On Our Way Out of the Pavlik...

In my first blog I briefly explained the diagnosis of Adam's Developmental Dysplasia of the Hip and being prescribed the Pavlik harness by our pediatric orthopedic specialist.

When we got the idea that this isn't something that they were just checking on to be cautious about, I panicked and researched what I could on the internet about hip dysplasia and the common treatments. Our pediatrician, in the hopes of not worrying me I suppose, had told me that if he had anything wrong it was "no big deal, just a little ace bandage thing that he would have to wear for about 6 weeks." But when I did my internet research and found only the Pavlik harness as treatment for hip dysplasia in infants, I was confused . . . this is the little ace bandage she was referring to? I started to cry immediately, before I even got the diagnosis. Somehow I had a feeling that this was in our future and it seemed like an impossible thing to have to handle. THAT was a rough day.

Baby on the front of the Weaton Pavlik Harness package

The purpose of the harness is to keep the hips and knees bent (flexed) and thighs spread apart (abducted). This position is best to help the hip grow normally. Hip dysplasia is a very common problem that affects 1 in 100 infants (about as common as autism), but the harness has a 92% success rate. Hip Dysplasia is not all that common in boys, especially boys who were not breech. However, we do have suspicions that my dad's brother had this when he was a baby (they treated it differently then - with a body cast), and my cousin's son also was diagnosed with the same problem a few years ago.

Imagine being told that not only does your 3 week old baby have something wrong with his hips (see my previous blog), and not only are your hormones going insane trying to balance out since the pregnancy, but that you have to put him in this huge harness that covers his feet and legs up to his knees and goes over his shoulders like suspenders. To top it off, it's not a 6 week treatment but a 3-4 month ordeal.

Adam's first day in the harness

While sitting in the office and hearing the news, I held Adam and tried to pretend like I understood what the doctor was saying about how this was in no way a permanent disability. I nodded along while he sympathetically told me that they all understand how overwhelming and terrifying it is to see your little baby strapped into the harness, but it is not painful and is something that we will get used to. I must not have been very convincing, because then he told me before they brought in the actual harness that many mothers cry, and that it's okay if I do. So I started to cry. I think the nurse cried a little for me too.

Don't get me wrong, I am not saying that this is the worst possible thing that could have happened, just that it was traumatic. I was okay two days later after I did some more crying, some more research and decided to trust that this was not a permanent disability or a permanent treatment. Then, I told my hormones to shut up already and deal with it. I was lucky that this was going to be worse for me that it was for him. He won't remember it, he is not in pain, and there is a very good chance that this will work and he won't need further (more painful) procedures (we will see). So I packed away all of his 0-3 month old clothes (didn't matter cause he didn't really fit in them for very long anyway). Then a friend from Shannon's work brought up some larger baby clothes; specifically, some Winnie the Pooh pajamas. They fit over his harness comfortably and he looked so cute and warm that it didn't feel so bad anymore. It felt like he could be "normal".

My mom and my aunt went out and bought 10-15 new outfits in the 18-24 month size because those were the only things he could wear without affecting the harness. We also bought those limited edition huggies diapers that looked like denim so if he was just wearing a little 12 month old t-shirt it was just a little more stylish.

He is actually wearing the harness here at 7 weeks old, underneath a 24 month romper.

We had to relearn everything. The most comfortable way to nurse him, how to change his diaper with the harness on, how to change his clothes, how to hold him, how to position him so he wouldn't get a flat spot on his head, and how to continue his development. I didn't have the heart to make him do much tummy time because it looked so uncomfortable and he hated it anyway. This, like all other things, required an adjustment period.

So we learned it all over again. We found out he likes to see what's going on so he didn't want to be cradled anyway. He has always wanted to be held upright, which luckily is also the easiest way to hold him while he's wearing the harness. He loves the Bumbo and can use it with the harness. The boppy was great for nursing, even better than my previous techniques. We figured out which diapers were more difficult to maneuver around the harness. That over-sized clothes worked great, but not the ones with collars because they came up over his face. I learned to give an expert sponge bath since he was supposed to wear it even at bathtime. I learned that people either noticed the harness or didn't, and those who did either asked politely and responded positively, or didn't ask at all. Soon enough I was fine with all of those reactions.

