What is Pavlik harness treatment for children?

The Pavlik harness is a soft splint. It is most commonly used for treating infants with developmental dysplasia of the hip (DDH). It helps keep the infant's hips and knees bent and the thighs spread apart. It can also help promote healing in babies with broken thighbones (femurs).

DDH occurs when the hip joint does not form normally. The hip joint is a ball-and-socket joint. The socket is a cup-shaped structure in the pelvis called the acetabulum. The ball, or head, is the rounded upper end of the femur. In DDH, the cup-shaped cavity of the acetabulum is more shallow than normal. As a result, the head of the femur does not fit into it well. The femoral head may slide partially out of the socket (sublux). In severe DDH, the head of the femur can slide completely out of the socket (dislocate). It may stay dislocated.

Strong fibrous tissues called ligaments normally help hold the femoral head in the acetabulum. In DDH, the ligaments may become stretched and loose.

By holding your baby's legs out and bent, the Pavlik harness helps keep the femoral heads in their sockets. It allows the ligaments to tighten. It encourages normal development of the acetabulum.

Why might my child need a Pavlik harness treatment?

It is normal for the hips of infants to be a bit loose. But this usually resolves on its own. It is particularly common in babies who were born feet or bottom first (breech). If their hips are too loose, they can sublux or dislocate easily. They may need treatment.

If your healthcare provider has concerns about possible DDH, he or she may recommend that your baby go to an orthopedist for evaluation. Sometimes the evaluation can involve an ultrasound of the baby's hips. If your baby has DDH, the orthopedist will probably recommend a device such as a Pavlik harness to encourage your baby's hips to develop normally.

Girls and breech babies have the highest risk for DDH. It also runs in some families. It is more common in first-born babies.

Healthcare providers sometimes use a Pavlik harness for femur fractures in infants younger than 6 months. The harness helps hold the baby's leg still so that the bone can heal.

What are the risks of Pavlik harness treatment for a child?

Pavlik harness treatment is usually successful in treating DDH. But sometimes complications can occur. They may include:

• Skin breakdown (dermatitis), especially in the groin, behind the knee, on the shoulder, or on the leg
• Lack of treatment success
• Nerve damage in the leg or shoulder
• Bone breakdown because of decreased blood supply (avascular necrosis)
• Flattening of the back of the femoral head
• Downward dislocation of the hip
• Subluxation of the knee

The most common complication is skin problems. You can reduce the risk for these skin problems by keeping all appointments and having the straps of the harness adjusted by the orthopedist as needed. Only the orthopedist should adjust the straps. You should keep your baby’s skin clean and dry. Don’t use lotions, ointments, or powders under the harness. If nerve problems develop, they typically go away on their own. If the Pavlik harness is not successful, your child may need a rigid brace instead.

How do I help my child get ready for Pavlik harness treatment?

You should not need to do much to prepare for your child's Pavlik harness treatment. Your baby may need to wear the harness for several months. During this time, it will be important to keep your baby's skin clean and dry. That will include changing diapers often. Consider stocking up on leak-proof diapers. Also ask what type of clothes to bring when you take your baby in for the first fitting. Your baby will need regular follow-up visits for harness adjustments and monitoring as he or she continues to grow.

What happens during Pavlik harness treatment for a child?

The Pavlik harness is a soft splint with a number of straps that fasten. It consists of a chest strap and leg straps. The chest strap goes across the baby's back and reaches around to close in the front. The leg straps attach to the front of the body strap, loop under each foot, cross over in the back, and attach to the top of the body strap. Each leg strap has two additional straps that wrap around the lower leg. The harness helps support the baby's legs in a bent, outward-rotated position. It prevents the baby from straightening his or her legs. It makes it hard for the baby to bring his or her legs together.

At first you should keep your baby in the harness all the time. You will learn how to put on your baby's clothes without taking off the harness. You will also learn how to change your baby's diaper in the harness. You may need to give your baby sponge baths with the harness on instead of full baths with the harness temporarily off. You will need to make sure to dry your baby well after bathing and after diaper changes.

The harness is adjustable, so it can change as your baby grows. You will need to visit your baby's orthopedist regularly for adjustments. It is very important to have your baby's legs positioned correctly. Only allow the healthcare provider to make the adjustments. Do not try to adjust the harness yourself.

Your baby will also need regular ultrasounds to follow development of the hip joint. If the harness does not seem to be working within about 3 weeks, your baby's orthopedist may recommend using a cast or having surgery instead.

The orthopedist will tell you when you can take your baby out of the harness. After about 6 weeks, you will be able to take your baby out of the harness during the day. The baby will need to continue wearing the harness at night for about 6 more weeks.

What happens after Pavlik harness treatment for a child?

Most children have normal hip development after Pavlik harness treatment. It is important to continue follow-up as recommended by your child's orthopedist. Follow any instructions your child's orthopedist gives you. If your child has problems walking or seems to be in pain, he or she may need more treatment. Your child may need follow-up exams and imaging tests such as ultrasound or X-ray. Talk with your child's orthopedist about other signs to watch for. Ask when you should bring your child in for evaluation.

Next steps

Before you agree to the test or the procedure for your child make sure you know:

• The name of the test or procedure
• The reason your child is having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• When and where your child is to have the test or procedure
• Who will do the procedure and what that person’s qualifications are
• What would happen if your child did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or your child has problems
• How much will you have to pay for the test or procedure