• Reference Number: HEY1493/2024
• Departments: Paediatric Medicine, Physiotherapy
• Last Updated: 31 July 2024

What is DDH?

Previously known as Congenital Dislocation of the Hip, DDH encompasses a range of hip joint abnormalities, from mild instability to complete hip dislocations at birth. DDH means the ball and socket do not fit snuggly together, there are varying degrees of severity. If the ball is not held safely in place, the socket may be more shallow than usual, this is called acetabular dysplasia. If the ball loses contact with the socket and stays outside the joint, it is called a dislocated hip. These are all forms of DDH.

What causes DDH?

DDH can happen to any baby, but some factors make the condition more likely.

The most common risks factors are:

• Breech position in the last three months of pregnancy.
• Breech presentation / Delivery (bottom or feet first).
• Positive Family History such as a mother, father, brother or sister who have had a hip problem treated as a child.
• Girls are affected more often than boys, particularly the first born.

It is important to remember DDH cannot be prevented, and it isn’t anyone’s fault.

Even though as parents you may be distressed at discovering your baby has a hip condition, he/she will not be in pain.

How is DDH treated?

Treatment involves the application of a light-weight splint known as a Pavlik Harness which holds the legs wide apart (abduction) and bent at the hips and knees (flexion). This position keeps the hip in a good position and promotes normal development of the hip joint.

An ultrasound scan is usually performed approximately every 2 weeks to allow the doctor to monitor your babies’ progress.   The harness is usually in place for at least 6 weeks.

If left untreated the long-term consequences are potentially serious. The growth of the hip may be affected resulting in a shorter leg and pronounced limp, and there will be a much greater risk of prematurely developing osteoarthritis and hip pain.

How to care for your baby in a Pavlik harness

As your baby grows the harness will need adjusting to keep the hips in the desired position. This will be done every two weeks by a trained member of the Children’s Therapy team.

The harness should NEVER be removed even if it is soiled, unless directed by your doctor or therapist. You should NEVER unfasten the straps. Should the harness become soiled you can clean it using a damp cloth or baby wipe. If the harness is badly soiled it may need changing, so please contact the Children’s Therapy department during normal working hours. However, this is not urgent as a soiled harness presents no infection risk if there are no open wounds.

The nappy can be worn in the normal way but must be worn underneath the straps. Do not lift your baby by the feet during nappy change.

Baths are not allowed whilst wearing the harness, please ‘top and tail’ wash your baby instead while in the harness.

Each day it is important to check your baby’s skin for red areas. The areas to check are; groin, behind the knees, under the arms, the feet and under the straps at the front and the back of the harness. Creams do not help protect the skin and may even irritate. We do not advise the use of creams but if you wish to, ensure they are rubbed in well.

POSITIONING- Place your baby on its back to sleep. DO NOT lay your baby on his/her side as this is not good for your baby’s hips. If baby has to be positioned sideways for nursing purposes, ensure that baby’s legs are kept apart. Your baby needs to spend time on their tummy when awake and being OBSERVED to help with hip position and development.

Most parents find their babies fit into their usual car seat and pram without problems. Try to avoid long car journeys as car seats normally hold baby’s thigh close together, limiting the effectiveness of the harness.

When to seek advice

Between appointments DO contact the department if:

• Your babies’ feet are constantly slipping out of the foot straps.
• The harness straps are too loose or too tight.
• If your baby has sores or persistent red marks behind their knees, in their groins, under their arms, the feet or under any of the straps.
• Your baby stops kicking or moving either of their legs or feet.

What precautions must I take after treatment

Once the doctor decides your babies’ hips have reached a normal position, they will be taken out of the harness during clinic.

You should not be worried about allowing your baby to move freely when out of the harness, but do not attempt to move his/her legs yourself and do not swaddle your baby. Do not use baby walkers or baby bouncers, allow your child to progress naturally to independent mobility.

This leaflet was produced by the Children’s Physiotherapy & Occupational Therapy Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in July 2027.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.