I have become a professional at putting it on and taking it off quickly. Shannon and I are both masters of diaper changes while the harness is on - so much so that I had forgotten it took a while to figure out and realized what an adjustment this must be for the daycare teachers (not that they have complained). After about 8-9 weeks it got WAY too hot outside for him to be wearing the large and bulky 2 year old clothes so I started putting 3-6 month old clothes (because that's what he was wearing at 2 months) on under the harness. It wasn't the most attractive, but it was more practical for the summer. Eventually I got brave enough to take it completely off at bathtime because it was a much faster process to take it off than to work around it.

Wearing his harness over his onesie.

Some websites that I have seen warned NEVER to remove or attempt to adjust this "complicated" device and to contact their doctor immediately if it appears that the harness isn't fitting correctly or needs adjusted. Luckily our orthopedic specialist (David S. Brown, M.D. of Pediatric Sports and Spine Associates) scheduled a few appointments early on and he and their staff taught me how it should fit and how to adjust it whenever necessary.

And it is a damn good thing they did because Adam grew FAST. In fact, he grew out of the "small" harness after 6 weeks and was fitted for a "medium", which he is almost too big for now (another 6 weeks later).


People have asked me whether the harness is uncomfortable or if it bothers Adam, and I have to say that up until just recently, 99% of the time it doesn't bother him. There were one or two instances in the beginning when he would cry and we would go through the checklist: hungry? no. need a new diaper? no. gas bubbles? no. sleepy? no. Finally in desperation I would pull the velcro to adjust the straps to give him some room and he would immediately calm down. Apparently it was too tight because he had literally grown overnight.

But honestly, these were incredibly rare instances. Recently he has gotten so tall and weighs quite a bit - he is much larger than the typical 3 month old - so it really can't be comfortable for him to have his legs pulled up so high beneath him. He doesn't complain much about anything but I'm often trying to position him in a way where it's not putting much of a strain on his legs and back. But he's cute - he's very ticklish on his neck - so when I pull the straps from around his shoulders he wrinkes up his face, gives a big grin and shrugs his shoulders from the sound of the velcro.
A lot of the pictures I have shared recently are of Adam sans-harness. I feel I have adjusted fairly well to returning to work (although I still miss him and have fleeting thoughts each morning of what it would be like if I could just stay home and play with him all day). I am adjusting to having to be at work and away from him all day, and just dealing with getting to see him only a couple hours before his bedtime each night. But when you add the harness on top of that, I felt too distant from him and just can't take it. So, for the last two weeks Adam has worn the harness all night and all during the day at daycare. When I pick him up and get him home from work I take it off for a few hours and put him in "real" clothes instead of the 24 month jumpers that go over his harness (at daycare it is an easier solution so they don't have to remove it at any time), cuddle with him, and let him move his legs a little.

But after today, NO MORE HARNESS DURING THE DAY!! Tomorrow I'm taking the day off of work to hang out with him and celebrate.

Technically, the instructions are to have him wear the harness full-time for three months and then at naptime and bedtime for another month after that; however, Adam is not all that interested in napping, even when they wear him out at daycare. He takes a couple of 20-30 minute cat naps through out the day, and you can't predict them. And if you wake him up accidentally, it's over. No more nap.

So even if it was just me at home with him, I don't think I'd be able to slip the harness on him without waking him up or be able to predict his naptimes in order to get it on him before he zonked out. So I'm not going to make them do it at daycare either. He sleeps 10-11 hours at a time at night (he wakes up to eat once but goes right back to sleep) so this works for him. Whether it makes a difference in how his hips are corrected, we will see.

