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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Pediatric Orthopedics

Treatment with Braces and Harnesses

At a Glance

For babies with developmental dysplasia of the hip, a Pavlik harness can hold the hip in a safe position while it grows. The orthopedic team must set and monitor the harness, and parents should promptly report weak leg movement or skin injury.

Starting treatment for Developmental Dysplasia of the Hip (DDH) can feel like a major adjustment for both you and your baby. The goal of non-surgical treatment is simple: to hold the “ball” of the hip securely in the center of the “socket” so they can grow together correctly [1]. For infants under 6 months old needing intervention, this is usually done using a specialized brace that uses the baby’s own movements to deepen the hip joint [2]. Note that stable, mildly immature hips are sometimes simply observed by the orthopedic team rather than immediately braced.

The Pavlik Harness

The Pavlik harness is a common first-line treatment for infants with DDH who require intervention [2]. Unlike a rigid cast, it is a soft, fabric brace made of shoulder and leg straps. It works by keeping the baby’s hips flexed and gently spread open:

  • Flexion: The knees are pulled up toward the chest (angles are carefully set by your orthopedic team) [3].
  • Abduction: The legs are allowed to fall gently outward.

This position prevents the legs from straightening or pulling together—the two movements most likely to pop a loose hip out of its socket [1].

Success Rates and Timing

The Pavlik harness is highly effective for many infants. Success rates in some studies are reported between 70% and 95% [4][2], but this varies substantially depending on the baby’s age, the hip’s specific type, and whether the hip is fully dislocated or just unstable [2].

  • Treatment Duration: Depending on the treating team’s protocol, many babies wear the harness full-time at first, followed by a “weaning” period where it is worn only during naps and nighttime [5][6]. Families should always follow their treating team’s specific wear and weaning plan.

Monitoring and Adjustments

Because your baby is growing rapidly, the harness must be adjusted by your orthopedic team—at intervals determined by your doctor’s specific protocol [7].

Your doctor will use ultrasound to monitor the hip’s progress. In the beginning, you may have periodic ultrasounds (often weekly at first in some protocols) to confirm the ball is staying centered [8]. After an initial trial period (such as 3 to 4 weeks depending on the case), your specialist will reassess to decide if they should stop the harness, try a different rigid brace, or consider a procedure under anesthesia [9][8].

WHEN TO CALL YOUR CARE TEAM

While the Pavlik harness is safe, there are two specific issues parents must watch for daily:

1. Femoral Nerve Palsy

This is an uncommon but important complication where the harness puts pressure on the nerve that controls the front of the thigh [3]. It occurs in about 2% to 6% of cases and is most common in the first two weeks of treatment [10][11].

  • The Sign: Your baby stops kicking one leg or is unable to actively straighten their knee [12][11].
  • What to Do: If you notice your baby is “not kicking” or the leg seems weak, contact your orthopedic team immediately. They will usually loosen the straps or pause treatment briefly, which almost always allows the nerve to recover fully [13][11].

2. Skin Breakdown

Infant skin is delicate, and the straps can cause irritation in the folds of the neck, groin, and behind the knees [14].

  • The Sign: Persistent redness that doesn’t go away, blisters, or open sores.
  • Prevention: Keep the skin clean and dry. Many doctors recommend your baby wear a thin, cotton onesie and long socks under the harness to protect the skin from the straps [15][14].

Rigid Bracing Alternatives

If the Pavlik harness is not successful, or if your baby is already over 6 months old when diagnosed, your doctor might use a rigid abduction brace (such as a Rhino or Ilfeld brace) [16][17]. These braces are made of firmer plastic and hold the legs more securely [18]. They are often used as a step between the soft harness and more intensive surgical options [17].

Avoiding Complications

To prevent a serious issue called avascular necrosis (where blood flow to the hip ball is restricted), the harness must not be adjusted too tightly [19].

  • Avoid Extreme Angles: Excessive or forced abduction can contribute to this risk [19].
  • Professional Adjustments Only: Never tighten or alter the harness straps yourself to “make it work better.” Only your medical team should adjust the tension to ensure the hip remains in a safe zone [15].

