Hip Spica care

What is a hip spica?

A hip spica is a cast which starts from half way down the body (from the tummy), around the hips and extends down both legs. In most cases on the affected side, the cast will continue down to the ankle. On the unaffected side it will stop just above the knee. It will have an opening for hygiene. Hips spicas are made of a lightweight synthetic material which is very strong but reasonably lightweight and comes in a variety of colours. The purpose of a hip spica is to keep the affected hip in the best position in order for it to develop normally.

Will I still be able to pick my child up when they are in the spica?

Yes, the spicas are extremely strong and durable so you will not cause any harm by carrying your child or moving them around with the spica on. They will be a little heavier but the casting material is lightweight, so it shouldn’t mean the child is too heavy to carry. You can carry your child on your hip as normal. Support under the spica when lifting up. Never pick them up by the broomstick if present.

Will I be able to breastfeed my child?

Yes. You may need extra cushions/ breast feeding pillow to get comfortable. It may take some time to get into a comfortable position for you both.

Will my child be able to move around?

You will be surprised at how mobile your child will be in the spica! They can roll to either side and onto their front with little effort. It has also been known for older children to walk in their spicas although this is not recommended on a regular basis!

How will I position them?

It is important that your child is well positioned to avoid discomfort and also pressure areas. We recommend a pillow underneath the legs (but not the pelvis) to support the lower leg of the “free” leg and to avoid pressure on the heel of the leg in full plaster. It is important to check the areas where the plaster finishes, around the top, on the tummy and the back and where the plaster finishes on the legs for redness and sores.

It is important to change position regularly. We recommend that you child has some periods on their tummy to encourage air flow around the plaster. It is important that your child’s feet do not rest on the mattress as this may cause pressure areas.

Frequent nappy changes will reduce the moisture that may get under the cast and could cause pressure sores. Make sure the skin is kept clean and dry. If you notice redness, please reposition and contact the nurse specialist for advice. Avoid excess use of wet baby wipes as their moisture can saturate or damage the cast.

A hairdryer on cool setting can be carefully used to dry the cast or leave the cast to air dry.

Your Physiotherapist will go through optimum positioning with you at your pre op appointment and your physio may see you on the day the plaster is put on in hospital.

Will I be able to use my normal pushchair or car seat?

Your child’s legs will be wider apart than normal and many car seats and push chairs / buggies will not cater for this. The car seats and buggies that work with hip spicas need to have either width expanding or low, shallow sides.

Examples are:

Maxi Cosi Opal HD and Britax 2 Way are the two recommended car seats for Spica babies. The Maxi Cosi car seat can be hired directly from Maxi Cosi Happy Hips Service for an initial deposit of £120 to hire. For every month used, £10 from the deposit is deducted. Upon return you will receive any remaining deposit. If you have a Maxi Cosi car seat already, then it will be free to hire.

In car safety -can hire The Britax 2 Way Elite- £220 hire with a returnable £75.

A suitable chair can be purchased £220 and the seat can be used after the need for the hip spica by taking out the extra padding and can be used for until the child is 4-5 years old. Pricing correct at time of print.

Suggested buggies: Silver Cross Pop and Mama’s and Papa’s Armadillo.

A Silver cross Pop stroller buggy can be hired (depending on availability) from the Paed orthopaedic nurse specialist for £20 deposit and £10 when equipment returned.

Is there any other special equipment my child will need?

You may find the following things useful:

Small towels, blankets, cushions, pillows, hip seats, breast feeding pillow, bean bags are often comfortable for your child to lie on as they tend to mould to the position the child is in. For feeding, highchairs can still be used if they are wide based and without a middle bar, for example the Joie Mimzy Snacker. Alternatively, travel fabric based feeding solutions are another option and fit most household dining chairs, for example Totseat or Baby Polar Gear booster Seat.

Depending on availability the hip spica chair can be loaned by the Paed Orthopaedic Nurse Specialist for £20 deposit and £10 when equipment returned.

Will I be able to bath my child?

No. Although the plaster material is water resistant, it is not waterproof and if the padding underneath the plaster gets wet, it can cause breakdown of the skin. Therefore we recommend strip washing only.

Will I be able to dress my child?

Yes. Clothes can be worn over the spica but may need to be adapted. Dresses (for females) and vests, tops, harem trousers at least one size up from their current size. Legwarmers or cut off tights depending if the cast has a bar keeping the legs together (broomstick). Marks and Spencer’s currently stock hip dysplasia outfits which may work. Etsy also sell hip dysplasia clothing.

What about toileting?

There will be an opening for hygiene in the plaster. The best method we have found is to cut out the pad of a size smaller nappy or use a large sanitary towel and tuck this within the opening to absorb any soiling. Instead of cutting the smaller nappy you can tear off the tabs as this can be quicker. Please do not put talc/ baby powder down the cast.

Then use a larger size nappy over the top and around the outside of the plaster. It is important that the skin stays as clean and dry as possible. We therefore recommend that initially you check your child’s nappy on a regular basis, such as every couple of hours to ensure they remain dry. A useful You tube film (opens in a new tab) from Steps charity website about toileting.

It is common for swelling and bruising to appear post-surgery around the groin area under the cast.

It is important to contact the hospital if:

• Your child is overly distressed and not comforted by painkillers.
• The skin underneath or around the spica is looking red and sore.
• If you notice any sores or blisters on the skin under the edges of the cast.
• If your child has a fever.
• If the cast is too tight or too loose.
• Your child’s toes are blue, cold and swollen. Immediately elevate their feet.
• If the plaster breaks, cracks or softens.
• Any unusual smells from the cast that cannot be explained by soiling.

Useful contact numbers:

Consultants secretary: Tel: 01223 216101

Clinical Nurse Specialist: Tel: 01223 254996

Orthopaedic practitioners in the plaster room: Tel: 01223 217772

Useful reading and websites:

Cast Life- A parent’s Guide to DDH by Natalie Trice.

Spica life.com

There are numerous blogs and facebook pages/ groups that may be useful.

In Car Safety Centre: (Britax Nordic Car Seat, for hire or purchase)

Tel 01908 220909 In car safety website (opens in a new tab) - Prices correct at time of printing.

Maxi Cosi- car seat hire: 01284 413141 Maxi Cosi website (opens in a new tab) - Prices correct at time of printing.

National Support Group

STEPS - The National Association for Children with Lower Limb Abnormalities,

Lymm Court, 11 Eagle Brow, Lymm, Cheshire, WA13 0LP;

Steps website (opens in a new tab)

DDH UK (Formally Spica Warrior) Website: DDH UK Charitable Trust (opens in a new tab)