We are seeing more and more questions from ‘Pavlik parents’ so here on the DDH UK blog we are looking at what being prescribed a Pavlik harness means for you and your baby.
The main thing to remember is the every child is unique, every hip is unique and every treatment plan, you have guessed it, is unique. What we are talking about isn’t set in stone but we hope it will help you understand what is happening, why and that you aren’t alone.
If your baby has been diagnosed with DDH and is younger than 12 weeks old, there is a good chance your consultant will discuss trying a Pavlik harness as the first line of treatment.
What is a Pavlik Harness?
If you have never seen a Pavlik harness, they are made from a sturdy fabric with a set of straps that are positioned around your babies shoulders, chest and down to the legs and feet, (picture the shape of dungarees but with no tummy or crotch, and you will get an idea of the harness).
The aim of the Pavlik is to be worn by your baby for 24 hours a day for several weeks, the straps are adjusted by your health care professional to ensure secure and sturdy support for the hip joints of your baby.
Your baby will now be in an “M” position or somewhat like a frog and this is to allow the hip to be held in the optimum position to encourage normal development.
Once the harness has been fitted, you will be told how long your baby is to wear it for, both in terms of hours in a day as well as overall number of weeks.
The hospital will arrange regular review points during this period to ensure the fit of the harness is correct along with ultrasound scans to see if progress is being made. The frequency may vary from hospital trust to hospital trust.
There is a huge likelihood that with a new medical diagnosis for your precious and beautiful baby that the introduction of this piece of material can feel both upsetting and overwhelming as well as a barrier between you.
Having discussed a little about why the harness has been suggested and how it works let’s talk through our top tips to help you and your baby through these next weeks.
Firstly, I guess, my top tip would one that you actually can’t see:
Try to think about the harness as a positive thing, rather than a negative barrier. The Pavlik is going to be a part of your lives for potentially a number of weeks, if you are able to, think of it as helping your baby to try to develop those healthy hips that are needed. Each day spent in the Pavlik is potentially one step closer to healthy hips.
The initial period of getting used to the harness will take you and your baby some time. The baby will be in a new position that may feel a little strange, they might be unsettled for the first few days, and you may feel anxious.
But, I promise you, it WILL get better.
This little person of yours will adapt so quickly to what will be come their new normality, possibly even quicker than you do. The key words that will keep popping up are readjustment, adapting and resilience, both for you and your baby and the rest of the family.
So, back to the practical points of Pavlik harness use…
Pavlik Harness Hygiene
Bathing your baby whilst they are in a Pavlik is something that for a period of time that can’t be done, and there is no avoiding this as it is important for your baby to initially remain in the harness position.
So, looking after your baby’s hygiene will involve gentle washes. Using cotton wool and water rather than baby wipes is generally the recommended the way. The most important thing is to ensure that all of your baby’s lovely chunky skin creases are really dry to reduce any soreness or rashes. Check these skin creases regularly to make sure they aren’t becoming red, if you should notice anything, please mention it at your clinic appointment or via the clinic contact details that you will be given.
Some clinics may offer you the chance to bathe your baby whilst you are there for check ups, ask if this is possible.
If you need to clean any areas of the harness (should there be a nappy/diaper leak, for example), the Pavlik should in the early days, remain in situ on your child, but cleaned using small amounts of warm soapy water and a sponge or soft cloth.
At a later date it may be possible for your health care professional to provide you with a second harness for these occasions. The soiled harness can be washed within a washing machine, inside a pillow on a very cool cycle, but it is best to check this with your clinician first.
Nappy/Diaper Changing in a Pavlik Harness
When it comes to baby nappy/diaper changing it might feel a little scary, your mind racing with lots of “how do I”, but don’t panic. The advice here starts with the key words; PREPARATION and PROTECTION.
Before you begin, ensure you have everything you need and lots of it(and may not need but have as a just in case) ready like a scout about to complete a task! Get everything ready and within easy reach for you.
A top tip that lots of Mums and Dads in the know use, and shared with us by Joanna Burkill, mum to Georgia who has just successfully been treated for DDH in a Pavlik, is to fashion a pair of leg protectors, like welly boots, from a couple of nappy sacks or try some adult socks. Just loosely tie them at the knee, before you open the nappy/diaper, they very cunningly can protect baby and the harness getting into a bigger mess than the starting point already is. (Please make sure that you safely discard and nappy/diaper sacks after use, so they aren’t a hazard to your now clean little one. )
Your Clinician should show you how and remind you of the correct way to lift and move your baby when changing nappies/diapers. The technique is to use your hand on their lower back and bottom to lift the baby, not to lift each leg individually. This is a perfect demonstration to ask for them to show you and for you to try whilst in clinic to ensure you are happy and confident to do it when you are back at home.
Skin to Skin Contact in a Pavlik Harness
The bond between baby and parent is heightened by having skin to skin time, the harness does not need to stop that. Just adapt how you go about it; “think outside the box”, as they say.
The loving touch can be experienced in slightly different ways than it was pre harness: tummy stroking, gentle massage on baby’s hands and arms and of course those all important cuddles and kisses. Remember that the harness is there to help your baby.
Dressing in a Pavlik Harness
Buying larger sizes of baby sleep suits and vests is often the easiest way to dress your little one. Making sure that there is no pulling or tightness from the clothing, leave a few poppers open if need be.
Girls have the option of larger dresses with socks or leg warmers if preferred, but that is just personal choice. Boys also look super-cute in leg warmers.
The main thing to remember is that the legs need to stay in the M position so don’t go for trousers, tights or anything that will prevent a healthy, correct hip position.
Sleeping in a Pavlik Harness
Your baby will be need to be positioned on their back for sleeping. This is to allow the harness hip position to remain as perfect as possible. If you use any sleep positioning aids, such as pillows or supports, take them along to clinic with you so your clinician can assess if they need any adaptations or can continued to be used.
Sleeping bags are still useful IF they don’t impede of the leg position, but you may find blankets easier.
Pavlik Harness – Car Seats, Prams and Pushchairs
The key thing with your travelling accessories, is, again, that they are wide enough to allow for frog leg position to remain unchanged. You are trying to avoid anything that draws the knees together. There is debate about the use of baby slings, so discuss this with your clinician if you had planned to use them.
Other Tips for Pavlik Harness Use
Another great tip shared by Joanna Burkill, mum to Georgia, is to video the process of the harness application at clinic by the Health Care Professional. This gives you a perfect reference point on what the harness should look like, any information that they may give you and provide you with the reassurance that everything looks ok. You could also ask questions and by recording the session you will have your own personal reference library to refer back to when at home.
The Pavlik harness can have excellent success rates, but as ever, it is impossible to make a blanket prediction on whether the harness will work for your baby, as every case is different.
Your consultant will assess and discuss any progress that your baby is making with you.
What else can I do?
To arm yourselves with information and to find the connections and support of people that have either experienced DDH, why not look at the information sections here on our website www.ddh-uk.org
Become part of one of our regional coffee groups and meet other parents and carers with their children for cake and play dates.
Remember, DDH UK is here to help and support you every step of the way, #becausehipsmatter
Thank you to the members of the DDH UK Facebook support group for providing images of their babies in Pavlik Harnesses.