Caring for your child in a
hip spica after hip surgery
Information for parents and carers
page 2
Contents
Page no.
Introduction 4
What is a hip cast? 4
Why does my child need a hip spica? 4
Care of your child whilst in a hip spica 5
Using the toilet 5
Double nappy technique 6
Cast care – do’s and do not’s 8
Washing and bathing 9
Skin inspection 9
Moving your child 10
Transfers 10
Buggies 11
Wheelchair 11
Car seat 12
Pressure care and positioning 12
Seating: Specialist spica chairs 13
Daily living 14
Clothes 14
Feeding and diet 14
Play 15
Leaving hospital 16
Travelling home 16
Financial support 17
Removal of spica: Three months after surgery 17
Precautions 18
Exercise 18
Useful contact details 19
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Introduction
This leaflet has been designed to give you guidance when your
child is in a hip spica. You may find it useful to read this alongside
information provided through STEPS, a national charity supporting
children with hip conditions: [Link]
What is a hip spica cast?
A hip spica cast, known as a ‘spica’
(pronounced “spy-ca”) is an orthopaedic
plaster cast used to hold the hips and
thighs in one position. It is used to aid
the healing of your child’s hip surgery.
The plaster cast will also cover their
tummy, usually to just below their belly
button, and one or both legs. It often
has a crossbar from one knee to the
other for stability; this is sometimes
known as the ‘broomstick’.
Your child will need to have the spica
for a total of 12 weeks. After the first
6 weeks your child will be admitted to
hospital for a few hours. Under general anaesthetic (whilst they
are asleep) they will have the spica changed to a fresh one in a
similar position. This new cast will stay on for a further 6 weeks.
Why does my child need a hip spica?
Your child will be in a spica to help keep them in the correct
hip position after their operation. The exact operation will be
planned by the consultant, following detailed clinical assessment,
and will be discussed with you and your child (if appropriate).
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Care of your child whilst they are in a spica
Caring for your child whilst they are in a spica is not as
complicated as it may first appear. Your child will still be able to
wear a nappy or use the toilet. They will also be able to sit up
and lie in bed comfortably.
Information about how to turn your child and help them with
using the toilet is detailed in the following sections.
Using the toilet
If your child wears nappies or pads you will be shown the
‘Double Nappy Technique’ (page 6) once they are in the spica.
The STEPS DVD explains the process very clearly.
Nappies need to be checked more often than usual and changed
as soon as they become wet or soiled, so that the plaster does
not become damp or dirty.
If you have been thinking about starting potty training it would
be best to delay this until after the spica is removed.
If your child is toilet trained, they may find at first that going
to the toilet with a spica is a challenge. They may find it easier
to use a bed pan or urine bottle. You can discuss this with the
Occupational Therapist at your Pre-Operative Assessment Clinic
appointment.
Bed pan Urine bottle Commode
page 5
Double nappy technique
You will need to buy two different sizes of nappy. The first should
be slightly smaller than the nappy your child currently wears. The
second needs to be about a size 5 or 6, to cover the outside of
the spica.
You will need to remove the sticky tab edges of the smaller
nappy, to fit it into the spica. They should tear away easily when
they are pulled firmly. The nappy area of the spica will have some
felt around it. Before your child is discharged, the spica will also
be covered with some waterproof tape. You will not need to
change the waterproof tape each time you change a nappy, but
you will be shown how to replace it, in case it becomes loose.
This will help to keep a waterproof barrier around the nappy
border.
Comfortably place your child on their front. Remove the sticky
tab edges of the smaller nappy. Gently squeeze the nappy inside
the spica’s edges, high up the back and in around the sides.
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Place your child on their back and continue to push the nappy
high up at the front, ensuring that the whole edge of the nappy
area has coverage.
With the smaller nappy fully tucked in, you can now roll your
child to apply the larger nappy to the outside of the spica,
excluding the ‘broomstick’ if applicable.
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Cast care
This section explains how to care for your child’s spica cast. This
is very important because the spica cannot be taken off, unless
there is an emergency.
Do:
• Encourage your child to keep moving their toes and feet, to
help minimise swelling.
• Wring out flannels firmly when washing your child, to avoid
getting the cast too wet.
• Keep an eye out for your child getting items lost inside the
cast. Previous items found inside the cast during a cast change
are rubbers, felt tip pen lids and small pieces of Lego!
• Lift and move your child as shown by the Therapy Team.
• Contact someone (see back of leaflet) if your child complains
of numbness in their feet, sudden severe pain or tightness
from the cast, or if you notice any swelling, change to the
colour of their skin or cracks in the plaster.
