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For children with a body harness or spica cast by hip dysplasia

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Spica cast

  1. What is a spica cast?
  2. Tips for the care of the spica cast
    -          Changing nappies
    -          Cleaning the spica cast
  3. Tips for the care of your child in a spica cast
    -          Checking the spica cast
    -          Cramps
    -          Moving around
    -          Lying on the back / sitting on your lap
    -          Pressure sores
    -          Washing their hair
  4. Clothing whit a spica cast
  5. Carrying a child with a spica cast
  6. Sitting with a spica cast
  7. Sleeping wit a spica cast
  8. The development of your child with a spica cast
  9. Experience with a child with a spica cast
  10. When the spica cast can be removed


1. What is a spica cast?

A spica cast is a bandage made of plaster or fast drying lightweight plastic. The spica cast is from the waist down to the ankles and has a hole cut out at the crotch. Sometimes the cast is from the waist down to one knee and one ankle. The bandages ensure that the femoral head remains firmly in place in the acetabulum or socket. Underneath the cast, there are quilted cotton tights to protect the skin.

Sometimes a bar is placed between the legs to prevent the cast from breaking at the level of the crotch. This bar is not intended to lift your child with. A spica cast is often applied for a period of 6 weeks to 3 months.

Please see a few examples of a spica cast below. The way of putting the cast on varies: untill the feet, till the knee, with or without a bar. Every cast is different. The last picture shows a Kiek Hip Wear jumpsuit on top of a spica cast with a bar.

 spica castspica castspica cast

2. Tips for the care of the spica cast

Changing nappies

Change your child’s nappies regularly. Toddlers pee more and more often than babies and it is difficult to keep the cast clean and dry when they have not yet been potty trained.

We advise you to put a normal nappy underneath the cast and a bigger nappy over the cast, if necessary, in combination with a Tena Lady (or Sanitary Napkin) inside the smaller nappy.

  • A normal size nappy underneath the cast, at the front as well as the back. It works best when you keep a small rim of the nappy above the cast at the side of the tummy and at your child’s back. You can cut the adhesive edges of the nappy if you want, as they will not be used and may be of discomfort to your child. To do this, the cast has to have enough space. You can use a flat wooden spatula to push the nappy underneath the cast.
  • A big nappy over the cast.
  • You may want to use a Tena Lady/sanitary napkin inside the smaller nappy to prevent leakages. The benefit is that you don’t have to change the inner nappy every time, because you can just change the Tena Lady and you will not have to push a new nappy underneath the cast.

Our advice is to take nappy changing seriously. We have heard of many parents whose children had got diarrhoea before they had arrived home from the hospital. Cleaning the inside of the cast is a very difficult, if not impossible task. A dirty cast is not a reason for the hospital to change the bandages, with the exception of inflammation of the skin.

Cleaning the spica cast

Outside of the spica cast
  • Clean the cast with a damp cloth and if you wish blow it dry with a hairdryer.
  • You can prevent the cast from getting dirty by wearing clothing over it. For example the special jumpsuits from Kiek Hip Wear for spica casts, which also fit with the spica casts with a bar between the legs. This has two extra benefits: the fabric of the jumpsuits makes it more comfortable for you to carry your child (the cast can be rough on your own skin/bear legs) and it looks more attractive.
  • The edges of the cast are often taped with a wide tape. This can be replaced to freshen up the cast or when the cast starts to ‘crumble’ or wear off.
Inside of the cast
  • When the inside of the cast gets wet, you can try to dry it with a hairdryer (not too warm) or with paper towels (let them absorb the moisture and remove them afterwards).
  • When there is stool or diarrhea in the cast you can clean it with baby wipes.
  • There are some products available at the pharmacy against odours in the cast: Confort Aid and Nilodor.

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3. Tips for taking care of a child in a spica cast

Checking the spica cast

  • There are a few things you can check when you have a child in a spica cast;
  • Whether the cast is not too tight, whether it does not pinch;
  • Whether the toes of your child are a healthy colour pink;
  • Whether the feet are not too cold or too warm;
  • Whether your child can move its toes;
  • Whether the toes do not thicken /swell;
  • Whether your child is in a straight position in the cast when lying down; and/or
  • Whether the cast does not have any sharp edges.

You can reduce the sharp edges of the spica cast by taping them up with felt/terry with an adhesive edge (this is available from the plaster room) or with a panty liner or wide piece of Leucoplast tape.

