This week has been a bit of a whirlwind. On Tuesday, B had an ultrasound scan to check her hips were developing properly. This was a follow-up scan as she had her first one at six weeks, due to being breech. We were told at six weeks that the ligaments in her right hip were a little loose, but she’d be checked in a month. On Wednesday, we had a phone call from the physiotherapists at the hospital to say that B has DDH – Developmental Dysplasia of the Hips – and would require treatment the next day. On Thursday, less than 48 hours after that follow-up scan, B was fitted with something called a Pavlik harness, which she’ll have to wear for probably the next 12 weeks. As I’d never heard of DDH before, let alone a Pavlik harness, I thought I’d write about the process here in case any other parents, like me, are wondering what on Earth their little baby is going to go through.
What happens at the appointment?
First of all, we met with two physiotherapists, a registrar and a student doctor. The physiotherapist started by explaining why the harness needed to be fitted. In B’s case, her left hip is fine, but in her right hip, the socket part of the joint isn’t deep enough. The Pavlik harness holds the hip joint in position to enable the cup part of the socket to deepen, hence correcting the hips. The physio was very thorough and asked if I had any questions about the process. Of course I had lots, and I’ve tried to cover as many of the answers as I can in this post. The orthopaedic surgeon also popped in to reiterate what the phsyio had told me.
Once I understood why the harness was needed, the phsyio checked B over to make sure that she had good range of motion in her neck, feet, ankles and knees, as well as her hips. It was interesting as the physio noted that B’s hips feel fine, as did the GP at her six week check. I suspect her DDH may have ben missed, had we not had that routine scan.
How is the Pavlik harness fitted?
Our hospital put the Pavlik harness against the skin, but I have seen photos online where a vest is placed underneath. However, because the harness should only be removed and refitted by a professional (at least that’s the policy at our hospital), it’s best to have clothing over the top rather than underneath.
First, the harness is placed on the bed and the baby laid on top. Then, a strap is placed around the baby’s chest at the nipple line, loose enough to easily fit two fingers underneath. Two little booties are fitted on the baby’s feet, and straps from these are fitted to the chest strap, front and back. Straps are then fitted over the baby’s shoulders, which also fit to the chest strap. The Pavlik harness is made from very soft fabric, but an extra bit of padding was added to the chest strap at the front to help keep baby comfortable.
The best way I can describe the Pavlik harness is almost like a pair of braces, which hold the baby’s legs and hips in a frog-like position. This keeps the ball of the baby’s femur held in position in the hip joint, allowing the cup of the socket to develop properly around it.
How did B react to having the Pavlik harness fitted?
I was worried that B might be distressed by having the Pavlik harness fitted. She surprised me though! If anything, I think she actually enjoyed the process, smiling at everyone and enjoying the attention. She certainly doesn’t seem concerned by wearing it at all, although that may change once she realises that it isn’t coming off any time soon!
What happens after the Pavlik harness is fitted?
Now that B has had her Pavlik harness fitted, she will wear it for a minimum of six weeks. We’ll need to return to the hospital every two weeks to have the harness checked, and to give her a bath. We’re not allowed to remove the harness ourselves, so she’ll just be having top and tail washes at home. Because B is just about to grow out of the small size harness, we’ve got to go back after one week in the first instance, as the physio thinks it’s likely she’ll have grown out of the one she’s in by then. In six weeks’ time, B will have another hip scan to see how the joint is developing.
We have to be careful about how we change B’s nappy. This means no pulling on her legs to lift her bottom. Instead we need to slide one hand behind her bottom from between her legs, then push the nappy underneath. Fortunately, the harness doesn’t interfere with the nappy at all. We also need to check B’s creases each time we change her nappy to make sure they’re not looking red or sore, and apply a bit of Metanium if they are. We also need to check the straps to make sure they are correctly positioned, and aren’t rubbing anywhere else.
The good news is that we can continue to use B’s car seat, Sleepyhead and even Babybjörn Carrier One as normal. I wasn’t expecting to be able to use the carrier, but as it’s been approved by the International Hip-Dysplasia Institute, it’s fine. The Pavlik harness keeps the baby’s hips in position, and the Babybjörn carrier doesn’t interfere with that.
How long does the Pavlik harness need to be worn for?
We’ve been told to expect B to be in the harness for 12 weeks. This is because they like babies to wear the harness for as long as it takes the hip to correct itself, then the same amount of time again to make sure it’s properly sorted. Some babies need to wear the harness for more time, others less. As B seems to be a mild case, the physio said it might only be needed for six weeks, but she doesn’t want me to get my hopes up then have them dashed if B needs to wear the harness for longer. So we are expecting 12 weeks, and what will be, will be!
What sort of clothing can be worn with the Pavlik harness?
This is where I expect my knowledge to improve over the coming days, weeks and months! After her harness was fitted, I dressed B in a romper suit that is a bit on the big side, pictured at the top of this post. It covered the harness beautifully, with just the little boots sticking out of the bottom. I think one-piece items like footless sleepsuits, rompers and dresses will work best with the Pavlik harness, as I suspect the straps that go from the chest to the feet will prevent waistbands from fitting properly. I think most trousers would also be too narrow in the gusset and leg to go on over the harness. I’m looking forward to hitting the shops – it will be nice for B to have some shiny new clothes instead of M’s hand-me-downs!
I’d love to hear others’ experiences of the Pavlik harness. Please let me know yours in the comments. Of course, if you have any questions about our experience, then I’d love to hear from you, too.