysplasia as a precaution. There is concern that they may put strain on the hip joints.