Hip Dysplasia: Caring for Your Child in a Body (Spica) Cast
Hip Dysplasia: Caring for Your Child in a Body (Spica) Cast
Spica casts, also called
body casts, are frequently used to treat children who have hip, pelvis, or leg
problems, such as
developmental dysplasia of the hips (DDH). You may be
nervous about having a child in a spica cast. It can be overwhelming to be responsible for the care and cleaning of the cast. But
caring for a spica cast is not as hard as it may at first seem. After you get
into a routine, you'll find that you can handle the daily tasks involved in
cast care. You will become more and more confident that you can keep your child
safe and comfortable while he or she is in the cast.
You can help
care for your child's spica cast by:
Learning basic cast-cleaning techniques.
Learning how to manage daily care issues, such as changing a
Gaining confidence in handling your child and knowing how
to identify problems that can develop.
How do you care for your child's spica cast?
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
Keeping the cast clean and dry
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
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
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
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
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.
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
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
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.
How this information was developed to help you make better health decisions.