Kids Health Info

Denis Browne Bar for DDH

  • Developmental dysplasia of the hip (DDH) is a dislocation of the hip caused by an abnormal development of the hip joint in some babies. The ball at the top of the thighbone is not stable within the hip socket. The ligaments of the hip joint may also be stretched and loose. This used to be called Congenital Dislocation of the Hip (CDH). For more information, refer to the  DDH factsheet.

    Treatment

    Babies with DDH often need to wear a special brace (medically called an orthosis). The Denis Browne Bar (DB Bar) is one type of brace used to treat DDH. The DB Bar has cuffs that go around the thighs and are attached to a bar. This holds the hips and knees up (flexed) with the legs apart (abducted).  This position allows contact between the thigh and hip bones and helps the muscles and ligaments to strengthen while the hip is developing.

    Dennis_Brown_Bar.jpg

    When does your baby wear the harness

    Your surgeon or paediatrician may advise that your baby wears the DB bar either:

    • 24 hours a day without removing it at all; OR
    • all the time except when bathing; OR
    • only when sleeping.

    Home care

    Putting the brace (orthosis) on:

    • When putting the brace on, make sure the foam tabs are on top and the buckle is facing you.
    • Straps come from the back of the brace, run over the top of the thigh through the buckle, then back upon themselves to attach on the back of the cuff.
    • Always put a material lining on the skin under the cuffs (cotton socks with the foot cut off work well) 
    • Each cuff should be fastened firmly around the thigh with a snug fit.
    • The bar should sit underneath the bottom when your baby is on their back.
    • Clothes go over the top of the brace.

    Getting used to the brace:

    • It takes some babies a couple of days to get used to the brace. Some babies may cry or seem unsettled for the first couple of nights. This should settle down after a few days.

    Hygiene and skin care:

    • If your doctor has said that the brace must be worn 24 hours a day, it can not be taken off for bathing. Your baby will need to be sponge bathed and the orthotist will show you how to do this.
    • Monitor your baby's skin daily. Take care to clean your baby's skin and if you notice any skin irritation or redness, contact the orthotist.
    • If you are able to take the brace off for bathing, make sure you dry the skin well with a towel before putting the brace back on. When bathing your baby, pay particular attention to the creases at the back of the knees and near the hips. The brace will also need to be cleaned. Change and wash the material lining at least once every day. The inside of the cuffs and the brace also need to be washed and towel dried at least once every day. See the next section, Cleaning the brace, for more information.
    • We strongly suggest not to use any creams or powder under the brace unless advised otherwise.

    Cleaning the brace

    • If you are allowed to remove the brace, use a soft nail brush and some baby soap to clean the foam.
    • Rinse and wipe well and towel dry.
    • Do not use a hairdryer to dry the brace.
    • If you cannot remove the brace, wipe the inside of the cuffs with a face washer and then dry well.
    • Avoid wetting the velcro straps and make sure the brace is completely dry before putting it back on your baby.
    • The inside of the cuffs of the brace need to be washed and towel dried at least once every day.

    Nappies and clothing

    • Your baby can wear nappies as normal with the Denis Browne Bar.
    • Do not hold your baby's feet together during nappy change.
    • Only loose fitting clothes should be worn over the brace.

    Feeding

    • You can keep breastfeeding your baby while the DB Bar is on. You will need to find a position that is comfortable for both you and your baby. Extra pillows may help.

    Positioning of your baby

    • Your baby will need to sleep on their back while the DB Bar is on. It is important to change your baby's position to avoid a 'flat spot' developing on their head. The skull bones are very soft and the pressure of being in one position for too long can affect the shape of their head, making it flat at the back. (See factsheet on plagiocephaly for more information).
    • During sleep time the position of the baby's head should be varied to ensure the baby does not favour a particular side (left or right).
    • Supervised tummy time will decrease the risk of your baby developing a flat spot on the back of the head. It will also promote body stability, limb coordination and head control in your baby. 

    Follow-up

    • The orthotist will arrange regular appointments to monitor your baby's growth and adjust the orthosis as needed You need to book in advance to see the orthotist and organise the appointment to be on the same day as you see the doctor. You will need to see the orthotist after you have seen the doctor.
    • Contact the orthotist if you have any questions or concerns about your child's treatment or the DB Bar.

    Key points to remember

    • Your baby may cry a little or seem unsettled for the first couple of nights after the brace is fitted. This should settle after a couple of days.
    • Monitor your baby's skin every day. Thoroughly clean your baby's skin and if you notice any skin irritation or redness, phone the orthotist.
    • If you have been told that you can take the brace off try to keep your baby's legs apart when bathing your baby, changing nappies or putting your baby to sleep.
    • The inside of cuffs and the brace need to be cleaned at least once a day. Make sure the brace is completely dry before putting it back on your baby.

    For more information

    Individual instructions

    • Your child's Orthotist is: ____________________________________________________     
      T: (03) 9345 5870

     

    Factsheet developed by the Orthotists and Prosthetic Department, RCH. First published Sept 2006. Updated November 2010.

Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts.