Hip Dysplasia and the Wheaton Pavlik harness

R at One Egg Please has just learned that her daughter will have to go into a harness for hip dysplasia, and that's prompted me to look back at my own experience with my daughter's hip dysplasia earlier this year.  As with all such posts, please note that this is very much an individual account.  It's anecdotal evidence and cannot be considered generally representative.

Hip dysplasia ended up being the last (I hope!) in a long list of minor complications and false alarms starting from when my daughter was an embryo.  She was diagnosed more or less at birth since the 'click' was so obvious, but for the first three days of life we were struggling to keep her blood sugars up, so I had time to get used to the idea of hip dysplasia without ever actually worrying about it.  I was just relieved there were no more needles in her future.

Our paediatrician said that she had never come across a bigger 'clunk' than the one our daughter's right hip made, so we were referred straight to an orthopaedic specialist.  At exactly two weeks old, she had her first appointment with them.  They set up an ultrasound for her, but they didn't need to wait for that to set her up in a Wheaton Pavlik harness.  She clearly needed it.

Our first sight of the harness was dazing.  I'd vaguely expected something around her waist, not the huge tangle of straps that the doctor fitted to her from shoulder to foot.  It was gratifying to discover that there were no rigid parts (save for a few plastic loops) and everything against her skin had a fleecy pad.  The point of the harness (in my layman's comprehension) was to hold her legs frogged, so that the ball of her hip joint was pressed firmly into the socket.  Hip dysplasia arises when the socket isn't big enough, and having the ball press into it stimulates growth.

Frog-girl - about three weeks into wearing the harness

Learning how to get it on and off ourselves was intimidating, but not a problem once I got a feel for how it all fit together.  The doctor had used a sharpie to mark where the velcro should go (the adjustments for size largely depending on fastening the velcro higher or lower), and that helped hugely.  We were assured that we could do everything we already did with the harness still on, and by and large that was true, although it was a bit of a learning curve.  One leg or the other seemed constantly in the way, yet after a few days, we'd adapted.

The only thing I never managed successfully after the harness was swaddling.  Of course, after I was done with the harness, I came across Swaddle Straps which look like a perfect solution, but as swaddling was a long gone thing of the past by that point, I can't personally vouch for them.  I can go on record saying that my daughter's sleep was pretty bad for a few nights – she has always been a light sleeper anyway, so suddenly having her legs in a new position while her arms could flail freely spelled disaster.  In the end, we switched to sleep sacks and got used to those.

Because she was spitting up all the time, we ended up putting her clothes over the harness to give it some protection.  Clothes could be washed more easily than the harness.  I tried washing it exactly once, to get rid of the sour milk gunk.  Cleaning it was fine; drying it was next to impossible, thanks to all the fleecy padding that soaked up apparently gallons of water.

I spent about half an hour running a hair dryer over the wretched thing, frantic that my daughter had been out of it for so long as if her hips were going to regress or something.  We ended up having to put it back on the baby when it was still wet, which generally made me feel like a failure.  After the trauma of that experience, we never washed it again.  I lived in fear of getting poop or urine on it which would necessitate a wash, but thankfully we escaped that.

Basically, I have zero advice when it comes to maintaining harness hygiene.

Still, with clothes going over the harness, we only had to take it off when we were washing her, so that meant she was in it all the time, stimulating that hip socket.  She used to love her bath, kicking her legs for sheer joy at the novelty of it, but she was never fussed about going back into the harness.

Finding clothes to go over the harness was a huge pain.  I had always scorned dresses for baby girls, because they seemed so impractical, so it was ironic that they became the near exclusive fixture of my daughter's wardrobe.  I'd put her in a onesie under the harness very now and then, just for a change, but mostly she wore these little short dresses over the top, with nothing but a nappy underneath (and her legs splayed out to show that off in most unladylike fashion).

This is more or less what all of our pictures from 1-3 months look like

I tended not to worry about trousers and the booties made socks unnecessary, but every now and then, on cold days, I'd put a size-too-large all in one sleeper on her, leaving the crotch unsnapped. Sometimes the sleep sack would function as a coat too.  Otherwise, I'd just pile blankets over her legs – since she was so young, she spent most of her time lying in one position anyway, so blankets were a viable replacement for clothes.

In retrospect, it was weird how accustomed we got to it.  When we were out and about in public, I'd be sitting with her on my lap for five or ten minutes, when it would suddenly strike me that the people around me must wonder why the harness was there (nobody ever asked nor stared that I noticed).  I used to tell people if I was making conversation with them, but otherwise I didn't worry about it.  That part wasn't something that bothered me.

Hip dysplasia runs in families, and it turned out that my husband had it (unusual – it's more commonly female babies that have the problem).  His mother had never mentioned it to anybody, hadn't even thought about it for a long time, so we would never have found out if it hadn't been for our daughter.  Back in the days of her father's infancy, the treatment was to wear one nappy over another.  I can't help but think that this sounds an easier (though probably less effective) solution.

For all of that, it is uncommon enough that when she went in for her two month well-baby appointment, I was asked if the visiting student doctor could come in and get a first-hand look at the harness.  It's always been my policy to permit the observations of student doctors anyway, and I certainly had no wish to deny them the joy of looking at my stupendously cute daughter (and her gross, milk-stained harness).

For eight weeks she wore her harness, and then, at ten weeks old precisely, we had another appointment with the orthopaedic doctor, to find out the results of a second ultrasound: normal!  The harness came off, and we were told we could do what we liked with it.

I wanted to incinerate it, but we kept it, tucked away in a keepsake box.  When my daughter is much older, we'll get it out to show her.

Having her out of harness was crazy and wonderful.  She felt so skinny and seemed ridiculously long when she stretched her legs out.  We had to learn how to hold her all over again, as suddenly she had these long legs flopping all over the place, and when we picked her up, we felt her body not her straps.  She had to learn how to sleep with her legs free too... another round of broken nights!  Best of all, we could see her toes again!

The day her harness came off: we still haven't bought her any pants, she still hasn't got used to stretching out her legs, and none of us have realised that she doesn't need to be photographed with her legs apart anymore.

By serendipity, the day her harness came off was the anniversary of her (in vitro) conception.  What better way to celebrate?  In the above picture, she has her petri dish resting on her tummy, since I was repeating the photo-set-up I'd done with her brother, one year after his conception.

Still, we soon adapted back into normal babyhood, and an X-ray at five months was also normal.  We have to go back again once she's walking, but we're optimistic that everything will be fine now.  My suspicion is that we were helped a lot by getting such a prompt diagnosis.  It seems logical to me that if you stimulate the hip socket to grow at the time when the baby's growing the fastest, you're going to get a better result.  From what I can tell, talking to others, our eight-week session with the harness is on the short side.

Now, at nine and a half months, my daughter is crawling all over, pulls herself up, cruises a little and gets a kick out of pushing a walker.  I think I can safely say that it hasn't inhibited her development one whit.