Developmental dysplasia (or dislocation) of the hip (DDH) is an abnormal development of the hip joint. In DDH, the ball at the top of the thigh bone is not stable within the hip socket and the ligaments of the hip joint may also be stretched and loose. See our
Developmental dysplasia of the hip fact sheet for more information.
Babies with DDH often need to wear a brace. The Pavlik Harness is one type of brace used to treat DDH. It has straps that are fastened around the baby's legs and held up by shoulder and chest straps. This holds the hips and knees up with the legs apart. This is the best position for the hip joint to be in.
It allows contact between the thigh and hip bones and helps strengthen the muscles and ligaments while the hip is developing.
Your doctor will let you know if your baby needs to wear the harness 24 hours a day without removing it at all, or if the harness can be removed for bathing.
Care at home
Putting the harness on
Your baby's orthotist will make sure the harness fits your baby correctly, and will show you how to put it on and how to check that it is positioned properly.
- The chest strap should be firm but you should be able to fit two fingers underneath it. This allows the chest to expand properly when your child is breathing.
- The ankle and lower leg straps should be firm to hold the foot, but not too tight.
Getting used to the harness
It takes some babies a couple of days to get use to the harness. Some babies may cry a little or seem unsettled for the first couple of nights. This should settle down after a few days.
Hygiene and skin care
Monitor your baby's skin daily. Take care to clean your baby's skin and if you notice any skin irritation or redness, contact the orthotist.
- Try to keep the harness dry at all times.
- If your doctor says the harness must be on 24 hours a day, it cannot be removed for bathing. In this case, your baby will need to have sponge baths. The orthotist will show you how to do this.
- If you are allowed to remove the harness for bathing, then only undo the Velcro straps to remove it. Do not adjust or undo the metal buckles.
- When bathing your baby, pay particular attention to the creases behind the knees and hip creases. Dry the skin well with a towel before reapplying the harness.
- Always try to keep your baby's legs apart if bathing them with the harness off.
Nappies and clothing
Your baby can wear normal nappies under the Pavlik Harness. When changing the nappy, do not hold your baby's feet together as this will move the hips from the correct position. Loose-fitting clothes that do not pull the knees together should be worn over the harness.
Feeding
You will be able to continue breastfeeding when using the Pavlik Harness. You might need to try some different positions until you find one that is comfortable for both you and your baby.
Positioning your baby
Your baby will be sleeping on their back with the harness on.
It is important to regularly change your baby's head's position while they are asleep to avoid a flat spot developing on the back of the head. The skull bones are very soft and the pressure of being in one position for too long can affect the shape of their head. See our
Plagiocephaly fact sheet for more information.
Supervised tummy time for your baby will decrease the risk of developing a flat spot. It will also promote body stability, limb coordination and head control in your baby. Tummy time is important, even when your baby is wearing a Pavlik Harness.
Cleaning the harness
The Pavlik Harness should be washed only if absolutely necessary.
- Remove the soiled section of the brace (remember how it is attached), wash in cold water with soap and gently clean with a nail brush.
- Blot dry with a towel, or use a hair dryer on low heat.
- Do not tumble dry the harness (it may shrink).
Potential problems
Femoral nerve palsy is a very rare problem that can happen when using a Pavlik Harness. If you notice that your baby stops kicking, contact the orthotist as soon as possible.
Follow-up
Your orthotist will usually arrange regular reviews to monitor the progress of your baby's growth and adjust the orthosis as required. The review with the orthotist will be linked with your doctor's appointment. If your doctor's appointment is changed, you will also
need to reschedule your orthotist’s appointment.
Contact your orthotist if you have any questions or concerns regarding your child's treatment with a Pavlik Harness.
Key points to remember
- Monitor your baby's skin daily. Take care to clean your baby's skin and if you notice any skin irritation or redness, contact the orthotist.
- Always try to keep your baby's legs apart, especially when bathing with the harness off.
- Babies may cry a little or seem unsettled for the first couple of nights after the harness is fitted. This should settle down within a couple of days.
- The Pavlik Harness should be washed only if absolutely necessary and do not tumble dry.
- Make sure you vary the position of your sleeping baby to avoid plagiocephaly (misshapen head).
For more information
Common questions our doctors are asked
What should I do if my baby gets a rash under the
harness?
It is important to monitor your baby’s skin each day, and
contact the orthotist if a rash appears. If mild skin irritation occurs, a
barrier ointment (like Vaseline) can be helpful, but discuss this with your
child's orthotist.
My baby seems very reluctant to spend time on her tummy. How
should I deal with this?
Tummy time is
difficult to achieve when your child is placed in any kind of orthosis (e.g.
harness, spica, plaster), though you can try encouraging tummy time during
orthosis-free time, if allowed. Fortunately, in the long-term, your child's
developmental ability will not suffer by missing out on tummy-time for this
short period in their life.
Developed by The Royal Children's Hospital Orthotics and Prosthetic department. We acknowledge the input of RCH consumers and carers.
Reviewed August 2020.
Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.