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For children with a body harness or spica cast by hip dysplasia

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Hip abduction brace child

Hip dysplasia and hip luxation are treated with a hip abduction brace. The hip brace spreads the legs and keeps the legs in a straddle position. The straddle position ensures that the femoral head is positioned in the middle of the acetabulum and that the acetabulum can develop.

If the child has a hip deviation on one hip, the hip brace is fitted on both legs. So a hip brace on both legs doesn’t automatically mean that your child has a hip deviation on both legs.

  1. From what age does my child need to wear a hip brace?
  2. For how many hours a day should the hip brace be worn?
  3. Can I bath my child with a hip brace?
  4. Attention points for nappy changing
  5. Does the hip brace hurt?
  6. Are there different braces available?
  7. The hip brace is dirty
  8. The hip brace is broken
  9. Which clothing can my child wear with a hip brace?
  10. Sleeping with a hip brace
  11. Does my child with a hip brace fit in a normal stroller or buggy?
  12. How can I transport my child with a hip brace in a car?
  13. Is there any delay in the child’s development as result of wearing a hip brace?
  14. Tips to prevent a flattened head
  15. The child’s movement after completion of the treatment
  16. What can I do with the hip brace after the treatment?

1. From what age does my child need  to wear a hip brace?

The starting age for treatment differs per country. In some countries the treatment starts as soon as the hip deviation is discovered, even if the baby is only a few days or weeks old. In other countries the treatment does not start before the age of three months, unless there is a known severe hip deviation. In those countries the standard procedure is a check at the age of three months (ultrasound in the hospital) when the baby is born in breach or when hip dysplasia is known in the family.

Sometimes the hip dysplasia is discovered at a later age. The treatment will start from that moment on. In general the hip brace is used for treatment up to the age of two. After that the treatment consists of operations.

2. For how many hours a day should the hip brace be worn?

In general the hip brace has to be worn 23 hours a day and can be taken off to change and take a bath. Often in the final months of the treatment the hip brace only needs to be worn during nappy time and at night.

Sometimes it is not allowed to take the hip brace off in the case of a hip luxation, not even for changing or washing. That is to prevent the hip from dislocating (again). In that case the child usually wears a pavlik harness.

Always follow the advice of the doctor, since every treatment is different.

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3. Can I bath my child with a hip brace?

It depends if the hip brace can be taken off or has to be worn 24 hours a day. If the hip brace can be taken off for changing and washing, your child is allowed to take a bath.

If, in the case of a hip luxation, the hip brace (mostly a pavlik) is not allowed to be taken off at all, the child cannot be bathed.

You can wash your child’s hair with a facecloth and a little soap. Alternatively you can wash your child’s hair in the kitchen, by placing your child on a changing mat close to the sink. Make sure you have all necessary attributes close to hand and preferably have somebody to assist you.

As an alternative we have a hair wash basin. This enables you to wash the hair, for example on the dining table or on the floor. Again, in the interests of safety: make sure you have all washing attributes ready before you start and preferably with an assistant.

4. Attention points for nappy changing

The risk of leakage increases because of the straddled legs. It can help to change the nappies more often.

It is preferable not to lift your child by the legs when you change the nappy If you are not sure how to change nappiess, ask for advice in the hospital.

5. Does the hip brace hurt?

Wearing a hip brace should not hurt. Your child can be a bit moody or cry at first, but that should be over in a few days. If you think your child is in pain, contact the hospital.

6. Are there different braces available?

Yes, there are different braces. Here is an overview of the most common braces used internationally. Every hip deviation is unique and has its own treatment. The choice of the brace depends on the seriousness of the deviation and the age of the child. Every treatment is different because every child is different, which is why it is impossible to compare different treatments.

Worldwide the pavlik harness is the most commonly used hip brace from birth up to the age of about 6-7 months. Thereafter the pavlik is replaced by a different type of brace, since children tend to become ‘too strong’ for the pavlik harness. For older children who can walk a different type of brace is used, mostly with hinges to support the walking process.

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7. The hip brace is dirty

Check the accompanying manual for the cleaning instructions. Close the Velcro and clean the hip brace with hand-warm water and a mild soap. Clean the Velcro regularly to ensure a good suture (remove dust and wires from other clothing).

