Caring for your child in a Hip Spica

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1 Caring for your child in a Hip Spica Parent/Caregiver Information Child Health Service What is a Hip Spica? A hip spica is a cast which is used in some leg fractures and hip conditions in children. The cast is used to immobilise the hip joints and/or thigh bone (femur) allowing the bone and soft tissue structures (such as ligaments) to heal in the correct position. The hip spica usually extends from the mid chest down to below the knee. If both hips or thighs are involved, then the cast will extend to the toes. A hole is left in the groin area to allow your child to pass urine/bowel motions. Most hip spica casts are made of full fibreglass. However there will be times when a plaster of Paris cast is underneath with a Fibreglass shell. Hip spica casts take approx hours to dry. During this time it is important that your child rests on pillows. The Orthopaedic clinic nurses will check the cast and trim and/or pad the cast as necessary to ensure it is as comfortable as possible. Cast and skin care A waterproof tape is applied to the edges of the cast to prevent damage to the plaster from sweat and other moisture. The tape also prevents the edge of the cast from damaging the skin. The tape can be wiped with a damp cloth to remove soiling. If the tape rubs off, it is important to replace it. To maintain good skin care there are a few important things to remember. It is important to keep the plaster as dry as possible. Avoid food or items getting or dropping down the cast. Ensuring that your child is wearing a tee-shirt will help avoid this. Check the skin around the edge of the top of the cast and in the crotch area for any red marks, rash, blisters or skin breakdown. Contact the Orthopaedic clinic if this happens. Do not use lotions, powders or oils under the cast or around the edges. Powders have a tendency to build up or cake around the cast, and lotions/oils will soften the skin making it easier for the skin to breakdown Ensure the nappies fit snuggly to avoid any leakage Bathing Hip spica casts are not waterproof and must be kept dry at all times. If your child s cast becomes wet it will become very smelly. The plaster will also become soft and crack. Sponge washing is recommended whilst your child is in the hip spica as it is important to keep the cast dry. A damp cloth e.g. baby wipes can be used close to the edge of the cast to remove any stray crumbs and to help keep the plaster clean. Dry the skin well to prevent skin breakdown. Hair washing Always use two people when washing your child s hair. To wash your child's hair, place their head over a basin or bath. Support their head with one hand and using a jug of water in the other hand to wash their hair. CapitalDocs ID: PD PIB-39 V2 Issue date: July 2016 Review date: July 2019 Page 1 of 5

2 Use the second person to cradle the child on their lap whilst you wash the hair. Always tuck a towel or plastic into the top of the hip spica to protect the cast from getting wet. Toileting If your child is in nappies use disposable nappies as these draw moisture away from the cast. A double nappy technique should be used to avoid soiling the cast. This requires two individual nappies of different sizes. The first nappy needs to be just bigger than the groin hole, tucking it into the front and back of the cast. Place the second nappy over the cast and nappy area to secure the first nappy. Remember to change nappies regularly to prevent overflow and the risk of dampening the cast. This may mean you need to change the nappy during the night. The taped edges of the cast can be wiped clean if soiling occurs. Older children may be able to sit on the toilet. This will depend on the angle they are cast in. A footstool can be used to rest the casted leg on. If this is not possible a bedpan or urinal will be provided before your child is discharged from hospital. Children should be propped in an upright position when toileting to assist gravity in keeping moisture away from the cast. Lifting your child Your baby or child will be heavier once the hip spica cast is on. The cast can add up to 5kgs extra weight. It is, therefore, important to pick them up in the correct way. Care must be taken not to strain your back. Use your legs to lift and keep a wide base of support with your back in a straight position. Your child should be held close to your body to reduce the load, with one hand placed under the bottom area and the other in the upper trunk area. If your child has a broomstick fitted between the knees, support their bottom and back. Do not lift your child by the broomstick when picking them up or turning them as this weakens the total plaster shell. For older children you can use sliding sheets to transfer your child from bed to chair. You must always use two people to do this. Your Occupational Therapist and Physiotherapist can demonstrate this technique to you on the ward. It is important that the cast remains solid, particularly in the hip area. Check the cast daily for cracks and dents. Any movement of the cast at the hip area should be reported to Orthopaedic clinic immediately. Young children may grow out of their cast after 4-6 weeks. If you believe the cast is becoming too tight you should contact Orthopaedic clinic for a review. Your child s cast will also be checked at each outpatient visit. This is a good time to discuss with staff any problems you are having. Positioning It is important that your child is placed in a variety of positions during the day. Turning or changing your child s position at least every 2 to 4 hours will help to relieve pressure areas occurring from your child being in one position for too long. When positioning your child ensure the cast is well supported and there are no gaps between the cast and the underlying surface. Ensure the top of the cast is not pressing into your child s tummy. Where CapitalDocs ID: PD PIB-39 V2 Issue date: July 2016 Review date: July 2019 Page 2 of 3

