A 3-month-old infant is being evaluated for developmental dysplasia of the hip (DDH). The nurse is teaching the parents about safety measures during treatment with a Pavlik harness. Which statement by the parents indicates the need for further teaching?

The Pavlik harness must be worn continuously; removing it for bathing is incorrect. Other options are appropriate safety measures.

Key Safety Principles for Pavlik Harness Treatment

The Pavlik harness is a widely accepted first-line treatment for developmental dysplasia of the hip (DDH) in infants. When teaching parents about home management, the nurse must emphasize that the harness must remain in place continuously as prescribed by the orthopedic specialist to maintain proper hip positioning. The harness works by holding the infant's hips in a flexed and abducted position, which allows the femoral head to seat properly within the acetabulum, promoting normal joint development.
Analysis of Parental Understanding

Statement Requiring Further Teaching (Option 2)

The statement about removing the harness for 2-3 hours daily indicates a significant knowledge gap. The Pavlik harness is designed for continuous wear, typically 23-24 hours per day, with removal only permitted under specific circumstances directed by the healthcare provider. Removing the harness for extended periods compromises the therapeutic positioning and can delay or prevent successful hip reduction. The harness straps maintain precise angles of hip flexion and abduction; any prolonged interruption disrupts this alignment and reduces treatment efficacy.

Statements Demonstrating Appropriate Understanding

Option 1: Daily skin assessment under the harness is essential. The straps and chest band can create pressure points, and infants have delicate skin prone to breakdown. Parents should inspect all areas where the harness contacts the skin, paying particular attention to the groin, behind the knees, and under the shoulder straps. Early detection of erythema or excoriation allows for timely intervention.

Option 3: Maintaining diaper area hygiene while the harness is in place requires specific techniques. Diapers should be placed under the harness straps rather than over them to prevent soiling of the harness material and to keep moisture away from the skin. Frequent diaper changes minimize prolonged exposure to urine and stool, which can cause irritant contact dermatitis and skin maceration.

Option 4: Regular orthopedic follow-up is critical for monitoring hip development through clinical examination and imaging studies such as ultrasound. The specialist assesses the stability of the hip joint, confirms maintenance of reduction, and adjusts the harness fit as the infant grows. Missed appointments can result in unrecognized treatment failure or complications.
Clinical Reasoning for NCLEX-RN

When evaluating parent teaching for DDH management, the nurse must recognize that misconceptions about harness wear time directly threaten treatment outcomes. The continuous nature of Pavlik harness therapy distinguishes it from other orthotic devices that allow scheduled removal. Parents may express concerns about bathing and skin care, which provides an opportunity for the nurse to teach sponge bathing techniques and safe methods for localized skin cleansing without complete harness removal. The nurse should also reinforce that any harness adjustments must be performed by the trained healthcare provider, as improper strap tension can cause femoral nerve palsy or avascular necrosis of the femoral head ^[1].