Pavlik harness timeline evidence

[u/Regular-Lion5115]

My baby was put into a Pavlik harness at 10 days old with 2c hips. She responded to treatment after a week and we've been told to expect 12 weeks of the harness, with an hour out per day starting in 5 weeks. From what I've seen, it seems like length of full-time harness use (23-24hrs/day) is largely dependent on the doctor/institution. I have also seen studies which point to their being little evidence for 24hr treatment after hips are stable. I would love to be able to take her out for longer- I hate the harness so much, it has really impacted my mental health.

Can folks here tell me a) what your treatment protocol was b) how old old your baby was when you started and c) where you are located (city, institution)?

please do not respond telling me why the harness is important/why I need to follow my doctor's orders. I am looking to start a conversation with him based on what I'm reading and see what he says

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[u/TykeDream]

I didn't have a baby who needed this harness [and I don't know that telling your doctor about other kids will be conducive to starting a conversation]. I read about it on Johns Hopkins website: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/pavlik-harness-treatment-for-children

It looks like they suggest that after about 6 weeks, babies can be in it during the day and out of it at night. I think appealing to something like this - information from a prominent research institution - is a good conversation starter, if that is what you are seeking when speaking to your child's doctor.

Not to overstep, but what about the harness is harming your mental health? Is it because it's complicating nursing or causing issues with baby's sleep? If so, you can absolutely raise those issues as well with your child's medical provider. That said, they may say, "Yes, this is the [temporary] price to pay for baby to have functional hips." If it's something more like you don't like how it looks or the way people look at you if you take the baby out in the harness in public, that is something you might talk to your own doctor about as they may be indicators of postpartum depression/anxiety which is very normal. I think figuring out why the harness bothers you in addition to talking to the doctor about medical concerns using research you have seen is going to be your best avenue.

[u/Regular-Lion5115 → u/TykeDream]

If you haven’t had a baby in a harness, I can imagine feeling like the look of it is what concerns parents most. But actually, it makes everything worse: sleeping, feeding, changing. My body hurts from the discomfort of the positions I have to assume to feed her. I will never get to cuddle my newborn again skin-to-skin, because she won’t be a newborn anymore when this is over. This is truly the only nice thing about having a newborn baby! I am a second time mom so I do know the difference, and this is just objectively much worse. 

I deeply resent medical professionals asking new moms about their mental health when the only thing they will do materially in response to bad mental health is prescribe you an SSRI. My sadness, fatigue and frustration is rooted in a very real thing, not just a hormonal imbalance I’m experiencing. The doctor in this case’s response to me saying: yes I am feeling bad, no I am not sleeping is just to give me sad eyes and tell me h understands this is hard. I think that if the research is not solid on a 24/7 harness past 6 weeks, an in fact this is not common practice for many physicians, that actually considering parental mental health would mean looking at the cost-benefit of the harness past this point rather than always taking the most conservative treatment route. I can do whatever I want, technically- take her out for 3 hours instead of one and just lie. But what I would like is to have a conversation about what it means to ask parents about their experience but do nothing with that information. 

[u/Annaioak → u/Regular-Lion5115]

No link; I just deeply want to validate your feelings here! Public health utterly disregards maternal mental health and it is shameful.

The COMFORT of infants is also routinely disregarded. No one capable of speech would be in such a contraption 24/7. I think it would be worth it to inquire about what the treatment protocol is when this is diagnosed at a later age, and what studies have been done indicating that 24/7 is necessary. Kids get flat heads from sleeping on their backs way less than 24 hours a day. I wore a headgear to correct a serious overbite for about 8 hours a day. Changing bone structure does not require ceaseless effort. It is sadly very likely that 24/7 was just the thing studied that worked and no one has bothered seeing if lower levels work because (again) baby comfort and maternal mental health are not usually considered in clinical trials.

[u/Regular-Lion5115 → u/Annaioak]

Thanks so much for this comment, this is exactly how I’ve been feeling (and ya there’s no way they’ve bothered to do comparison studies of like 18hrs vs 23 or whatever, which would be such a game-changer for me) ♥️

[u/Wayward-Soul → u/Annaioak]

my son was born with clubfoot. He went through 8 weeks of casts to turn his feet and then lived 23hrs/day in a shoe and bar contraption for 3 months before it becoming a sleeping only accessory until like kindergarten. It sucks but he needs it. And every time he is uncomfortable and kicking around his bar during the night I think that the only reason this is an option is because babies don't know any better. No adult would be forced to sleep with a snowboard on their feet for years.

I am so grateful for the medical advances which means my baby can have this type of treatment versus an extensive series of less-effective surgeries but dang I hate that bar.

[u/Material-Plankton-96]

Boston Children’s Hospital says it’s typically worn for 24 hours a day for 8-12 weeks.

I don’t think there is anything they can do to materially improve your mental health besides SSRIs, therapy, and potentially suggesting resources like support groups or similar. Unfortunately, this is the cost of giving your baby healthy hips. Otherwise, she could end up having a hip replacement in her 40s like my cousin, which is something I absolutely wouldn’t want her to go through.

It’s hard when circumstances rob us of experiences we crave, but that’s not a reason to fight the doctors. It’s worth asking questions, but unfortunately, I don’t think this is something they can fix without harming your daughter.

[u/a_mccut]

Hi! I’m adding a link to prevent my comment being deleted here’s the study I used

My daughter was born breech, and she’s a first born and a girl. So she had all the check marks for hip dysplasia. She was in the NICU the first 10 days of life where they did occupational therapy on her, as well as double diapering her. (there is no study that supports double diapers)

She had a follow up with our pediatrician at 2 weeks and she ordered her a hip ultrasound, which led to a orthopedic doctor appointment and ultrasound. She did not need a harness ultimately.

However we stayed on top of the occupational therapists excercises, healthy hips of the shape M while wearing her, and it’s as simple as not grabbing the feet during diaper changes (rolling the legs up gently), and during tummy time always keeping her in a frog position.

I would strongly listen to your doctor (obviously), but hip dysplasia is extremely painful and can very much impact your baby’s health. Most of the time it doesn’t get caught until they walk, unless they’re breech presentation.

I also say, talk to your OB about your mental health. I was placed on Zoloft second day post partum. Even out in public I have to remind myself no one is judging me and no one is even aware of me and my baby. Motherhood is a wild ride, you can get a ton of support with it. ACOG Resources

[u/mymindhaswings]

https://www.rch.org.au/kidsinfo/fact_sheets/Denis_Browne_Bar_for_DDH/

First of all, I want to say that I really sympathise with the feeling of loss that comes with having a child in a hip brace. I really felt like I lost a lot of snuggles with my baby because they were strapped into a stiff contraption.

Our little one was diagnosed with moderate DDH at 10 weeks old and the orthopaedic specialist we were referred to prescribed a Denis Browne bar style harness for three months. The first six weeks we were allowed to take her out for an hour a day (either in one big lump, or could break it up as we saw fit) and then after six weeks as things were progressing well, she was allowed three hours a day out of the harness. The only caveat for that extended time out of the brace was that he didn't want us letting her sleep without the harness on, as babies tended to bring their legs back to straight and out of the healthy hip position while they were sleeping.

Something that helped my acceptance of the bracing was that I have a sibling with a disability (unrelated to hip dysplasia, just a weird coincidence) who benefited significantly from early intervention and bracing for their condition.

Having a newborn in a brace is rough, and I wish you the best.

We're based in Australia, FYI.