3 possible position your child so that the head and shoulders are higher than their bottom. This helps to keep the cast dry in terms of toileting. Lying on the back: Position pillows horizontally under the upper back and back of their legs. A tri pillow or rolled towels can also be useful in aiding positioning. Check that they are comfortable and the cast is supported. Aim to keep the heels free from pressure. Lying on tummy: Pillows or bolsters can be placed horizontally underneath the chest to support and elevate the upper body. Alternatively they can be laid on a bean bag. Keep the arms free so they can play with toys placed in front of them. Sitting: A bean bag offers good support as it moulds well around the cast and your child s body. Sleeping: It is important to alternate positions when sleeping by putting cushions under the mattress to position your child s weight to one side. After 4 hours change sides to shift the pressure. Your child can also sleep on their back. Breast feeding This can feel awkward to begin with. Use pillows to help support the weight of your child. Tri pillows are a useful shape for positioning your child whilst feeding. Feeding Ensure your child is propped upright when eating to aid digestion. Your child can eat whilst in the stroller, on an adults lap or propping them up with pillows or bean bag (tri-pillow can be useful) for eating. Always use a bib, towel or apron to prevent spills or crumbs dropping down the front of the cast. Some people find it useful to put a large T-shirt on their child to cover the cast area. Clothing Due to the size and shape of the hip spica clothing the lower body can be difficult. Clothing can be adapted with velcro or buttons at the sides of garments as fastenings. Remember during warmer climates your child can become hot on the parts of the body covered by the cast. Clothing should be loose and preferably made of cotton or natural fibres. Dresses are good for girls as they can be slipped over the cast. Pain relief Pain relief should be taken as advised by the nurse or doctor. Paracetamol is usually the most appropriate pain relief. You should follow the instructions on the bottle. If this is not sufficient to control your child s pain please contact the Orthopaedic clinic. Play It is important for your child s development that they engage in play. As they are restricted in movement they will need to be adequately stimulated. Otherwise they will become bored and frustrated. Music provides good auditory sensory input. Positioning your child on their tummy on a bean bag will support the cast. This will enable their arms to be free to play with toys. Depending on your child s age they may be able to lie on their back on a bean bag. A play frame could then be positioned over the bean bag. CapitalDocs ID: PD PIB-39 V2 Issue date: July 2016 Review date: July 2019 Page 3 of 3

4 Don t be afraid to have your child placed on your lap with pillows. You can then stimulate them with toys and books. Returning to Kindergarten/School When your child returns to Kindergarten or School you will need to consider: Access to the building Toileting needs Your child s restricted mobility Your child s positioning Mobility Your child should not walk on his/her cast unless instructed to do so. If s/he is allowed to walk on the cast a shoe will be provided to protect the bottom of the cast. Babies and Toddlers Your Occupational Therapist can discuss the options that will best suit your child with you. If due to special positioning requirements your child needs the short term loan of a stroller your Occupational Therapist may be able to assist with this. Older children Older children may require the use of a wheelchair, crutches or walking frame for mobility. Your Occupational Therapist and Physiotherapist will assess your child s needs. If you reside in Wellington equipment can be loaned from the hospital. If you are from outside the Wellington Hospital area your local hospital is responsible for providing equipment. Your Occupational Therapist can assist with organising this prior to your child s discharge. Transportation It is a compulsory requirement of New Zealand Transport law that as the driver, you must make sure that any child under seven years of age is properly restrained by an approved child restraint that is appropriate for the age and size of the child. They must not travel in the car if you cannot put them in an approved child restraint. Please see the NZ Land Transport webpage for further information; NZ Transport Agency (Child restraints-factsheet 7). February If your child does not fit into their usual car seat with their hip spica it is the parents/caregivers responsibility to find an alternative car seat. There are some car seats that are more suitable for a hip spica. Any adaptations (i.e. padding towels) made to a car seat will result in the car seat no longer meeting the Land Transport safety standards for car seats. Your Occupational Therapist will advise you on the positioning of your child however; it is the parents/caregivers responsibility if they wish to transport their child in a car. If you are unable to source a car seat to fit your child (as in the case of older children), the hospital will arrange ambulance transport home on discharge from the ward. What to expect when the plaster is removed Your child may be irritable or frustrated for a few days once the plaster has been removed. The skin can be dry and sensitive to the touch. Gentle massage with baby oil can be useful. Movement can be stiff and slow initially. The muscles of the legs have not been used whilst the plaster cast was on. These muscles will be weak and thin when the plaster cast is removed. Your child will tire quickly as they are using muscles they have not used for a while. Allow your child to CapitalDocs ID: PD PIB-39 V2 Issue date: July 2016 Review date: July 2019 Page 4 of 3

5 gradually increase their muscle strength through exercise and movement. A warm bath is a good place to encourage movement as the warm water eases stiffness. When to call Orthopaedic clinic Your child s cast develops cracks or dents, especially at the hip Your child s cast becomes too tight or too loose Skin becomes red, damaged or blistered Swelling, tingling or numbness develops in the toes Your child has an unexplained fever You notice a foul odour or drainage from your child s cast Your child cries constantly, sleeps poorly or complains of pain Your Occupational Therapist is: Contact us Orthopaedic Clinic Hours: Monday to Sunday (including public holidays) open 8am to 9.30pm Phone: Ext 5952 If you have any concerns outside of these hours, please contact your local after-hours medical centre; Kenepuru Hospital accident and medical. Open 24 hours a day. Phone Paraparaumu team medical Coastlands Shopping centre. Open 8am 10pm daily. Phone Waikanae medical centre. Open Monday Thursday 7pm 8am and Friday 5pm 8pm or anytime weekends and public holidays. Phone Accident and urgent medical centre Wellington. Open 8am 11pm daily. Phone If you are unsure if your child needs to visit your GP or Afterhours medical centre you may wish to call Health Line for free advice. Open 24 hours a day. Phone CapitalDocs ID: PD PIB-39 V2 Issue date: July 2016 Review date: July 2019 Page 5 of 3