Which procedure would the nurse use to elevate the head of an infant in a spica cast?

A series of helpful videos developed by STEPS in the UK covering common situations with children in hip spica casts.

Spica Cast Maintenance

Information on how you can modify the Spica Cast to help your child be more happy and comfortable.

For information on Spica Cast Liners: click here

Car Seat Restraints for Children in Spica Casts

Information on “Options for Safe Transport”.

Chairs and Spica Casts

High-Chairs

• Babies in a spica cast can’t sit normally in a high-chair. The child may be able to sit sideways with their left leg in front (normal position) and their right leg behind the high-chair’s support bar.
• A high chair can also be made from a car seat that is designed for spica casts.
• Umbrella strollers work well with the cast. Some come with a removable padded bar that can be put under the baby for more stability. Use a pillow behind the baby to prop him or her up and always use the seat belt.
• A stroller can be used in place of a high chair to feed baby and it folds easily for travel.

Other Baby Chairs

• A bean-bag chair is almost a “must-have.” It molds around the child and you can place them in almost any position you need from semi-reclined to almost straight up so it can be used for entertainment purposes or whatever you need. Small bean-bags can be used as padding to support the child.
• Straight back infant seats also work wonderfully (most seats are “L” shaped to bend at the waist and won’t work with the cast).
• Another option, if your handy, is to build your own custom seat for your child.  For detailed instructions on one such example, download this pdf.

Slings and Spica Casts

Parents have had success using a variety of baby slings to carry babies in spica casts. Remember that the cast adds weight and bulk, so make sure you feel comfortable when carrying your baby and that you are not straining your muscles. If your baby’s cast has a bar between the legs, a sling might not work.

Clothing Options

Cast appropriate clothing is available from select retailers. These specifically designed outfits are designed to fit over a Spica Cast or Palvik Harness.

There are numerous options available for covering the harness:

• Hip-Pose.com To see how Hip-Pose got started check them out our Advocate Spotlight page.
• Starfish Babes
• Hipsleepers – Hip Dysplasia sleeping bags, clothes & accessories

For additional information on clothing please see the Healthy Hips Australia’s brochure by clicking here.

Breastfeeding a Child in a Spica Cast

Breastfeeding has health benefits for both the mother and the child. Nursing can be a special time when you and your child are close. This brochure is intended to offer support for mothers who want to continue to breastfeed. The IHDI supports all families regardless of how they choose to feed their children You might need to adjust the positions that you use when you breastfeed. Here are some positions that may work for you when your child is in a cast.

Breastfeeding With a Cradle Hold

Most mothers who breastfeed are familiar with this position. With a child in a cast, you might feel more comfortable with a pillow on your lap to protect you from pressure from cast. Some mothers also use a pillow to support the child’s leg, especially if the child turns so that one leg is up in the air.*

Breastfeeding With a Sitting Child

This position might work for you if your child does not like to turn her head to nurse or spits up after eating.  The cast adds weight, so some babies might be too heavy for this position.  You may want to put a pillow on your leg underneath the baby.*

Breastfeeding While Lying Down

You can use the laid back position or side-lying hold to breastfeed your baby. If you are in bed, use pillows to make you and your baby comfortable. Some mothers use these positions with a beanbag chair because the beanbag chair supports the cast.*

Diapering Your Baby in a Spica Cast

Tips for diapering when your baby is in a Spica Cast.

Bath Time with a Spica Cast

A full size infant bath sponge can be used:

1. Set the sponge next to the kitchen sink and lay baby on top
2. Fill the sink with water and wash exposed skin with a damp washcloth
3. Pull baby to the edge of the sponge with your hand cradling his or her head to wash and rinse hair
    Never leave baby unattended – even for a second
4. You can also reach under the cast with a damp washcloth, and then a towel to keep things dry

Sleeping in a Spica Cast

• Keep the baby on an incline while sleeping, use a wedge pillow. Place folded towels under the baby’s feet.

Older Children in Spica Casts

Managing an older child in a spica cast presents different problems than managing an infant or baby. Although the child’s size may make it more difficult for parents, the children often tolerate the cast better because they are able to participate in their own care.

Two adults can usually lift the child, but a Hoyer lift (or other types of lifts) can be rented if lifting is a problem. A hospital bed with an overhead trapeze bar may also be helpful. The trapeze bar is a triangular handle that hangs down from a frame over the bed so the child can grab the handle and pull up in bed or help shift position.

Most children age 2-7 years learn to turn themselves over by using the unenclosed leg. Any position in the cast is generally acceptable because the cast protects the child from too much movement. Older children can also ask for pillows and positioning when they are uncomfortable. In other words, the child will help with his/her own care. Older children can generally use a bed pan without getting the cast soiled. You might ask the doctor to place the cross-bar where it will least interfere with toileting.

Transportation in an automobile requires safety restraints. This is also more difficult in the larger child. The most practical method of transportation is probably to place the child in the rear seat using an E-Z-On vest with a seat belt over one or both legs. No restraint system will protect completely from a high-speed crash so it’s best to limit transportation as much as possible while the child is in a body cast.

Additional transportation options are available at: Convaid.com

Cast Removal Preparation

Removing casts is performed with a cast saw that vibrates instead of making a circular motion like saws that cut wood. The vibration will cut through hard cast materials, but not through the cast padding underneath the cast. The cast saw is loud when operating so it sometimes helps to bring headphones or ear muffs if your doctor doesn’t have any.

What happens after the cast removal is completely dependent upon your particular child’s needs and your doctor’s treatment plan for your child. Sometimes a child is weaned off the Spica Cast by having a period of time where the child is fitted with a hip abduction brace.

*Acknowledgements The International Hip Dysplasia Institute wishes to thank Betsy Miller, author of The Parents’ Guide to Hip Dysplasia, Pip Mercer, Breastfeeding Counselor with the Australian Breastfeeding Association, and the parents who participated in the creation of this site.

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