Contact the plaster room if you think something is not right.

Cramps

Young children are often not affected by the spica cast. An exception can be when they suffer from cramps. Because of the cast, the baby cannot pull up his legs (this is what your baby would normally do when suffering from cramps). Take the time to let your baby burp after you have fed him or her. Contact your doctor if cramps become a problem, he can maybe prescribe something against the cramps.

Moving around

Some kids do not try to move around (of course this also depends on the age of your child), others roll over, start crawling on their bellies or even start to stand on their own and walk with the cast. Let your child make the moves he or she wants to make, but stimulate the standing and walking (for example by putting them on their feet).

Wooden trikes can function as some kind of wheelchair. Our two year old daughter with a spica cast has had a lot fun with her wooden bike. First very short distances through the living room. In this short film you can see how she got around after a while. For parents with a child with a spica cast this video will be uplifting.

For us the wooden trike has functioned as a kind of wheelchair. We took it everywhere and as soon as we got out of the car I put her on the trike. Our daughter loved sitting on the trike, but it was also a relief for myself. Even though the cast is not heavy, carrying around a child in a spica cast is. For more information read also “Carrying a child with a spica cast”.

Crawling board to support your child with crawling. You can put some wheels underneath a big wooden board, so that your child can move around the room on his or her tummy. I know that some parents are very enthusiastic about this, but my experience is not positive because my daughter’ s hands kept going underneath the wheels. So after trying it a few times, she no longer wanted to use it.  

 

Lying on the back / sitting on your lap

Put some pillows or rolled-up towels underneath your child’s legs when he or she is lying down, so that the cast does not put pressure on your child’s back. Because the legs are higher, it will also prevent swelling of the feet.

You can just let your child sit on your lap or in a high chair in his or her spica cast, unless your doctor has told you not to do so (this is very unlikely).

An alternative for the rolled-up towels is our changing mat:

-          The seam in the middle of the changing mat makes sure your child’s body is automatically lower than his or her legs (and the cast will not press into his or her back).
-          The bead filling moulds to the body.
-          Your child’s head rests on the changing mat, this can help prevent unbalanced growth of the head resulting from a preferred posture or position.

The changing mat can be used on top of the mattress in your child’s bed.

Pressure sores

Pressure sores may occur on your child’s buttocks, lower back and sternum of your child because of the spica cast. You can cool these by putting a squeezed flannel on the sores (do not use soap). Make sure the cast does not get wet on the inside. After that you can rub the sores with baby ointment.

Tummy time: For a change of posture, you can put your child on his or her tummy. He or she probably will not like this. A few minutes is enough, or for as long as your child enjoys it. This way they will use some other muscles (their back muscles), nice for a change and good to keep on using all their muscles.

Washing their hair

With a spica cast, you cannot put your child in a shower or bath. You can wash your child with a flannel. Make sure the cast does not get wet.

Washing your child’s hair can be done in two ways:

  • Lying down on the counter in the kitchen;
  • With an inflatable hair wash basin, lying down on the (dining room) table.

Either way, try to do it together. Never leave your child unattended and take care that your child does not fall.

Young children usually do not like it when their hair is being washed, especially when they are wearing a spica cast, because they are not used to water anymore. Let them play with their hands in the water before you start to wash their hair.

hair wash basin

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4. Clothing with a spica cast

Normal trousers do not fit over a spica cast. We have developed jumpsuits that fit over the spica cast:
-          You prevent the cast from getting dirty on the outside (food waste and similar).
-          It is more pleasant for you to carry your child with a spica cast or to have your child sit on your lap (when you have bare legs, as the cast can be rough on your skin).
-          You cannot see the spica cast and your child looks lovely.
-          They are especially developed for children with a spica cast, you can just select the usual clothing size.
-          As the jumpsuit has poppers in the inner leg, it also fits when a bar is fitted between the legs of the spica cast.
-          The jersey has had a peach treatment and feels very soft on your child’s skin.
-          The jumpsuit can be used as a baby suit, so that you can wear a t-shirt, sweater, cardigan or one of our special dresses over it. When it is warm outside, just the jumpsuit is enough. We have developed jumpsuits with long sleeves as well as short sleeves.

Besides the jumpsuits we have designed the following to wear with a spica cast:


Available in different colours, please click on the photo to view all the products.

dress spica castwide sleeping bag
Dresses
Sleeping bags
Leggings to wear underneath pavlik or harness
Clothing to wear on top of harness or spica cast

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5. Carrying a child with a spica cast

A child with a spica cast can never be carried just underneath the shoulders. You always have to support the lower body.

