Orthopaedics - Caring for your child in a hip spica

A hip spica is an orthopaedic cast used to immobilise the hip(s), spine or thigh to assist the healing process of congenital conditions (DDH), injured hip joint(s), or fractures of the middle spine or femurs (thigh bone). Some patients who have undergone hip/femoral surgery may also be managed in a hip spica.

There are four types of hip spicas: bilateral (both legs), unilateral (one leg), one-and-a-half and a half.

Becoming familiar with the management plan that is required for the treatment of your child’s condition will help them and the rest of the family adapt their routines accordingly.

Moving your child safely

You will need a safe way of moving your child around while they are wearing a hip spica. Most children will fit in to their own prams or strollers, especially if they can be reclined. You may need to hire a wheelchair if your child is too large for a stroller.

Lifting

When lifting your child, it is important to support them and the weight of the plaster. Do not lift them under the arms without supporting the cast as well.

Keep your child as close as possible to your own body when lifting them up. This helps prevent straining your back and makes your child feel secure.

Older children in hip spicas can be very heavy and an occupational therapist may be able to help with equipment (eg hoists).

If you have any concerns about lifting your child or concerns about the amount of support you have at home, please discuss these with your nurse.

Positioning

Supervise your child at all times if they are on their side or their tummy for play time. Children in a hip spica cannot move easily, so you will need to change their position often. Never place your child on their tummy unsupervised.

• You should change your child’ s position every two to four hours (day and night) to avoid developing pressure areas under the cast.
• Children can be positioned for play on their back, side or tummy, using pillows for support. Lying on the unaffected side with the cast supported with pillows between the legs can be a comfortable position.
• Make sure your child’s toes, ankles and heel (if not included in hip spica) can move freely. Ensure their heels are not pressed into the mattress/chair, as this can cause pressure issues.

Following the above positioning tips should help to decrease the risk of pressure sores (sores caused by constant pressure or friction on the skin).

Sleeping

Never place your child on their front (tummy) to sleep in a hip spica. When putting your child down for a sleep or rest, they must be on their back.

Safe sleep guidelines still apply to babies in hip spicas.

If you have any questions or concerns, it is important to discuss them with your treating doctor before going home.

Toileting and nappies

Care of the toileting area of your child’s cast is important. A hip spica will rarely be changed because it smells due to soiling and urine staining. You will be instructed to use the double nappy technique.

• Nappies need to be checked often (at least every two hours during the day and every four hours during the night).
• Nappies must be changed as soon as they are wet or soiled. Use baby wipes to clean inside the plaster cast.
• For extra protection, tuck sanitary or incontinence pads into the front and back of the toileting area. Cover with a disposable nappy to keep the cast dry. Older children can use a urine bottle or pan for toileting. They can be lifted onto the toilet, making sure they are sitting as upright as possible (This will be demonstrated prior to discharge).
• An over-toilet aid with arm supports and adjustable height legs may assist with toilet transfers (please seek advice from your occupational therapist).
• Leaving the toileting area open will assist in airing the cast.
• Positioning of your child with their head elevated above the level of his hips can also prevent urine or faeces from soiling the cast.

Car transport and moving around

In Queensland children aged seven years and under must be secured in an approved child restraint when travelling in a car. This legal requirement remains the same when your child is in a hip spica.

Car seats often need modifications such as padding or longer crotch straps to allow your child to fit into their seat when they are in the hip spica.

If your car seat is not suitable, you are able to hire car seats from Kidsafe House. Tel: 07 3854 1829 www.kidsafeqld.com.au

An occupational therapist will discuss safe transport and hire options with you and any concerns you may have about car seats for your child.

Things to remember

• Do not get the hip spica wet
• Avoid using powders, oils and lotions in the casts
• Check skin around the edges of the plaster daily for redness, blisters, pressure areas or skin irritations
• Your child will continue to grow while in a hip spica. Check regularly to make sure the cast is not too tight
• Prevent your child from poking or pushing objects down inside the cast
• Prevent your child from removing or pulling at the cast lining/padding
• Attend your scheduled follow-up appointments
• Contact the orthopaedic department or return if you have any concerns

Play and entertainment

Children adapt quickly to being in a hip spica – try to continue your child’s previous routines as much as possible. Ensure your child is stimulated to prevent boredom.

• Toys should be placed within easy reach.
• Frequent changes of scenery will help with boredom.
• Regular interaction with family and friends is important.

An occupational therapist will talk with you about ideas for play and different positions for play which are suitable for your child.

Feeding and diet

Breastfeeding infants can and should continue to breastfeed. Experiment with different positions until you and your child fine one that is comfortable.

• If your child is eating solids, feed them smaller meals more often to reduce bloating of the stomach.
• Sit your child as upright as possible when feeding (probably in their pram or wheelchair), ensuring the child and chair are well secured.
• Discourage large amounts of fluid and food intake prior to bedtime or sleep to avoid increase in excretions (faeces and urine).
• Encourage and maintain well balanced healthy intake from all food groups to help prevent constipation and to promote healing.

Clothing

Your child will need to wear large-sized clothing that can fit over a hip spica. Larger children can be dressed in pants altered with velcro or press-studs down the side to fit over the cast. Older children can wear larger sized underpants.

The cast may create increased warmth around your child’s body. Be mindful of extra layers of clothing or blankets – particularly in the warmer months, as your child may become overheated.

Protect the ‘free’ unaffected leg with loose pants or a sock to prevent scratching or rubbing on the affected side.

Bathing and hair washing

A sponge bath (using a a bowl of water, baby soap and a face washer) will avoid getting the hip spica wet. Your child’s hair can be washed over the edge of a sink or bath using a jug. You will need the help of another person to do this (our staff will demonstrate this prior to discharge).

An older child may be washed in the same way but positioned on the bed or floor.

Avoid using powders, oils and lotions in the cast.

Always make sure the plaster stays dry when bathing and washing hair.

Seek medical advice if

• Your child has pain or swelling.
• You notice a blister or sore developing inside the cast.
• You notice an unusual odour coming from the cast.
• Your child experiences numbness or persistent tingling.
• Your child’s cast becomes badly soiled.
• Your child’s cast becomes too loose/tight.
• Your child develops skin problems at the cast edges.
• Your child develops a fever not related to a cold, ear infection or other illness.
• You have any questions regarding your child’s treatment.

Contact us

Orthopaedic Outpatients Department
Level 1, Queensland Children’s Hospital
501 Stanley Street, South Brisbane
t: 07 3068 2579
e: chq_1borthoOPD@health.qld.gov.au

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

Resource No: FS084. Developed by Orthopaedics Unit. Updated: March 2015. All information contained in this sheet has been supplied by qualified professionals as a guideline for care only. Seek medical advice, as appropriate, for concerns regarding your child’s health.