Do not:
• Put anything inside the cast, because:
o scratching* inside could cause irritation which would remain
undetected under the cast
o you could disturb the wound sites
o lost items could cause areas of pressure which could lead to
pressure sores.
• Use a hair dryer to dry out excess moisture or dampness in the
spica from washing your child, as they can cause burns.
• Lift your child up from under the arms or by the ‘broomstick’
* Tip: An itchy area can sometimes be relieved by tapping at the
itchy point from outside the cast.
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Washing/bathing
Spicas are not waterproof and, as they cannot be removed,
your child will only be able to have a wash with a flannel or wet
wipes. Depending on the age of your child, you may find that
the easiest way of doing this is to lay your child on a bed, on
top of a towel, with a waterproof layer underneath. Try using a
disposable changing mat or perhaps a bin liner under the towel.
A damp cloth with a small amount of soap can then be used to
wash your child’s skin. Hair washing can be done in a number of
ways; some parents choose to sponge wash younger children’s
hair or use hair washing trays on the bed. The Occupational
Therapist at the Pre-Operative Assessment Clinic can advise you
on where to get a hair washing tray. You
might want to visit the STEPS website to
read alternative methods that people use.
Hair washing tray
Skin inspection
Your child will have restricted movement whilst in their spica, so
it is important to check the visible areas of their skin for red or
sore areas.
There are certain areas on the body which are more at risk of
becoming sore:
1. The nappy area – we strongly recommend that you change
their nappy more frequently than normal.
2. Around the feet or knees where the spica finishes on each
leg. Joints that bend can rub in places you might not think to
look.
3. Around the top of the spica, as movement can lead to rubbing.
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Moving your child from one place to another
Transferring into chairs and beds
It is entirely normal to feel anxious about moving and handling
your child in a spica. The Occupational Therapy team will work
with you to increase your confidence before their discharge
home.
Younger children
Prior to leaving hospital you will be shown the best ways in
which move and to handle your child whilst they are in their
spica.
Key points
• When lifting your child you must always support the spica.
NEVER attempt to pick them up from under their arms or by
the ‘broomstick’.
• Keep your child as close to your body as possible. This will help
protect your back and make your child feel safer.
• Remember, the spica is there to protect your child after their
surgery. This means you can continue with cuddles without
fear of hurting them or causing any damage.
Older children
It may be necessary for your child to be hoisted whilst in the
spica. This will be discussed with you and planned by the
Occupational Therapy team at your Pre-Operative Assessment
Clinic appointment. If necessary, we will liaise with Community
Teams to ensure that the correct equipment and support is in
place before your child is discharged from hospital.
During your hospital stay the team will teach you how to safely
hoist your child. If you already use a hoist and sling at home we
will need to check that it is suitable for your child while they are
in a spica. If your child uses a wheelchair they will have their
positioning checked and adjusted once they are seated.
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Buggies
Whether or not your child will be able to be seated in their
usual buggy can be difficult to judge before their operation. The
position of the spica’s final mould needed for the best possible
healing will determine whether you can still use your child’s
buggy. The Occupational Therapist will assess your current buggy
at your Pre-Operative Assessment Clinic appointment. They will
also help you to seat your child comfortably in the buggy after
the operation, if it is still suitable.
Positioning your child into their usual buggy may still be possible
if:
• the buggy is reasonably wide with no restrictive front or side
bars
• the seat is fairly shallow
• the seat has extendable crotch and shoulder straps
• the backrest can recline (lie back).
Rolled up towels and pillows can be used to fill in any gaps
between the cast and the buggy.
If you are considering buying a new buggy you may wish to
speak to the Occupational Therapist first or seek further advice
from the charity STEPS.
Wheelchairs – for the older child
If your child already has a wheelchair please bring this to your
Pre-Operative Assessment Clinic appointment so that it can
be assessed. As the spica limits how much the hip and the knee
joints can move, sitting in what your child feels is a usual position
is likely to be impossible. For this reason, using a wheelchair that
tilts and reclines is usually helpful. The Occupational Therapy
Department may be able to loan a specialist wheelchair with a
spica board to older children that are not able to be re-seated in
their own wheelchairs.
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Car Seat
A child in a spica is unlikely to fit back
into their own car seat. The Occupational
Therapist will discuss this with you at your
child’s Pre-Operative Assessment Clinic
appointment. A car seat leaflet is available
with information about the In Car Safety
Centre; this is a UK based shop in Milton
Keynes which offers a wide range of
children’s car seats, special needs seats and
accessories.
