We present a systematic review of the use of the Pavlik method in developmental dysplasia of the hip. Our aims were to evaluate treatment protocols, reported results and factors associated with successful outcomes. We found 218 relevant citations, of which 62 fulfilled our inclusion criteria. Our results have shown satisfactory clinical and radiological outcomes with the use of the harness at long-term follow-up. However, failures of harness use have been reported along with episodes of avascular necrosis. Ultrasound plays a key role in the early detection of such cases. Alternative methods of splintage have been described but larger comparative studies are required to change current practice.