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Developmental Dysplasia of the Hip

DDH is when the femoral head (“the ball”) at the top of the femur (“thighbone”) is not stable within the hip socket and the ligaments of the hip joint may also be stretched and loose.

Treatment

Babies with DDH often need to wear a brace called a Pavlik Harness. 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 develop it’s normal depth. It allows contact between the thigh and hip bones and helps rebalance the muscles and ligaments of the hip while it is developing.

When Does My Baby Need to Wear a Brace

Your Orthopaedic doctor advises that your baby wears the harness:

  • 24 hours a day without removing it, harness should be worn under clothes
  • All the time except when bathing, harness can be worn over clothes

Follow Up

The doctor will arrange regular appointments to monitor the progress of your baby's growth and adjust the harness as required.

Putting the Orthosis On

  1. Open all the straps and lay your baby on the harness with the chest strap across the chest. Fasten the chest strap. The top of the chest strap should be at the nipple line. 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.
  2. 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.
  3. Place your baby’s legs into the leg portion of the harness so that the toes are in the “socks.” Secure the leg straps snugly, but not too tightly.
  4. Finally, thread the flexion (front) and abduction (back) straps through the leg portion of the harness and secure them. The straps on the harness will be marked to help you fasten them. 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.

Home Care Instructions

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.

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.

Holding and Feeding Your Baby with the Pavlik Harness On
Support your baby with your hand between the legs.

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 you body. Try the football hold. You can use child carriers for your baby because they keep the legs apart. Don’t swaddle your baby’s legs together.

Sleeping Position, Playing, and Moving
Your baby should sleep on his back. During play time 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 says to do so. This is very helpful, as it forces the hips out and back.

Keeping the Orthosis On
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. DO NOT tumble dry the harness as it may cause the harness to shrink.

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.