Pavlik Harness Orthosis

Your baby will be using the Pavlik harness orthosis (say: or-THOE-siss). Carefully read these instructions twice. If you have any questions, ask your orthotist right away. It is very important that you understand these instructions and follow them closely.

The Pavlik harness orthosis is used to correct developmental dysplasia of the hip. It is a set of soft straps that hold your baby's legs apart with the knees bent. The Pavlik harness holds your baby’s hips in the correct position.

Pavlik Harness Orthosis
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The Pavlik harness is used to correct developmental dysplasia of the hip joints.

Your orthopaedic surgeon will tell you how long your baby should wear the orthosis.

Putting the orthosis on

  1. Open all the straps and lay your baby on the harness with the chest strap across the chest.
  2. Fasten the chest strap.  The top of the chest strap should be at the nipple line. 
  3. You should be able to fit 2 of your fingers underneath the chest strap when it is fastened. This will ensure your baby can breathe properly in the harness. 
  4. Fasten the shoulder straps to the chest strap. You should be able to fit 1 of your fingers underneath the shoulder straps when they are fastened.
  5. Place your baby’s legs into the leg portion of the harness so that the toes are in the “socks.”
  6. Secure the leg straps snugly, but not too tightly.
  7. Finally, thread the flexion and abduction straps through the leg portion of the harness and secure them. The leg straps have colour-coded tabs: Red-Red, Blue-Blue. The blue tabs will be on the left leg and the red tabs will be on the right leg.

The straps on the harness will be marked to help you fasten them.

As your baby grows, the tightness of the leg straps can be adjusted when needed. The toe part of the “socks” can also be snipped off as your baby’s feet grow. Your orthotist can help with adjustments when necessary. Do not adjust any of the straps on the harness without speaking with your physician or orthotist.

Common questions about the Pavlik harness orthosis

Why do both legs need to be in the harness?

The hips will be more stable if both legs are in the harness.

Will my baby be uncomfortable?

Your baby may be unsettled for the first 24 to 48 hours, but the harness does not hurt. Your baby will need to get used to keeping his legs apart and to having less freedom of movement.

Femoral nerve palsy

Femoral nerve palsy is a rare condition that sometimes occurs in babies who use a Pavlik harness. This condition does not last forever, but your baby needs medical attention right away if it does happen.

It will look as if your baby’s leg has fallen asleep. Your baby will not kick his leg or move his toes when tickled.

If this happens, take off the harness and call the orthopaedic clinic or the orthopaedic resident on call.

Clothing, diapers, and bathing

Clothing

Your baby must wear the harness on bare skin during 24-hour use. This means that the harness must be beneath all clothing so you can remove the clothing to wash it. Make sure clothes are loose enough so they do not put pressure on the straps.

Your baby can wear the following over the harness:

  • undershirts
  • dresses
  • sleepers that are a few sizes bigger; for example, a 4-month-old may need a sleeper made for an 8-month-old

Your baby should not wear:

  • pants or shorts

Diapers

Your baby can wear a diaper under the harness. You do not need to double diaper. When changing your baby’s diaper, keep your baby’s knees apart at all times.

Bathing

You must sponge bathe your baby with the harness on. Try to keep the harness dry.

For babies who are allowed 1 hour per day out of the harness

  • Your baby can wear an undershirt under the harness because you will have the opportunity to change it daily when you remove the harness for 1 hour.
  • The hour out of the harness can be used for bathing and changing undershirts.
  • Your baby can wear a diaper under the harness.

Holding your baby with the orthosis on

Support your baby with your hand between his legs.

When breastfeeding your baby:

  • Keep your baby’s feet away from you with pillows to support the hips.
  • If your baby has one-sided (unilateral) hip dysplasia, hold him with the affected side away from your body.
  • Try the football hold.

You can use child carriers for your baby because they keep the legs apart. Don’t swaddle your baby.

Positions for your baby

The best position for your baby is the frog position. Your orthotist will show you this position.

The worst position for your baby is with the knees together and legs straight. Never position your baby this way.

Sleeping position

Your baby should sleep on his back.

Playing and moving

Stretch and play with your baby’s legs within the confines of the harness. It is good exercise and helps with digestion and your baby’s mood.

When your baby is ready, encourage tummy time if your physician or orthotist says to do so. This is very helpful, as it forces the hips out and back.

Keeping the orthosis clean

Have your baby wear a one-piece sleeper and bib during feedings and for spit-ups or drooling.

If your baby must wear the harness 24 hours a day, you can spot-clean the harness with a cloth and mild detergent.

If your baby is allowed 1 hour per day out of the orthosis, hand-wash the harness in cold water and a mild detergent, but only if the orthosis is soiled. To make sure it does not shrink, put the orthosis in the dryer on the fluff cycle with no heat.

Car seats

Adjust the straps of the car seat to accommodate your baby's position in the harness.

Limit drives to less than 1 hour. For longer drives, give your baby a 10- to 15-minute break out of the car seat. This will help to remove any tension in the straps.

Things to watch for

Skin problems

  • Check your baby’s skin every day.
  • If the skin is irritated (appears red), try a light dusting of corn starch.
  • Dry your baby’s skin well after bathing, especially behind the knees and in the hip creases.
  • If your baby's skin is still irritated, contact your physician or orthotist.

Follow-up

Your first follow-up appointment is usually between 1 to 2 weeks after the first fitting of the harness. It will include an ultrasound of your baby’s hips. The ultrasound will be done in or out of the harness, depending on whether or not you are taking the harness off at home.

After that, another follow-up appointment will be scheduled after 2 weeks and then 1 month after fitting.

If you have any questions or concerns, call your orthotist or orthopedic surgeon.

Key points

  • Your baby needs to wear a Pavlik harness orthosis to correct developmental dysplasia of the hip. The Pavlik harness works by keeping your baby's hip joints in the right position.
  • Your baby will need a few days to get used to the harness.
  • The harness should be adjusted as your baby grows.
  • Watch your baby for signs of skin irritation or femoral nerve palsy.
  • If you have any questions or concerns, call your orthotist.

The Certified Orthotists at the Centre for Orthotics and Medical Devices

12/29/2009

At SickKids:

All proceeds from orthotic treatment at The Centre for Orthotics go to support patient care and research at SickKids. For more information, please see www.centrefororthotics.ca.





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