Hip Dysplasia: Caring for Your Child in a Body (Spica) Cast

A spica cast is a hard covering made of plaster or fiberglass that may be used as part of treatment for children who have hip or leg problems, such as developmental dysplasia of the hip (DDH). In DDH, the top of the thighbone (femur) does not fit securely into the hip socket (acetabulum), letting the thighbone either partially or completely slip out of the socket (dislocate).

After the doctor moves the thighbone into its normal position, the cast is used to keep the joint in place as it grows. Spica casts are usually worn continuously for 2 to 3 months.

The cast:

• Covers the waist, hips, and legs.
• May have a bar between the legs to strengthen the cast. See pictures of a spica cast with a bar and a spica cast without a bar.
• Has an opening in the genital area that allows normal urine and bowel elimination.

Continue to Why?

A spica cast is usually worn continuously for 2 to 3 months. This is a long time for anyone to be in a cast, especially a young child. You want to keep the cast in good condition so that your child will be as comfortable as possible. Also, proper care of the cast will help the cast stay strong and be most effective in treating your child's condition.

Continue to How?

Properly caring for your child's cast includes allowing it to dry properly, keeping it clean, preventing infections and other problems, and knowing when to call the doctor. You should also be able to position your child properly in the cast.

Drying the cast

If your child's cast is made of plaster, it may need time to dry after it is first put on. Your child will likely be in a semi-sitting position and may need you to help him or her move. Turn your child at least every 2 hours for the first 24 to 48 hours to prevent uneven drying of the cast. You can use a fan to help the cast dry more quickly, but don't use heat. When you tap the cast and hear a hollow sound, it is dry.

Keeping the cast clean and dry

Spot-clean the cast, and do your best to keep it dry. But realize that the cast may get dirty or wet now and then.

Focus on taking preventive measures and cleaning the cast when needed.

• If your child wears diapers, use a smaller size than you normally would and use only disposable diapers. Cut the adhesive tabs off the diaper so that they won't irritate your child's skin, and tuck the diaper inside the cast beginning at the child's rear and moving toward the front. The plastic side of the diaper should face the cast. The absorbent side of the diaper should be next to your child's skin. Change the diaper as soon as possible after your child urinates or has a bowel movement. At night, add an extra smaller diaper, sanitary napkin, or adult incontinence pad inside the diaper.
• If you can lift your potty-trained child, help him or her use the toilet. Try tucking a sheet of plastic food wrap under the back edges of the cast to help guide your child's waste into the toilet. Remove the plastic and throw it away each time after your child has finished using the toilet. (Do not flush plastic wrap down the toilet.) Be sure the skin is clean and dry after your child uses the toilet.
• Use a bedpan for a bigger child. Put your child in a semi-sitting position, in which the torso and head are up higher than the lower body. Gently turn your child onto one side and slip the bedpan beneath his or her bottom. After you return him or her to the semi-sitting position, adjust the bedpan as needed by locating it between your child's thighs. Make a "wick" from toilet paper for girls when they urinate. Roll some sheets of toilet paper and place them between the genital area and bedpan. This helps the urine flow into the bedpan in a controlled stream. Be sure the skin is clean and dry after your child uses the bedpan.
• Clean off heavily soiled areas of the cast and reduce odors. You can use a damp cloth, with or without cleanser, to wipe dirty areas on a fiberglass cast. Scrubbing toothpaste onto soiled areas can also help to get rid of odors. Use a cloth with as little water as possible to clean a plaster cast. Odor strips, such as those used in the shoes, can be taped onto the outside of the cast.
• If the cast gets wet, dry it by using a hair dryer on a low, cool setting. Keep the hair dryer about 18 in. (46 cm) away from your child's skin.
• Give your child a daily sponge bath. Take care not to get the cast wet. Use a damp cloth, and clean your child's exposed skin and also under the edges of the cast. Remove small crumbs or other particles from under the cast if you can do so easily. Do not poke under the cast with any objects to try to get anything out of the cast.
• Place your child's clothing over the cast to prevent food or small toys from getting inside it.

Positioning, movement, and comfort

Keep your child safe and comfortable by using basic care techniques.

• You can apply moleskin padding to the edges of the cut-out open area around your child's genitals and bottom if these hard edges irritate or hurt your child's skin. Cut 4-inch pieces of moleskin. Place one end of a piece under the inside edge of the cast. Wrap the other end up onto the cast and tape it in place. No tape should be touching your child's skin. Partially overlap the pieces until you have made a soft, padded edge all around the openings of the cast.
• Check for swelling. Your child's toes should be pink and warm (not hot). He or she should be able to wiggle them and feel them being touched.
• Watch for signs of skin irritation. Look at your child's skin around the edges of the cast every day. Use a flashlight to look under the edges of the cast.
• Change your child's position every 2 to 4 hours. Regular movement helps to relieve pressure areas under the cast to help prevent irritation and sores. Now and then, put your child in a semi-sitting position by propping his or her head on pillows or using a beanbag chair.
• Never move or lift your child using the crossbar of the cast. This type of movement can harm the cast or disturb your child's hip placement.
• Prevent pressure sores by keeping your child's feet off flat surfaces, such as the floor or bed mattress, for long periods. Place a pillow, rolled-up towel, or other soft object:
  • Under the top front of the ankles while your child is lying on his or her stomach.
  • Beneath the ankles and under the calf of the leg while your child is lying on his or her back.
• Provide comfortable clothing. Your child can wear oversized shirts, skirts, and dresses over the cast after it is dry. You can adapt clothing that goes over the legs and torso, such as shorts or pants, by cutting the side seams. You can then apply snaps or stick-on strips, such as Velcro, to the seams. The sides can be attached to each other or to the sides of the cast.
• Move your child with care. Bend your knees and keep your back straight when lifting your child. As you lift, support the weight of the cast with one arm cradled around your child's shoulders and the other around his or her buttocks. When two people move your child, one person lifts under the shoulders, the other lifts under the legs. Lift together on the count of three.

Your child needs physical contact with you, especially while he or she is in a cast. As long as you make sure to take basic safety measures, you can and should continue to hold, interact with, and provide stimulating activities for your child.

Encourage your child's involvement with your family.

• Move your child around to different areas of the house throughout the day. Try padding a wagon or stroller with pillows and blankets to move your child around the house. Older children can use a wheelchair with an adjustable back, which you can rent from a medical supply store or hospital. You may want to place your child in a reclining lawn chair in different rooms in your home or in the yard.
• Go for walks with your child. Many strollers are made with adjustable backs to recline as needed. Make sure your child is secured with safety belts or straps.
• Go for car rides. Your young child should always stay in the back seat and in a car seat. Depending on your child's leg positions, he or she may need a specially designed car seat. Ask your doctor about where to buy or rent one. Usually they are available through hospitals or medical supply stores. Older children may need to be positioned and safely secured lying down in the back seat.

Knowing when to call the doctor

Keep a constant watch on your child and the condition of the cast. Although you should call your doctor any time you have questions, talk to him or her right away whenever your child:

• Shows signs of pain or discomfort, such as crying or fussing for unknown reasons. An older child may complain of pain or burning in a certain area under the cast.
• Is vomiting or has a fever.
• Itches continuously or has other signs of irritation, such as redness, itching, blistering, or sores.
• Has oozing from underneath the cast.
• Develops swelling.

Also call your doctor any time the cast:

• Has anything fall into it that becomes stuck.
• Develops a bad smell.
• Has worn, cracked, soft, or loose spots.

Continue to Where?

Now that you have read this information, you are ready to care for your child's spica cast.

If you have any further questions about spica cast care, contact your doctor.