I don't want to sound nonchalant about it or uninterested in doing everything I can for him, because that is definitely not the case at all. The truth is, I am terrified this won't (or hasn't) worked. But I can only do what I can. The plan is for him to wear the harness every night at bedtime for 4 more weeks, and at that point they will do x-rays to see if his hips developed in the sockets correctly. If it worked, they will periodically check his hips until he is about 1 1/2 to make sure they don't go back to how they were. If the procedure doesn't work, however, it will require a corrective procedure where they will need to put him under anesthesia and pop the hip into place.

But I don't like to think about the possibility of fhat now. Right now, I'm going to enjoy tomorrow with my 15 week old who doesn't have to wear the Pavlik harness during the day anymore.

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September 8, 2011 - One Year after Finishing with the Pavlik Harness

Does the Pavlik Harness work? For us, yes. It worked 100% with no downside, and every hip x-ray Adam has had over the last year has shown that his hips look as if he had never had dysplasia in the first place. In fact, the harness in some ways helped him to build his abdominal muscles and legs, so when he came out of the harness at 3-4 months old, he was already ahead of the game with his physical development. He sat up at about the same time as other babies, but he crawled at 7 months, pulled up to standing a week later, learned to climb at 9 months, took his first steps at 10 months, was full on walking the day before he turned 11 months, and was running at 13 months... with no issues.

Our experience with the harness, albeit stressful and scary, was positive.

The day Dr. Brown diagnosed Adam and put him in the harness, he told me that when it was all said and done I would look back and think how simple it was and silly to be so upset. It was not offensive, he said it in a comforting and optimistic way and I believed him. But now, having gone through it, I don't know that I would say that's exactly how I felt a year ago or how I feel now.

The first 3-4 months were a blur. Being our first child, we were learning so many new things about parenting, babies, daycare, and the normal stress that goes with it. We had extra stress tacked on, but we dealt with it not knowing that other parents have very different newborn months experiences. In the long scheme of things, 3 to 4 months is just a blip. Now Adam is 16 months old, so he wore the harness for a quarter of his life. But when they put the harness on him, it felt like it would be an eternity before they would take it off.

Now, when I look back, I do not think it was silly of me to be so upset - I wonder how I was not more upset and scared... but we lived day to day with so much to take care of that we simply didn't have the time to be wallowing in our stress and fear.

When I look back now, my emotions about those 3-4 months and the few follow up x-rays/check ups afterwards can be summed up with two words: perspective and grateful. While I found it traumatic two weeks (and longer) after giving birth, and I thought that I would never ever forget how hard and stressful the first months were, I now find that I don't think about it nearly as much as I expected I would. I look at Adam now and see a bubbly toddler with personality galore and so much athleticism that I completely forget that he even wore the Pavlik for the first few months of his life. Of course, when you throw in the rest from this last year: terrible acid reflux, allergies that cause asthma-like symptoms, a million breathing treatments, a terrible early daycare experience (I think our second-best early parenting decision was to get him out of that school and into the one he's in now), pneumonia, RSV, and every other virus you could possibly think of ... you tend to change the way you think about life and focus on the good instead of the hard, stressful, or scary. So as I look back, I am amazed that what I believed was the hardest thing we'd have to deal with was actually, while not to diminish it's seriousness or "forget" my emotions about it, not the worst we have faced. That's a strange revelation as I look back over the last year.

I found myself jealous of other parents who got to cuddle with their newborns during that cuddly stage without anything in between them. But would I trade the harness for those 3-4 months back? Absolutely not. I know that we did the right thing by following the orthopedic surgeon's suggestions. He told me that we could take the chance and see if his hips align themselves on their own (because many parents do make that choice), but that the harness was such an "easy" way to do everything in our power to help him get there, so why "wait and see" and then regret it if the situation didn't correct itself on it's own? The treatment options for babies much older or who's bones have already started to harden is much more traumatic. I have to say I agree with him. Maybe Adam's hips would have been fine without the harness, but I am so glad we didn't take that kind of chance, and I believe it paid off in the long run for him and for us.

Not all parents and children in these situations have the same outcome, but for us, the Pavlik ended up being a successful and (in the grand scheme of things) an "easy" treatment option.

DAREDEVIL

Future Mountain Climber

Outdoor Boy

Happy Kid.