Introduction

The Denis Browne Bar (DB Bar) is used in the treatment of Developmental Dysplasia of the Hip. The DB bar holds the child’s hips up (flexed) and apart (abducted)- This position holds the hip and thigh bones in the optimal position for development.

The DB bar has cuffs that go around the thighs and are attached to a bar that sits between the child’s legs.

When should the brace be worn?

You should be told by your surgeon, physio or paediatrician when your baby needs to wear the DB bar. This may be:

• 24 hours a day without removing it at all, or
• 23 hours a day- Removing it for one hour a day for a bath, etc., or
• Only when sleeping

Putting the DB Bar on

• When putting the brace on, make sure the foam tabs are tucked under and the buckle is facing away from you.
• Straps come from the front of the brace, run over the top of the thigh through the buckle at the back, then back upon themselves to attach on the front 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 behind the bottom when your baby is on their back.
• Clothes go over the brace. Make sure the clothes are not too tight over the knees- you may need to go up a size!

Getting Accustomed to the DB Bar

Getting used to the brace

It takes most 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.

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.

Follow-Up

• The orthotist will arrange regular appointments to monitor your baby’s growth and adjust the DB bar as needed.
• Contact OAPL if you have any questions or concerns about your child’s treatment or the DB bar.

While Wearing the DB Bar

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.
• 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 your orthotist.
• If you can 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.

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 under the brace.

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.
• 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.