Pavlik harnesses for hip dysplasia proves a challenge for mothers hoping to breastfeed
Up to 6 weeks after Pavlik harness initiation for DDH, mothers were more likely to report difficulties with breastfeeding compared to a control group; however, Pavlik harness use did not produce statistically significant early cessation rates of breastfeeding by the six-week study mark.
Journal: Journal of Pediatric Orthopaedics (IF 1.5)
Article Year: 2025
This prospective study assessed 29 infants diagnosed with hip dysplasia (DDH) prior to 3 months of age who were ultimately treated with a Pavlik harness and compared this group to a control group of 29 patients who had been evaluated for DDH but who ultimately demonstrated a normal ultrasound and thus did not require further intervention. Their mothers completed three independently validated questionnaires at 2, 4, and 6- weeks post-intervention. The following questionnaires were used to surveil for both breastfeeding difficulties as well as depressive disorders: the beginning breastfeeding survey-cumulative (BBS-C), breastfeeding self-efficacy scale short form (BSES-SF), and patient health questionnaire-8 (PHQ-8). The DDH cohort had lower breastfeeding self-efficacy compared to the control group as detected by the BBS-C problem scores at 4 (17.6±6.4 vs. 20.8±3.7, P =0.045) and 6 weeks (17.2±6.2 vs. 20.2±3.3, P =0.029) as well as the BSES-SF scores at 2 (47.6±11.8 vs. 54.1±10.2, P =0.047) and 4 weeks (48.5±13.0 vs. 55.6±10.3, P =0.040). The PHQ-8 did not produce statistically significant differences in maternal depressive disorder likelihood. Notably, this study did not identify statistically significant early breastfeeding cessation or formula supplementation upon Pavlik harness use, results that run counter to a separate retrospective study significant at the time of publication in the world of pediatric orthopedics.
The researchers offer the potential hypotheses that Pavlik harnesses may impede optimal feeding positioning, latching efficacy, and skin-to-skin contact for reasons why this finding occurs. The researchers cite the fact that impedance is expected to be most prominent while mothers are in the semi-recumbent position, though this may or may not be conveyed to and understood by mothers—researchers found that mothers were not consistently educated on breastfeeding techniques while their children were using Pavlik harnesses. From an orthopedic standpoint, effective breastfeeding is important as studies have shown that exclusive breastfeeding leads to earlier development of the femoral head and thus improves DDH clinical outcomes; from an outpatient clinician’s standpoint, the benefits to breastfeeding are widely known to be clear.
Comment: While encountering a patient requiring Pavlik harnesses for hip dysplasia (DDH) is not terribly common, severe DDH may result in severe long-term complications and certainly requires further evaluation by specialists for possible intervention. Should the orthopedist opt for Pavlik harness correction, the outpatient clinician should be aware of the potential risk to an infant’s feeding as a possible side effect and thus monitor growth closely. This study does not assess whether these patient-reported outcomes resulted in clinically significant weight losses or diagnoses of failure to thrive (nor was it designed to make any recommendations targeting growth failure management). Further, the study recruited mothers of children less than three months of age, but the surveillance period had concluded by 6-weeks post intervention. Therefore, it is impossible to extrapolate outcomes in children up to 6 months of age, the age up to which the AAP recommends exclusive breastfeeding, and outpatient clinicians should remain vigilant for mothers who may require extra support regarding navigating their child’s Pavlik harness. Notably, patients in this study’s control group were nearly a month older than the experimental group with a P value <.001.
Researchers found that mothers were not consistently educated on breastfeeding techniques in the setting of Pavlik harness use; this sort of advice many clinicians may not feel necessarily comfortable providing. Additionally, outpatient providers may expect orthopedic specialists to provide breastfeeding tips and vice versa, with ultimately no one providing the advice and families left to figure things out independently.
To read more: Bram JT et al. Pavlik Harness Treatment for Infantile Hip Dysplasia Lowers Breastfeeding Self-efficacy. Journal of Pediatric Orthopaedics 2025 Sept; 45:8. (http://dx.doi.org/10.1097/BPO.0000000000002976)