Pavlik Harness Treatment for Infantile Hip Dysplasia Lowers Breastfeeding Self-efficacy.

Overview

abstract

INTRODUCTION: Breastfeeding is recommended exclusively until at least 6 months of age by the American Academy of Pediatrics. For mothers of children with hip dysplasia (DDH), Pavlik harness treatment may impact breastfeeding. The aim of this study was to assess how Pavlik harness treatment may impact breastfeeding by evaluating patient-reported outcomes (PRO) associated with breastfeeding. METHODS: This was a prospective cohort study of mothers of patients treated in a Pavlik harness for DDH at <3 months of age. Controls were recruited from patients evaluated for DDH who had normal ultrasounds. Patients with neuromuscular/developmental conditions were excluded. The validated beginning breastfeeding survey-cumulative (BBS-C), breastfeeding self-efficacy scale-short form (BSES-SF), and patient health questionnaire-8 (PHQ8) were administered to mothers at the initial clinic appointment and 2, 4, 6 weeks postbaseline. RESULTS: A total of 29 cases and 29 controls were enrolled. There were no differences in baseline demographics or socioeconomic/educational status between maternal cohorts. There were similarly no differences in demographics or birth characteristics between children except presenting age was lower in the DDH cohort (30.7±22.1 vs. 58.7±21.4 d, P <0.001). PROs were similar at enrollment. Six weeks after harness initiation, 76% of the DDH cohort were still breastfeeding (vs. 89% of controls, P =0.303), and 52% (vs. 77%, P =0.052) reported breastfeeding >80% of the time. Mothers of 13% of DDH patients reported that the Pavlik usually/always negatively impacted their breastfeeding ability at 6 weeks. The DDH cohort had lower BBS-C problem scores at 4 (17.6±6.4 vs. 20.8±3.7, P =0.045) and 6 weeks (17.2±6.2 vs. 20.2±3.3, P =0.029). BSES-SF scores were additionally lower among the DDH group at 2 (47.6±11.8 vs. 54.1±10.2, P =0.047) and 4 weeks (48.5±13.0 vs. 55.6±10.3, P =0.040). There were no differences in PHQ-8 scores. CONCLUSION: Pavlik harness treatment for DDH was associated with lower patient-reported breastfeeding efficacy PROs. Pavlik harness treatment did not lead to earlier breastfeeding cessation 6 weeks after harness initiation. Lower breastfeeding efficacy for these mothers may justify early education regarding effective breastfeeding methods in a harness. LEVEL OF EVIDENCE: Level II-prospective therapeutic cohort study.