Pavlik Harness for DDH

Developmental dysplasia (or dislocation) of the hip (DDH) is an abnormal development of

the hip joint. The ball at the top of the thighbone is not stable within the hip socket and the
ligaments of the hip joint may also be stretched and loose. This used to be called
Congenital Dislocation of the Hip (CDH). See factsheet DDH.

Treatment
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 of the hip while it is developing.

When does your baby wear the harness

Your surgeon or paediatrician may advise that your baby wears the harness either:

• 24 hours a day without removing it at all, OR

• All the time except when bathing.

At home care
Putting the harness on

• The chest strap should be firm but you should be able to fit two fingers
underneath it. This allows the chest to move properly during breathing.

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 • 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

• If your doctor has said that the harness must be on 24 hours a day, it can not be
removed for bathing. Your baby will then need a sponge bath. The orthotist will
show you how to do this. Please try to always keep the harness dry.
• 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 re-applying the harness.
• 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.

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, 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
will need to find a position that is both comfortable for you and your baby.

Positioning of your baby

• Your baby will be sleeping on its back with the harness on. It is important to
change your baby's position to avoid a 'flat spot' developing on their 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 factsheet Plagiocephaly.
• During sleep time the position of the baby's head should be varied to make sure
the baby does not favour a particular side (left or right).
• Supervised tummy time will decrease the risk of developing a flat spot on the back
of the head.
• It will also promote body stability, limb co-ordination and head control in your
baby.
• Tummy time should be encouraged and the Pavlik Harness will not stop this.

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.

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 • Blot dry with a towel, a hair dryer on low heat can be used.
• 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
• The Orthotist will arrange regular appointments to monitor the progress of your
baby's growth and adjust the harness as required. Please remember that you
need to book in advance to see the Orthotist.
You need to see them after you have seen the doctor, on the same day.
• Contact the 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 or putting your baby to sleep.
• Babies may cry a little or seem unsettled for the first couple of nights after the
harness is first 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.

For more information

• Factsheets:
Developmental Dysplasia of the Hips (DDH)
Plagiocephaly

Individual instructions
• Your child's Orthotist is:
____________________________________________________
Tel: (03) 9345 5870

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 Factsheet developed by the Orthotists and Prosthetic Department, RCH. First
published Sept2006. Reviewed Jan2007.
Disclaimer: The information contained on the site is intended to support not replace
discussion with your doctor or health care professionals. The authors accept no
responsibility for any inaccuracies, information perceived as misleading, or the success
of any treatment regimen detailed in the handouts.

More RCH Fact Sheets can be found at www.rch.org.au/kidsinfo/.

Last Updated 27-Jan-2007. Authorised by: Susan Jury. Enquiries: Judith Smith.
©RCH. http://www.rch.org.au

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