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

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Pavlik

1. What is a pavlik bandage

The pavlik bandage is a kind of harness which spreads the legs and keeps them apart. The knees are pulled up to an angle of about 90 degrees. If the child is relaxed, gravity will make the legs ‘drop’ outwards. Stiffness means that it can take a while before the legs spread.

The goal of the pavlik is to bring the femoral head into the centre of the acetabulum and to stimulate the joint to develop in the right way.

2. What does a pavlik bandage look like?

 Pavlik Bandage

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3. Can you take the pavlik bandage off for nappy changing

Most of the time it is allowed to take the pavlik off for washing and changing. In that case the orthopaedist will tell you that the pavlik has to be worn 23 hours a day. In some cases it is not allowed to take the pavlik off at all, usually when there is a hip luxation and there is a risk that the femoral head will luxate when the pavlik will be taken off. Always follow the instructions of the orthopaedist.

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4. What do I need to be aware of in respect of clothing with a pavlik

Everything that pushes the legs together needs to be minimised. It is crucial to prevent that the stiffness of the clothing keeps the knees together. Exactly for this reason we have developed special leggings to wear underneath the pavlik.

These leggings:

  • Have popper fastening which go all the way to the waistband at the back (so that the two legs can be almost completely loosened and are only attached to each other at the back). This way the nappy can be changed with the Pavlik on.
  • Are cut out of the fabric in the spread position, so that there are fewer folds in the back of the knee. This minimises the risk of skin irritation.
  • Have a piece of stretch fabric seamed into the crotch to make the spreading of the legs as easy as possible without any clothing obstruction.
  • Are specially designed so that they do not wear out with intensive use (in contrast to tights and normal leggings).
  • Have a flat inner-leg seam which minimises skin irritation under the hip brace and at the back of the knee.
  • Are longer than normal leggings; because of the bend at the knee, normal leggings are mostly too short.
  • Are made of soft cotton to protect the skin against the straps of the pavlik
  • Can still be worn after the hip brace has been removed.

pavlik leggingpavlik legging poppers

Besides the leggings for wearing underneath the pavlik, we have special jumpsuits to wear on top of the pavlik. Read more: which clothing can I put on when it is not allowed to take the pavlik off?

Please note: it is not advisable to wear trousers with a waistband on top of a pavlik. The waistband pushes on the straps of the pavlik which go from the shoulders to the knees, which influences the position of the legs in the pavlik.

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5. What do I need to be aware of in respect of sleeping with a pavlik

There must be enough space to spread the knees completely when the child is asleep. For this reason we have designed special wide sleeping bags. These sleeping bags allow your child to sleep safely, warmly and comfortably, with the necessary space for the legs to spread. In addition, the sleeping bag prevents the Velcro/buckle on the pavlik from opening during the sleep.

Can I use a normal sleeping bag in a bigger size?

It is not advisable to use a normal sleeping bag in a bigger size because of the bigger neck and arm openings, with the risk that your child’s head fitting through the neck hole and your child getting ‘into’ the sleeping bag (SIDS). The Kiek Hip Wear sleeping bags have regular neck and arm openings but with extra space at the bottom for the spread legs. The sleeping bags fit with every hip brace or spica cast.

Another disadvantage of normal sleeping bags that they do not offer enough space for the movement of the lower legs.

The Kiek Hip Wear sleeping bags are of regular length so that they will still fit once the pavlik has been taken off. We recommend to use the wide sleeping bags once the pavlik has been taken off since many children still love to sleep in a ‘frog posture’ with spread legs.

The wide sleeping bags are available from birth to 2.5 years in different TOGs (0.5 -1 - 2 - 2.5) for every season.

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6. Which clothing can I put on when it is not allowed to take the pavlik off at all

Your child is probably only wearing a romper underneath the pavlik when the orthopaedist instructs that it is not allowed to take the pavlik off for changing or bathing. This romper will stay on till the next appointment in the hospital. Only with permission of the doctor is it sometimes allowed to change the romper when the legs are kept in the same position during changing.