One option may be to loan or purchase the
Britax Two-Way Elite car seat from the In Car Safety Centre. The
Nuffield Orthopaedic Centre (with the aid of a donation from
Wheelwrights Charity) has purchased some of these car seats to
reduce the cost of a 3-4 month rental to £75 (2016 price). The
seats are suitable for children in hip braces who weigh between
9kg and 25kg. Please ask the Occupational Therapist about this
option.
Alternatively you can choose to buy your own car seat for £220
(2016 price). For further advice you can contact the In Car Safety
Centre directly on 01908 220 909 or visit their website:
[Link]
Please bring your car seat onto the ward after the operation,
where the Occupational Therapist will help you practice getting
your child comfortable in the seat.
Pressure care and positioning
Whilst in a spica, it is important for your child to change position
frequently. This will help to avoid pressure sores and encourage
them to join in with play activities.
Whilst in hospital, you will be shown how to position your child
lying on their back, side or tummy.
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In all these positions, pillows are used to help your child feel safe
and secure.
Small pillows or a rolled towel under your child’s legs will help
to keep their heels and feet off flat surfaces and allows them to
freely move around. It is important that your child’s feet do not
rest directly on the mattress, as this may cause pressure areas.
If red areas appear near the base of their spine or on their heels,
your child must stay on their tummy for longer periods of time.
When lying on their tummy, place a pillow under their chest and
tummy so that their spine is straight.
You could consider using a bean bag as a seat for your child. The
bean bag would need to be against a wall or sturdy surface, so
that they do not tip back.
Before you leave the hospital, the Orthopaedic team will make sure
you are confident with handling and positioning your child correctly.
Seating
Specialist spica chairs
Some companies and charities sell or loan specific spica chairs.
There are also some standard chairs, highchairs and seats that
can be used by children in hip spicas. There is a useful list of
suppliers and equipment on the STEPS charity website:
[Link]/How-We-Help/caring-for-a-child-in-a-
[Link]
We would recommend that
you wait until your child has
been set in the spica before
buying expensive equipment;
your Occupational Therapist
can give you advice on what
may be useful to buy.
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Daily living
Clothes
Clothes can be worn over the spica, though you may have to
adapt them. It is a good idea to get some clothes that are one or
two sizes bigger than normal, as your child’s current clothes may
no longer fit. Some parents have found vests with poppers at the
gusset to be the most practical; they also help to hold the nappy
in place. Since the spica itself is quite warm you will probably
only need to dress your child on their top half and feet.
For children who do not use nappies, underwear can be adapted
by putting a split down the sides and fastening these with Velcro,
poppers or ties. It can be difficult to find trousers which fit, as
the spica holds the legs in a frog position. If you search on-line
for ‘spica clothes’ you will see that there are companies that
specifically sell clothing, sleeping bags and even snowsuits, which
fit over the spica. Alternatively, if you are creative with your
needlework it is possible to modify clothes to suit your child’s
spica.
The final size and position of the spica will not be known until
they are in it, so we would recommend waiting until you are
home before adapting clothing.
Feeding and diet
Whilst in the spica your child can eat all the things that they
normally would. Be careful that they don’t eat too much, as they
may feel bloated and uncomfortable whilst in the spica. Eating
smaller meals more regularly can help to avoid this. Make sure
they have plenty of fluids, fresh fruit and vegetables, to prevent
constipation and promote healing. Contact your GP if your child
becomes constipated and uncomfortable.
Tip: u
se a bib, apron or tea towel tucked into the top of your
child’s clothes when they are eating, to try and prevent
crumbs falling inside their spica.
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If you are still breastfeeding your child you can continue whilst
your child is in a spica, although you will need to experiment to
find a good position in which to do so. Pillows can be used to
make this more comfortable for you both.
You will need to experiment to try and find the best position in
which to seat your child for mealtimes. You may decide to buy a
spica-friendly highchair or seat, which they can sit in at the table,
or you might want to feed them whilst they are sitting in their
buggy or wheelchair or bean bag. Make sure that you position
them as upright as is possible, in order to aid their digestion.
You may want to try positioning the buggy/chair under the
dining table (if it fits), or you can buy a padded lap tray so they
can sit next to the family at mealtimes. This will encourage
independence and normal interaction with the family.
Play
Play is an essential part of your child’s development and should
be actively encouraged. Crawling, standing and walking should
be avoided in the first few weeks (the spica will restrict some of
this movement anyway).
You can adapt the types of play and activities to things that your
child will be able to manage more easily when sitting. Parents
often say how surprised they are at how quickly their child
adjusts to being in a spica.
Tip: t oys should be placed close to your child, so they don’t in-
jure themselves trying to reach for them. Changes of scenery
may help to keep them entertained; we encourage you to
move them around and return to your usual routine as much
as possible.
