No Delay in Age of Crawling, Standing or Walking with Pavlik Harness Treatment: A Prospective Cohort Study
Tyler J Stavinoha1, Stephanie Y Pun, J Damian McGlothlin
1From the Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Lucile Packard Children's Hospital at Stanford, Stanford, CA.
Insights
Pavlik harness treatment for hip dysplasia in infants may cause slight delays in early motor milestones like rolling and sitting. However, later milestones such as crawling and walking are not affected, reassuring parents and clinicians.
Area of Science:
- Pediatric Orthopedics
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Pavlik harness is the standard treatment for developmental dysplasia of the hip (DDH) in infants under six months.
- The impact of Pavlik harness treatment on infant motor milestone achievement is not well-documented.
Purpose of the Study:
- To investigate the effect of Pavlik harness treatment on the attainment of early and later motor milestones in infants with DDH.
Main Methods:
- Prospective cohort study of 35 infants treated with a Pavlik harness for DDH.
- Monitored achievement of eight motor milestones through questionnaires and clinical visits.
- Compared milestone attainment age with a historical cohort of healthy infants using one-sample Student t-tests and Benjamini-Hochberg correction.
Main Results:
- Infants treated with Pavlik harness achieved "roll supine," "roll prone," "sit," and "crawl on stomach" significantly later than controls.
- No significant differences were observed in the achievement of later milestones: "crawl on knees," "pull to stand," and "independent walking."
Conclusions:
- While some early motor milestones are achieved later in infants treated with Pavlik harness, the delays are not considered clinically significant.
- Later motor development, including walking, is unaffected by Pavlik harness treatment.
- Findings aim to reassure clinicians and parents regarding the developmental impact of this standard DDH treatment.
Background:
Pavlik harness treatment is the standard of care for developmental dysplasia of the hip in infants younger than 6 months. The effect of Pavlik harness treatment on the achievement of motor milestones has not previously been reported.
Methods:
In this prospective cohort study, 35 patients were prospectively enrolled to participate and received questionnaires with sequential clinical visits monitoring treatment of their developmental dysplasia of the hip. One-sample Student t -tests assessed differences in milestone attainment age, and the Benjamini-Hochberg procedure was conducted to decrease the false discovery rate. Post hoc power analyses of each test were conducted. The age of achievement of eight early motor milestones were recorded and compared with a previously published cohort of healthy infants.
Results:
Infants treated with a Pavlik harness achieved four early motor milestones markedly later than the reported age of achievement in a historical control group. These milestones included "roll supine" (5.3 vs. 4.5 months; P = 0.039), "roll prone" (5.7 vs. 5.0 months; P = 0.039), "sit" (6.4 vs. 5.2 months; P < 0.001), and "crawl on stomach" (7.7 vs. 6.6 months; P = 0.039). However, there was no difference in time to achievement of later motor milestones of "crawl on knees," "pull to stand," and "independent walking."
Conclusion:
Several early motor milestones were achieved at a statistically significantly later time than historical control subjects not treated in a Pavlik harness. Despite statistical significance, the small delays in early motor milestones were not thought to be clinically significant. No differences were observed in the later motor milestones, including knee crawling, standing, and independent walking. Clinicians and parents may be reassured by these findings.
Level Of Evidence:
Therapeutic Level II-prospective study.
