Introduction
The Pavlik harness is a device that holds a baby’s hips in place to help them grow normally in the first six to ten weeks of life.
It is used to treat developmental dysplasia of the hips, or “clicky hips”.
About this device
Babies diagnosed with hip problems, like developmental dysplasia of the hips, will see a specialist health professional called an orthotist. An orthotist makes and fits different equipment like braces and harnesses and manages their use in treatment.
The Pavlik harness has straps that are fastened around a baby’s legs and held up by shoulder and chest straps.
These straps hold the legs up and apart, also known as a flexed or “frog” position. This is the best position for hip joints, allowing contact between the thigh and hip bones. This position helps strengthen the muscles and ligaments while your baby’s hips develop.
Your baby's orthotist will ensure the harness fits correctly and that you have education about checking and putting it on properly at home.
Generally, the harness is fitted correctly if:
- You can fit 2-3 fingers underneath the chest strap
- The ankle and lower leg straps are firm but not too tight or cutting off blood flow.
Care of the device
The Pavlik Harness should be washed only if necessary.
To wash the harness:
- remove only the part that needs washing, remembering how it was attached
- spot clean using cold water with soap, gently scrubbing the dirty part with a nail brush
- blot dry with a towel or use a hair dryer on low heat.
Do not put the harness in a tumble dryer, as it may shrink.
Contact your orthotist if you are concerned about cleaning the harness or if you need to clean it and your child needs to wear it 24 hours a day.
When to seek help
Speak to your child’s treatment team if you need help adjusting the Pavlik harness.
Your child’s doctor will tell you how often your child should wear the harness and when it can be removed.
Management
Bathing and skin care
If your child's doctor has said the Pavlik harness cannot be removed, you will need to give them a sponge bath instead.
If your child can remove the orthosis for bathing, you should only undo the Velcro straps as by your orthotist. Keep your baby’s hips apart in the flexed position as much as possible while bathing them.
Make sure your baby is completely dry before reattaching the straps. Pay special attention to skin folds around the thighs where moisture can get trapped.
Try to keep the harness as dry as possible.
Check your child's skin regularly for any redness or irritation that may appear from rubbing, trapped sweat or other fluids. Contact your child's treatment team as soon as possible if their skin becomes broken or irritated.
Positioning
The Pavlik harness works best when a baby is on their back. You will need to regularly change your baby’s head position while sleeping to stop their head from being in the same position for too long. This will lower the risk of developing a flat head, or plagiocephaly.
Tummy time is still important for babies who are using the Pavlik harness. Speak to your child’s treatment team for support and strategies for tummy time.
There should not be any issues with breast or bottle feeding with the Pavlik harness. It may take some time to find a comfortable position that works best.
Keep your baby in the flexed position with the harness when holding them.
Clothing
Babies who are using a Pavlik harness can use nappies as normal. When changing your baby’s nappy, lift them from their bottom instead of holding their feet together. This will lower the risk of moving their hips out of the correct position.
Babies can wear loose-fitting closed and sleep sacks that do not pull the knees together. Speak to your child’s treatment team for recommendations on types of clothing if you are unsure.
Carriers
Generally, babies should not be put in a carrier with a Pavlik harness while in treatment. This is because carriers can put pressure on their hips.
Some brands are approved for use by Healthy Hips Australia. See them here: Healthy hips - babywearing.
Car seats
Most babies will be able to fit into their regular car seat or capsule with a Pavlik harness while they are in treatment. Make sure you can secure the straps and your baby’s legs are not pushing hard against the sides.
Speak to your child’s orthotist if you have any concerns or want to check your baby’s position in their car seat while wearing the Pavlik harness.
If you have not yet bought a car seat or capsule, you can speak to your treatment team about recommended brands, models, and attachments.
Strollers
Most babies will be able to fit into their normal pram or stroller with a Pavlik harness while they are in treatment. Make sure you can secure the straps and your baby’s legs are not pushing hard against the sides.
Speak to your child’s orthotist if you have concerns or want to check your baby’s position in their pram or stroller while wearing the Pavlik harness.
You can speak to your treatment team about recommended brands, models, and attachments if you have not bought a pram or stroller.
Some brands and models are approved for use by Healthy Hips Australia. See them here: Healthy hips – prams.