Common questions in this guide

How does a Pavlik harness help treat baby hip dysplasia?
A Pavlik harness is a soft brace that keeps a baby's hips bent and gently spread apart. This helps keep the ball centered in the socket so the hip can develop correctly.
How long will my baby need to wear a DDH harness?
Many babies wear the harness full-time at first, followed by a period when it is used only for naps and nighttime. The timing depends on your baby's hip and your orthopedic team's protocol, so follow the prescribed wear and weaning plan.
What does it mean if my baby stops kicking one leg in the harness?
Less kicking or an inability to straighten one knee can signal pressure on a nerve in the front of the thigh. Contact your orthopedic team immediately, and do not tighten or adjust the harness yourself.
How is progress checked during Pavlik harness treatment?
The orthopedic team uses ultrasound to check that the hip ball remains centered in the socket. Some protocols use frequent early scans, and the team reassesses after an initial trial to decide whether to continue, change the brace, or consider a procedure.
How can I prevent skin problems under the harness?
Check the neck, groin, and knee folds daily for redness that persists, blisters, or open sores, and keep the skin clean and dry. A thin cotton onesie and long socks may help protect the skin if recommended by your care team.
What happens if the Pavlik harness does not work?
The doctor may try a rigid abduction brace, especially if the baby is older than six months or the harness has not corrected the hip. If bracing is not enough, the team may discuss a procedure under anesthesia.

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References

References (19)
  1. 1

    Principles of Bracing in the Early Management of Developmental Dysplasia of the Hip.

    Merchant R, Singh A, Dala-Ali B, et al.

    Indian journal of orthopaedics 2021; (55(6)):1417-1427 doi:10.1007/s43465-021-00525-z.

    PMID: 34785821
  2. 2

    Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip.

    Ömeroğlu H, Köse N, Akceylan A

    Clinical orthopaedics and related research 2016; (474(5)):1146-52 doi:10.1007/s11999-015-4388-5.

    PMID: 26047647
  3. 3

    Femoral nerve palsy during Pavlik harness treatment for developmental dysplasia of the hip is not an indication for harness abandonment.

    Ghanem I, Karam G, Ghanem D, Saliba I

    Journal of children's orthopaedics 2023; (17(3)):205-211 doi:10.1177/18632521231172986.

    PMID: 37288053
  4. 4

    Treatment of developmental dysplasia of the hip with the Pavlik harness in children under six months of age: indications, results and failures.

    Ömeroglu H

    Journal of children's orthopaedics 2018; (12(4)):308-316 doi:10.1302/1863-2548.12.180055.

    PMID: 30154920
  5. 5

    Comparison of Pavlik Harness treatment regimens for reduced but dislocatable (Barlow positive) hips in infantile DDH.

    Neal D, Beckwith T, Hines A, et al.

    Journal of orthopaedics 2019; (16(5)):440-444 doi:10.1016/j.jor.2019.06.027.

    PMID: 31516214
  6. 6

    Does gradual weaning improve outcomes after successful Pavlik harness treatment in developmental hip dysplasia? A retrospective comparative study.

    Kocak S, Diril SK, Caliskan M, et al.

    Archives of orthopaedic and trauma surgery 2026; (146(1)):64 doi:10.1007/s00402-026-06239-x.

    PMID: 41706204
  7. 7

    Short Term Results of Early Treatment of Developmental Dysplasia of the Hip or Luxation with Pavlik Harness in Human Position.

    Gahleitner M, Hochgatterer R, Großbötzl G, et al.

    Medicina (Kaunas, Lithuania) 2022; (58(2)) doi:10.3390/medicina58020206.

    PMID: 35208530
  8. 8

    Tübingen hip flexion splint more successful than Pavlik harness for decentred hips after the age of three months.

    Lyu X, Chen T, Yang Z, et al.

    The bone & joint journal 2021; (103-B(5)):991-998 doi:10.1302/0301-620X.103B5.BJJ-2020-1946.R1.

