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 may stop just above the knee. It will have an opening for hygiene. Hip spicas are made of a lightweight synthetic material which is very strong but reasonably light 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. Please support under the spica when lifting up. Never pick them up by the broomstick if present or under arms only.

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 prevent pressure sores. 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, the back and 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/heels 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 or nappy rash. 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 nappy off the cast to air dry.

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 low, shallow sides. Buggies need to have a separately reclining back and both shoulder and crotch straps which are able to be lengthened a significant amount. Car seats may also need both shoulder and crotch straps which are able to be lengthened a significant amount.

Car seats

Maxi Cosi Opal HD (0-18Kg) and Britax 2 Way Elite (9-25 kgs) are the two recommended car seats for children in hip spicas.

The Maxi Cosi car seat can be hired directly from Maxi Cosi Happy Hips Service (opens in a new tab). This service works based on an initial deposit from you of £120. For every month (or part month) you require the seat, they deduct £10, with any remaining deposit being refunded to you upon safe return of the seat.

In Car Safety Centre can hire an adapted seat - the Britax 2 Way Elite - for £265 with a returnable £75. Visit their website here for more details (opens in a new tab).

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.

See the following website: Steps charity equipment. (opens in a new tab)

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). Next, John Lewis, Asda and 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 YouTube film Hip Spica Baby Toddler Toileting (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 normal for the cast to become dirty and smelly as it is kept in place for many weeks.

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: Telephone: 01223 216101

Clinical Nurse Specialist: Telephone: 01223 254996

Orthopaedic practitioners in the plaster room: Telephone: 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)

Telephone: 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.

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

These groups on facebook have been recommended by previous spica families for advice and support, and as a source of second hand equipment

Steps Charity Worldwide – Support Group for Parents (1) DDH UK Support Network | Facebook (opens in a new tab)

DDH equipment to buy/donate/sell or swap in the UK - (1) DDH Equipment to Buy, Donate, Sell or Swap in the UK | Facebook (opens in a new tab)

Erin's Chair - Spica Chair - Facebook (opens in a new tab)

Car seat hire companies

(Prices correct at time of printing)

In Car Safety Centre

Britax Nordic Car Seat, for hire or purchase

Tel 01908 220909 /01702 808313/01908 220909

Website: In car safety centre (opens in a new tab)

Maxi Cosi- car seat hire

Happy hips service (opens in a new tab)

Britax Romer Hip Spica Car Seat Hire | Tiny Explorers Kids Rentals (opens in a new tab)

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)

Further Financial Support

Websites:

Wider support - Family Fund (opens in a new tab)

Tackling Financial Insecurity Together | Turn2us (opens in a new tab)

Local roundtable and rotary organisations can also be sources of financial assistance

Roundtable (opens in a new tab)

Rotary GB&I Template (rotary-ribi.org) (opens in a new tab)