We have designed special jumpsuits to wear on top of the pavlik:

  • wide model that fits on top of the pavlik
  • poppers from ankle to ankle for easy nappy changing
  • poppers on the shoulders so the head fits easily
  • daywear (for example with a vest) or nightwear as pyjamas
  • soft cotton with stretch for comfortable wearing
  • the jumpsuit ensures that the pavlik stays clean (no food remains etc.)
    jumpsuit to wear on top of pavlik harnessjumpsuit poppers pavlikjumpsuit pavlik hip dysplasia

Extra advantage: you don’t see the pavlik and your child looks lovely.

Instruction help to replace clothing underneath the pavlik if the legs have to stay in the same position

pavlik harness

source: International Hip Dysplasia Institute

When changing clothing it is important to remove only one section of the harness at a time to keep the hips in the proper position as much as possible. It may be a good idea to have someone help you for the first few times. To change tops:

  1. Lie your baby down and first loosen (do not take off) the chest band that attaches at the front with Velcro.
  2. Undo the shoulder strap (#1) and take the right arm out of the clothing.
  3. Take the clothing over the baby’s head and re-attach the shoulder strap (#1).
  4. Undo the other shoulder strap (#2) and remove the old clothing.
  5. Put on the new clothing over your baby’s left arm, then over his/her head and re-attach strap (#2).
  6. Undo strap (#1), pull the clothing over the right arm and re-attach strap (#1).
  7. Tuck the clothing down through the (loosened) chest band. CHECKPOINT: Strap (#1) and (#2) should be re-attached over the top of the baby’s clothing.
  8. Check that the shoulder straps are back on their markers (readjust the straps if needed).
  9. Retighten the chest band so that you can get four fingers between your baby’s chest and the chest band

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7. Can my child be swaddled when wearing a pavlik

It is not allowed to swaddle the legs of a child with hip dysplasia. It hinders the development of the hip joint, with or without a hip brace. If your child is a restless sleeper you may swaddle just the arms.

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8. Can my child fit in a pram or buggy when wearing a pavlik

Most of the time children with a pavlik fit in any pram or pushchair. Take care to ensure that there is enough space beside the legs so the knees can bend outwards. If the pram or pushchair is small and the knees cannot move outwards, that’s no problem for a short ride, depending on the seriousness of the deviation. However, it is not wise to put your child in a position with the knees up, without space for outward movement.

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9. Can my child fit in a regular car seat when wearing a pavlik

Children with a pavlik can usually fit in a regular car seat. Because of the sides of a regular car seat, most of the time the knees are up without space for outward movement. Depending on the seriousness of the deviation, a short ride with the knees up is not a problem. If your child is in a position with the knees up for a long time, the pavlik cannot work properly.

MaxiCosi has special car seat for children with a hip brace or a spica cast is some countries. Please check the MaxiCosi website.

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10. Does wearing a pavlik hurt

Children can be moody when they get the pavlik. This can be caused by muscle pain or getting used to the new position. After a few days the child should be ‘normal’ again.

Children wearing a pavlik can move and stretch their legs. Very occasionally, the nerve in the groin can be pinched. The leg gets ‘sleepy’ and that is an unpleasant feeling. If your child is in pain or does not want to move or stretch their legs, it is important to contact the doctor. Perhaps the pavlik needs adjusting.

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11. Can I wash the pavlik

The following things should be taken into consideration before washing the pavlik:

  • If it is not allowed to take the pavlik off for washing or changing your child, the pavlik cannot be washed
  • Try to clean the pavlik with a damp cloth and a little washing detergent. Remove stains with a brush (an old toothbrush for example)
  • Read the manual of the pavlik carefully about the cleaning options (there are different brands and materials for pavliks)
  • The drying time of the pavlik depend on the thickness of the material and can take hours. First ask your doctor during your next visit if it is allowed to take the pavlik off for that long.

In the event that you can wash the pavlik, you can even go a step further and …. paint the pavlik. Read more in our blog about painting the pavlik.

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12. Are all pavliks the same

The pavliks do not look the same but they work the same. There are different brands and materials, but these are only detailed differences to the exterior.

13. The pavlik treatment is finished, what can I do with the pavlik

Yes, we collect the used hip braces and used clothing for a charity. Children in Chernobyl can be treated with the used hip braces and pavliks. Please read more here.

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