    PMID: 33934653
  9. 9

    Developmental dysplasia of the hip: an update on diagnosis and management from birth to 6 months.

    Swarup I, Penny CL, Dodwell ER

    Current opinion in pediatrics 2018; (30(1)):84-92 doi:10.1097/MOP.0000000000000574.

    PMID: 29194074
  10. 10

    Femoral nerve palsy in brace treatment for developmental dysplasia of the hip : incidence and outcomes in a prospective international cohort.

    Schaeffer EK, Wang AWT, Hu J, et al.

    The bone & joint journal 2026; (108-B(6)):840-846 doi:10.1302/0301-620X.108B6.BJJ-2025-1550.R1.

    PMID: 42219184
  11. 11

    Femoral Nerve Palsy as a Complication of Pavlik Harness Treatment for Developmental Dysplasia of the Hip: Ten-Year Prospective Study.

    Khan T, Douglas C, Khan Z, Edel P

    Journal of pediatric orthopedics 2026; (46(10)):650-653 doi:10.1097/BPO.0000000000003433.

    PMID: 42841711
  12. 12

    Bilateral Femoral Nerve Palsy with Right Hip Subluxation in Newborn with History of Breech Presentation: A Case Report.

    Iqbal MZ, Sagade BS, Mehta R

    JBJS case connector 2025; (15(3)) doi:e25.00274.

    PMID: 40743322
  13. 13

    Incidence of Nerve Palsies During Pavlik Harness Treatment for Developmental Dysplasia of the Hip: A Retrospective Cohort Study.

    Gross PW, Chipman DE, Nagra K, et al.

    The Journal of bone and joint surgery. American volume 2024; (106(6)):525-530 doi:10.2106/JBJS.23.00948.

    PMID: 38506721
  14. 14

    Caregiver Experiences Using Orthotic Treatment Options for Developmental Dysplasia of the Hip in Children.

    Grzybowski G, Bliven E, Wu L, et al.

    Journal of pediatric orthopedics 2023; (43(2)):105-110 doi:10.1097/BPO.0000000000002312.

    PMID: 36607922
  15. 15

    Education of parents in Pavlik harness application for developmental dysplasia of the hip using a validated simulated learning module.

    Gargan KE, Bradley CS, Maxwell A, et al.

    Journal of children's orthopaedics 2016; (10(4)):289-93 doi:10.1007/s11832-016-0751-7.

    PMID: 27342120
  16. 16

    Effectiveness of abduction orthosis for the treatment of acetabular dysplasia.

    Yılmaz G, Bakırcıoğlu S, Çetik RM

    Eklem hastaliklari ve cerrahisi = Joint diseases & related surgery 2019; (30(1)):32-7.

    PMID: 30885106
  17. 17

    Ilfeld abduction orthosis is an effective second-line treatment after failure of Pavlik harness for infants with developmental dysplasia of the hip.

    Sankar WN, Nduaguba A, Flynn JM

    The Journal of bone and joint surgery. American volume 2015; (97(4)):292-7 doi:10.2106/JBJS.N.00707.

    PMID: 25695980
  18. 18

    Dynamic and Static Splinting for Treatment of Developmental Dysplasia of the Hip: A Systematic Review.

    Pavone V, de Cristo C, Vescio A, et al.

    Children (Basel, Switzerland) 2021; (8(2)) doi:10.3390/children8020104.

    PMID: 33557053
  19. 19

    An Eastern Europe and Middle East multinational expert Delphi consensus study on the prevention, diagnosis, and treatment of developmental dysplasia of the hip before walking age.

    Ömeroğlu H, Yüksel S, Demir P, et al.

    International orthopaedics 2024; (48(6)):1373-1380 doi:10.1007/s00264-023-06077-1.

    PMID: 38150007

This page explains DDH braces and harness care for informational purposes only and does not constitute medical advice. Follow your baby's orthopedic team's instructions for fitting, wear time, adjustments, and warning signs.

Guide contents developmental dysplasia of the hip
Research & Literature
03 Screening and Diagnosing Hip Issues 05 Procedures and Spica Casting