# 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?

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> subject: Child Health

## 문제

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?

## 보기

1. We will check the skin under the harness daily for redness or breakdown.
2. We can remove the harness for 2-3 hours daily to give our baby a bath and let the skin breathe. **✔ 정답**
3. We will keep the diaper area clean and dry, and change diapers frequently to prevent skin irritation
4. We will follow up with the orthopedic specialist as scheduled to monitor the hip development.

**정답: 2**

## 해설

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

## 심화 해설

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].References (research sources)

- [1]Quality, reliability, and educational value of YouTube™ videos on Pavlik harness treatment for developmental dysplasia of the hip.Research articleUnat B, Karabulut Ç, Bilgin MA, Erol R, Rızvanoğlu İH, Gönder N. (2026) · DOI: 10.1177/18632521261438642

## 임상 시나리오

Pavlik Harness Home Care GuideContinuous Wear is Critical for DDH Correction
The Pavlik harness must be worn 23-24 hours per day. It should never be removed for extended periods like 2-3 hours, as this disrupts the therapeutic hip flexion and abduction needed for proper joint development.

Perform daily skin assessments under the straps and chest band for redness or breakdown. Keep the diaper area clean and dry, using a barrier cream if needed, but never place the diaper between the skin and the harness straps.

CautionDo not adjust the harness straps yourself. Only remove the harness if specifically instructed by the orthopedic specialist, and attend all scheduled follow-up appointments to monitor hip reduction progress.

## 핵심 개념

- **Pavlik harness** — A soft splint used to treat developmental dysplasia of the hip (DDH) in infants by maintaining the hips in a flexed and abducted position.
- **Developmental dysplasia of the hip (DDH)** — A condition where the femoral head has an abnormal relationship with the acetabulum, ranging from mild instability to complete dislocation.
- **Continuous wear** — The prescribed schedule for a Pavlik harness, typically 23-24 hours per day, with removal only for specific medical reasons or brief, supervised care as directed.

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