Pavlik Harness Treatment for Children
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 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
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
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
- 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
- Lack of treatment success
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
What happens during Pavlik harness treatment for a child?
The Pavlik harness is a soft splint with a number of straps with hook-and-eye closures.
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.
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
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.
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