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Kids Health Information

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. See our Developmental dysplasia of the hip (DDH) fact sheet for more information.  

    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.

    Denis_Browne_bar

    See also our Denis Browne Bar for DDH video.

    Care at home

    When your baby should wear the brace

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

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

    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 lining made of soft fabric 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. You should be able to fit just the tip of your finger underneath the cuff.
    • 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 cannot be taken off for bathing, and your baby will need to be sponge bathed. The orthotist will show you how to do this.
    • Monitor your baby's skin daily. Take care to clean your baby's skin and pay attention to any skin irritation or redness. If the skin becomes broken, or the redness/irritation gets worse, contact the orthotist.
    • If you are able to take the brace off for bathing, make sure you dry the skin well 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. 
    • It is not recommended that you use any creams or powder under the brace unless advised otherwise.

    Cleaning the brace

    • If you are allowed to remove the brace, change and wash the fabric 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. 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 as it may distort the shape of the brace.
    • Avoid wetting the velcro straps and make sure the brace is completely dry before putting it back on your baby.
    • If you cannot remove the brace, wipe the inside of the cuffs with a face washer and then dry well.

    Your baby's movement

    • Observe your baby's knee movements at least once each day. Your baby should be able to kick their legs. You may need to encourage them to do this by tickling their foot a little. If they can't kick their legs, contact your orthotist.

    Nappies and clothing

    • Your baby can wear nappies as normal with the DB 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 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 head position frequently 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 our Plagiocephaly - misshapen head fact sheet for more information. 
    • 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 DB bar as needed.  
    • Contact the orthotist if you have any questions or concerns about your child's treatment or the DB bar.

    Key points to remember

    • Monitor your baby's skin each day and thoroughly clean their skin. Contact the orthotist if any skin irritation or redness gets worse or if your baby's skin is broken.
    • 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 settling your baby to sleep.
    • The inside of the 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. 
    • Vary the position of your baby's head when they sleep to avoid a flat spot developing.

    For more information

    Common questions our doctors are asked

    What should I do if my baby has diarrhoea and the brace has become soiled, but we are not supposed to take the brace off at all?

    If you are told not to remove the brace, it can be cleaned using wipes or a damp cloth. Contact your orthotist if you are concerned, or feel that it is necessary to remove the brace.

    What is femoral nerve palsy?

    The femoral nerve passes close to the hip joint, and in very rare cases this nerve may be affected by a baby's position in the orthosis, and this is called femoral nerve palsy. If your baby has this condition, the quadricep muscle in the front of their thigh won't be able to work properly and your baby won't be able to straighten out or kick the knee. It is usually temporary and your baby should make a full recovery.


    Developed by The Royal Children's Hospital Orthotics and Prosthetic department. We acknowledge the input of RCH consumers and carers.

    Reviewed August 2020.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.