Explain Like I'm Five: The Pavlik Harness

1 week old. First minute in the Pavlik harness.

Above is my daughter Elena, pictured at the age of 1 week of age. She is wearing what is known as a Pavlik harness, a cruel-looking device that can be confusing to understand. I certainly never thought I would have to understand it beyond the basic nursing questions.

I was more than a little wrong.

Elena in her harness, meeting her great-grandmother for the first time. Note how her hips could fold in but that she could not stretch her legs out, nor kick to the side.

As it turns out, Elena was doomed. She and I literally had all the risk factors. Let's count them together!

1. Firstborn child. Check!

2. Female child. Check!

3. Breech position. Check!

4. Low amniotic fluid. Check!

5. Family history of hip dysplasia. Check check check!

When she was first born, I remember craning my neck around from where I was positioned on the table to look at her as she was taken to the isolette. The entire NICU team was there because she was born at 36 weeks of age- just barely preterm. Due to the low fluid concerns, she had had the benefit of steroid injections not once, but twice, for her lung development. She came out screaming and breathing fine. After a few minutes, the NICU team left, satisfied that this newborn was fine. (More on that another day.)

My next concern were her hips, which an ultrasound technician a few weeks ago had already mentioned looked "pretty cramped." 

"Are her hips okay? Are they dislocated?" I called from the operating table.

"They look fine," a surgical tech or nurse (who knows) reassured me.

Elena's legs were positioned over her head anyway half the time since she had been breech for months. It wasn't until the next day that her pediatrician stopped by and rotated those hips. Neither her nor I heard any clicking. Clicking would be the typical noise, right? "Hmm," she said. "I don't know. Something doesn't feel right. I still want a hip ultrasound."

She got the ultrasound that day. The results came back: both hips were fully dislocated. Hips only click when they're located correctly but are loose and dislocatable, which is why we heard no sound.

We were immediately referred for an appointment with Dr. Bowen, a world-famous pediatric hip specialist who works out of A.I. Dupont. (Check this guy out- his experience is ridiculous.) He fitted Elena for her harness at 1 week of age (the image at the top) and told us our changes looked good. He explained that the harness will position the top of the femur toward the hip joint and, with continued positioning, the muscles and ligaments around it will gently pull the bone back into place. No surgery needed.

Plenty of infants do need surgery, he warned us, but Elena's premature birth is actually a good thing. Not as much is set in stone development-wise, and for her hips, it's better that she came out early and got them into proper positioning instead of her breech status.

She needed an extra-small size harness due to only weighing 5lb 14oz.

It only took 5 weeks of full time harness wearing for hips to "reduce", meaning to go back into their correct position. During that 5 weeks, her diapers were fit underneath the harness. She did not wear pants. It was tough to find onesies and outfits that would work.

Once Dr. Bowen was happy with her progress, he let us take her out of the harness for 1/2 hour each day to bathe her if we wanted. Two weeks after that, we changed to only wearing the harness at night. 

Then, at the age of three months, Elena was declared to have hips that were officially reduced and relocated! The harness came off and did not have to go back on. She will be checked by Dr. Bowen every few months until the age of two, due to continued development and potential for things to go awry. 

Fingers crossed, we'll never have to harness again! Have any questions? Please feel free to ask below. Learn more about the Pavlik harness.