A child in a  spica cast is heavy and difficult to carry. The spica cast is not too heavy (approximately 1,5KG after wearing it), but carrying a child in a spica cast is. It feels like you are carrying a concrete block, because the child is stiff from the waist down and does not give in when you are carrying your child.

To prevent a sore back it is important to carry your child in a correct way and at the right (working and carrying) height.

  • Carry your child with a baby carrier, a back supporting belt, with an integral padded foam shelf. This allows parents to carry their baby or toddler naturally on their hip without the usual strains on the back. The sturdy belt and ergonomically shaped seat close seamlessly around the body. This is comfortable for both the parent and the child. The weight of the child is distributed evenly around the hip and in this way causes less stress on the arms, shoulders and back.
  • Make sure the changing unit is as high as possible and also raise the bed and box base.

baby carrierbaby carrier

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6. Sitting with a spica cast

When wearing a spica cast, your child is no longer able to ‘hinge’ at the hips and the legs are spread wide. That’s why children with a spica cast do not usually fit into normal high chairs. Bouncers are not suitable because the child with a cast hangs on to the side bars without the support of the back.

For little ones that were not able to sit on their own before having the spica cast, the beanbag is the ideal sitting solution. The advantages of the beanbag Doomoo seat are:

  • The beanbag is filled with microbeads. Therefore you can use the Doomoo seat in different positions: flat, slightly upright or in a sitting position
  • The microbeads shape the bean bag around the body, so that children with a hip brace, body harness or hip spica can lie comfortably and look around.
  • Good support for the back and the head of your child
  • Handy to feed your little one in the beanbag
  • There are two top parts included: the top part of the bean bag can be unzipped and replaced by a top that does not have a strap).

We advise the beanbag for children up to the age of about 12 months.

Doomoo seatDoomoo seatDoomoo seat

For children who were able to sit on their own before the cast or who are older than 12 months, we have the following solution: the Minimonkey Minichair.

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7. Sleeping

We sell wide sleeping bags, so that your child fits in them with a hip brace or spica cast.
-          Your child will not get cold during the night.
-          A sleeping bag is functional to prevent your child from taking off the hip brace by tearing loose the Velcro.

Sleeping with a spica cast

Depending on the way the spica cast is put on, it might be necessary to put some pillows or rolled-up towels underneath your child’s legs when he or she is lying down (also during the day), so that the cast will not put pressure on the back. Because the legs are higher, it will also prevent swelling of the feet.
spica cast sleeping with a spica cast

Does a child with a spica cast still fit in a cot?

Children with a spica cast can still fit in a cot, especially cots with bars on the sides. When a child is older or when the legs are casted extremely wide, a camping bed (flexible sides) can be a solution.

8. The development of your child with a spica cast

Parents are often worried about the progress of their child’s physical development because of the spica cast. My experience and tips: try not to worry too much. Children move what they can with a spica cast. When the treatment is finished they catch up with a potential delay in their development. You can certainly help them in this period by encouraging and stimulating certain movements. You can use the help of a children’s physiotherapist. Always talk to the attending doctor.

I contacted a children’s physiotherapist when our daughter had her second spica cast at the age of 2. I wanted to prevent her from moving in the wrong way and wanted her to sit, crawl and walk correctly to help prevent an extra delay in her development. It was mainly for my own reassurance. I needed answers to my questions, such as: how is her development? Does she move correctly? Is there something strange in the way she moves? Does she make the right progress? How do I stimulate her in the right way? Can she do what other children at this age can do?

It is very comforting when someone can answer these questions. Uncertainty about the outcome of the treatment is what makes it difficult. In between checks at the hospital, it is comforting to get additional reassurance or help, for example from a children’s physiotherapist.

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9. Experience with a child with a spica cast

Does your child get a spica cast and are you looking for experience of other parents? I (Oeda, owner Kiek Hip Wear) wrote down the hip journey of our daughter and asked other parents to do the same. Read all the stories of parents whose children have been treated for hip dysplasia with the aid of a spica cast here.

10. When the spica cast can be removed

Spica casts are usually removed with an electrical saw or big tongs. This is very loud and can be a frightening experience for your child.  

On this picture you can see the legs of are girl whose spica cast has just been removed.

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