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Leaving hospital
Travelling home
You will need to ensure that your child has the correct car seat
and restraints to travel home from hospital safely when they are
in the hip spica.
As a parent/carer, it is your legal responsibility to make sure the
correct child seat has been fitted or that alternative means of
transport have been organised.
If you feel that you need hospital transport, please discuss this
with your child’s nurse as soon as possible.
If you already use wheelchair accessible transport please bear in
mind that you may need to allow for more leg room, as there
will either be elevated leg rests or a spica board to support your
child’s legs.
Points to consider if seating your child in a booster
or child car seat
What is the depth of the seat and leg space?
You will need to measure this to make sure there is enough
space, especially with rear facing car seats.
Where are you allowed to place your child in your car?
Think about the air bags. Can these be switched off to allow
your child to sit in the front of the car?
For safe transportation, the child car seat/restraint to be
used after surgery must be fitted in accordance with the
manufacturer’s recommended guidelines. If you have hired or
bought a seat from the In Car Safety Centre in Milton Keynes
they can help you with this.
Please be aware that if you adapt your own car seat in any
way, it may invalidate the manufacturer’s warranty. Neither the
manufacturer nor Oxford University Hospitals NHS Foundation
Trust will accept responsibility for any reduction of performance
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or safety of this restraint as a result of adaptation. You will be
asked to sign a form stating that you are aware of this and that
you take responsibility for anything which may happen whilst
your child is travelling in an adapted seat.
This is because the car seat will not have been crash tested by
the manufacturer with any adaptations you have made. This
means you cannot be certain it will help protect your child in the
event of an accident.
For more advice and information, including current legislation
regarding the safe transport of children, go to the RoSPA
(Royal Society for the Prevention of Accidents) website at
[Link] or telephone them on 01212 482 000.
Financial support
You may be entitled to financial help from a Disabled Living
Allowance (DLA) for children under the age of 16. You may also
be eligible for higher level Tax Credits. Speak to the Department
for Work and Pensions (DWP) for more information.
Removal of the spica
Three months after surgery
In order to check if your child’s hip surgery is healing well, their
spica will need to be split in the plaster room. An X-ray will be taken,
which is then checked by the Orthopaedic doctors. If the X-ray
shows that everything is healing correctly, the spica will be
completely removed on the Day Care ward by the nurses. The
Physiotherapist will then check your child’s leg movements and
show you some simple exercises. They will also give you advice
on how you can encourage their crawling, standing and walking.
For the first couple of days after the removal of the spica your
child may have aching legs, especially if they were very active
when the spica was first removed. Rest and pain relief will help.
Put them in a position where they will be less active for a while,
for instance, strapped into their pushchair.
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Precautions
Avoid bringing your child’s knees up towards their chest or
pushing their legs inwards (the movements the spica has
prevented them from doing). Both can be accidentally done
when lifting your child from the side or when changing a nappy.
Care must be taken with bending their knees too much for the
first few days, for example, when your child is crawling, standing
and walking. Your child may become upset with pain if their
knee is bent too far. During these activities keep your hand on
their bottom. This will help stop them from bending their knee
too far if they were to sit back on their heels suddenly when
crawling or drop to the floor from standing.
Exercise
Play is the best exercise for children. Once your child is free of the
spica, it is important to encourage them to crawl or walk over
to toys, or to stand and play. Your child’s muscles will gradually
strengthen and they will regain their hip and knee movement.
Toys, such as ride-on cars, are ideal for holding a good hip
position whilst working their legs and also protects them from
bending their knee too far.
As long as their wounds are clean, dry and healing well, you can
take your child swimming. This is good exercise, as your child will
freely move their legs and work their muscles at the same time.
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Useful contact details
Nuffield Orthopaedic Centre (NOC)
Windmill Road
Headington
Oxford
OX3 7LD
Tel: 0300 304 7777
[Link]
Paediatric Physiotherapy, NOC
01865 738 087
Paediatric Physiotherapy, Oxford Children’s Hospital
01865 231 999
Paediatric Occupational Therapy,
Oxford Children’s Hospital
01865 234 001
Paediatric Orthopaedic Nurse Specialist
01865 234 992
Paediatric Outpatients
01865 738 296
Ronald McDonald Parent Accommodation
01865 234 274
Patient Advice Liaison Services (PALS)
01865 738 126
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If you have a specific requirement, need an interpreter,
a document in Easy Read, another language, large print,
Braille or audio version, please call 01865 221 473
or email PALSJR@[Link]
Compiled by the Oxford University NHS Foundation Trust
Paediatric Orthopaedic Team
September 2016
Review: September 2019
Oxford University Hospitals NHS Foundation Trust
Oxford OX3 9DU
[Link]/information
OMI 5738P