Pavlik: the pavlik bandage is dirty, can I clean it?

8. The hip brace is broken

If there are any technical problems with the hip brace, contact the person who fitted the hip brace, usually the orthoptist.

9. Which clothing can my child wear with a hip brace?

Leggings
Jumpsuits
Dresses
Fleecesuits

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10. Sleeping with a hip brace

Wide sleeping bag for hip brace or spica cast
Make sure that the sleeping bag you use has enough space for the legs to move sideways, but which still fits at the neck and armholes. A bigger size of a ‘normal’ sleeping bag is dangerous because the neck hole and arm holes are too big. This creates a risk of suffocation of the child accidentally gets into the sleeping bag.

We have developed special wide sleeping bags for children with a hip brace or a spica cast. Enough space for the spread legs and which fits at the neck and arms.

11. Does my child with a hip brace fit in a normal stroller or buggy?

Sometimes yes and sometimes no. It depends on the age of the child, the type of hip brace and of course the type of stroller or buggy. Wait until the hip brace is fitted on and try it to see if it still fits.

Have you found a solution or a pram/buggy that fits? Please send us the information so we can enlarge our knowledge base.

12. How can I transport my child with a hip brace in a car?

Please read our car seat information. In some countries a special car seat for a hip brace or a cast, the Maxi-Cosi Opal, is available.

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13. Is there any delay in the child’s development as result of wearing a hip brace?

A temporary delay in development can occur as result of the hip dysplasia treatment. In the long-term the adverse effect of the hip brace treatment is negligible.

Personal note of Oeda de Jong, owner of Kiek Hip Wear:

Many parents worry about the restrictions in movement as result of the hip brace or spica cast. Children with a brace or a cast cannot, or find it difficult to, roll over and crawl. The development of the motor skills stops for a while.

Based on the experience with my daughter and all hip dysplasia parents I have talked to over the years I can say: try to relax, it will all be all right. Children are good patients, they do what they can without any limiting thoughts.

It is not terrible if the development stagnates due to a hip brace. It is terrible when a hip dysplasia or hip luxation is not treated, which can sometimes lead to life-long problems with standing and walking.

My experience with my hip dysplasia shop is that parents desperately want their child to be “the first” or “the best”. Every child develops at his or her own speed and it is lovely if you can let that happen and make no comparison to other children.

After the hip braces of my daughter we went to a physiotherapist (at our own initiative) to monitor her development.  I wanted to prevent her from making ‘bad’ movements such as sliding on her bottom instead of crawling on her hands and feet. This was mainly to deal with my own insecurity and I can recommend it to any parent who is insecure about the development of their child after a hip treatment. The hospital normally advises that a physiotherapist is not necessary and that it will all work itself out. Always listen to the doctor’s advice.

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14. Tips to prevent a flattened head

With a hip brace or a cast, children are in a supine position a lot. As result of the supine position, children may hold their head in the same preferable position all the time, causing pressure on the same area of the skull. This can cause a flattened head (flat head syndrome). In extreme flattened head cases, treatment with a helmet is necessary. This can be costly and annoying for the child. A special pillow can help to minimize a flattened head and flat head treatment. If the shape of the head changes or if you have any other medical questions, please consult your doctor.

Pillow

Tips to reduce a flattened head:

  • prevent a preferable position: alternately lie the head from left to right in a supine position, for example by laying the child’s favourite toy on the left and right side of the bed or playing area
  • When the baby is awake, monitor playing in the prone position: tummy time. This develops the neck muscles
  • Use different positions when (breast)feeding
  • Change the place of the cot in the room so the child will look to a different side
  • Change the position of the changing mat or turn it around so the child has to look to the other side to see you.

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15. The child’s movement after completion of the treatment

Please do not worry about the freedom of movement your child has now. Treat your child like you would normally do. The child can make any kind of movement but don’t push or pull the legs/hips.

The hospital will advise you if there are any movement restrictions applicable.

16. What can I do with the hip brace after the treatment?

You can donate the hip brace and hip brace clothing for the treatment of children in Chernobyl. Read more about our charity and how you can donate your hip brace and hip clothing, sleeping bag etc.

It is good to know that in many countries the reuse of hip braces and clothing for other children is prohibited because of hygienic laws.

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