Body Cast (Hip Spica): Caring for Your Child's Cast

A hip spica is a special type of cast that helps keep hip joints and/or the thigh in place.

Your child may need a hip spica or body cast in the following situations:

  • to keep the ends of a broken bone (fracture) together so they can heal correctly
  • to prevent a body part from moving after a surgery
  • to correct a deformity like club foot or a hip displacement 
Body Cast
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A body cast is mostly used for children with spinal injuries. The cast can also extend over the shoulders.

The length of the hip spica will vary depending on the injury

It usually extends anywhere from the mid-chest down to below the knees. If the problem is in both the hips and the thighs, then the cast will extend below one knee, most of the time.

There is a hole in the cast that covers the groin area, so your child is able to urinate. 

A body cast may cover the trunk of the body, and one or more limbs. They are mostly used for small children who have spinal injuries.

Applying the cast

A doctor or orthopaedic technologist will apply a cast made of either fibreglass or plaster of Paris material. The cast has soft padding and will feel warm to your child when it is first applied.

A fiberglass cast can take up to 40 minutes to dry.

A plaster of Paris cast can take up to 48 hours to dry.

Some casts are a combination of both fiberglass and plaster. These can also take up to 48 hours to dry as well. 

Do not cover the cast. This will help make sure that it dries properly.

Hip Spica on an Older Child
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The length of the hip spica cast will depend on the injury. If the problem is in both the hips and the thighs, the cast usually extends below one knee.

Caring for your child’s cast

Read the following to help care for your child’s cast.

Keeping the cast clean and dry

To keep the padding dry, line the edges of the hole near the groin, with “petals” of water-proof tape. This means that each piece of tape should overlap the other just like the petals of a flower. Make sure that each piece of the tape covers at least 2 to 3 inches of the padding inside the cast. The nurse or the orthopaedic technician usually shows you how to do this before your child leaves the hospital.

Your child may have a sponge bath. Be careful not to get the cast wet.

If the cast does get wet, you may clean the soiled area of the cast with a damp cloth and leave the area open to air until it is dry. You can also use a hair dryer on a cool or cold setting to dry the cast.

Changing your child’s diaper or toileting

If your child is very small, you should tuck a smaller size disposable diaper into the front and back of the cast and a larger size diaper should be worn over the cast.

Change the diaper as often as every 4 hours or as soon as the diaper is soiled so that the cast does not get soaked with urine or stool. This could make the cast have a bad smell and may also cause harm to your child’s skin.

If your child is toilet trained, make sure the back of the cast is protected with a plastic wrap that is tucked in well. This is especially important for a girl when she is using a bedpan so that the urine does not spill into the back of the cast. Boys can use a urinal.

You can elevate your child’s head and shoulder when they are on the bed pan. This will prevent the urine from going backward into the cast.

At night, you can check or change the diaper with position changes. 

Hip Spica for a Baby
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A small size diaper can be tucked into the cast. A larger diaper can be worn over the cast.

Protecting the cast from damage

Make sure your child does not walk, kneel, or stand on the cast unless the doctor says it is OK. Do not push or pull the leg that is in the cast. It might crack or break the cast or cause pain or injury to the affected leg.

Make sure your child does not put any small objects or toys inside the cast. Try to avoid food or crumbs from getting into the cast as well. Do not use any sharp objects, like knitting needles or combs, to scratch the skin if your child feels itchy. This may cause pressure, skin irritation, and damage. If your child feels itchy often, contact your doctor.

Protecting your child’s skin

Turn your child every 4 to 6 hours during the night. You may turn her from side to side or from stomach to back. Ask your child to extend her arms above the head, which will make the turn easier. 

Make sure the toes or heels are not pressing against the bed or rubbing on the sheets as it may cause skin break down or blisters.

You can turn your child more often if you notice any redness or skin break down. When you turn your child, you can massage the skin as well.

Do not use any talcum or baby powder inside the cast.

Making sure the cast is not too tight

Check the colour of the affected limb. You can use the other limb to compare. Toes and feet should be pink and warm to touch.

If your child can understand you, make sure that she is able to feel when touched. Ask your child to move her toes and feet 4 to 5 times a day.

If your child is too small to understand, just tickle your child’s feet and check for movement.

Check the cast more than once a day for any bad smells and re-petal the cast if needed.

If you find any consistent changes in the colour, feeling, and movement of your child's limbs or if you have any other concerns, contact your doctor.

Diet

If your child is taking narcotic pain medication for too long, it may cause some constipation. Since your child is not moving around as much as before, this can also cause constipation.

To prevent constipation, give your child a diet with fibre and plenty of fluids.

Getting around

A doctor will decide whether or not your child needs crutches. If crutches are needed, a physiotherapist or nurse will teach your child how to use the crutches. There is a small charge for the crutches.

If your child is small, a regular car seat will not be appropriate and she will need a special kind of car seat. The nurse caring for your child will be able to help you and provide you with all the necessary information you need.

Speak to the nurse if you think you will need advice on issues like getting to and from school or home.

Your child is allowed any activity as tolerated.

Seeing the doctor again

When you leave the hospital, you will be given a follow-up date and time if it is available. If not, in the next few days you will receive a call at home with the necessary information.

Taking off the cast

Your child’s cast will be taken off when the bones have healed. Your child’s doctor will decide when the cast needs to be removed.

An electric cast saw will be used to remove the cast. The saw is large and noisy and your child might feel scared. Before the procedure, we will explain to you and your child what is going to happen. This will help your child feel more comfortable.

We will also provide your child with an ear protector.

Caring for your child after the cast comes off

After the cast comes off, the skin that was under the cast will be dry and flaky and will need the following treatments:

  • Wash the skin several times with warm and soapy water.
  • Apply lotion to soften the skin.
  • Do not scratch or rub the skin too hard as it will be very tender.
  • After 3 to 4 treatments, the skin should begin to look normal again.

In an older child, you might see more hair than usual. This will fall out after several weeks.

After the cast is removed, you will be given more instructions on your child’s activities.

Your child may need some physiotherapy to learn exercises that will help with improving strength and movement.

Key points

  • A hip spica is a special type of cast that helps keep hip joints and/or the thigh in place.
  • A doctor or orthopaedic technologist will apply a cast made of either fibreglass or plaster of Paris material.
  • If your child has a hip spica, be careful not to get the cast wet.
  • Turn your child every 4 to 6 hours during the night. You may turn her from side to side or from stomach to back.
  • Check the colour, feeling, and movement of your child's limbs regularly and if you find any consistent changes, or if you have any other concerns, contact your doctor.
  • Your child’s cast will be taken off when the bones have healed. Your child’s doctor will decide when the cast needs to be removed.

Judith Fanaken, RN

6/27/2011

Who to call if you have any concerns

For any emergency, please go to the nearest Hospital Emergency.

You can also call or visit your family doctor.

You may also call the orthopaedic unit at 416-813-6948 to speak with a nurse.

For your follow up appointments or to make an appointment please call 416-813-5840 Monday to Friday from 8 am to 4 pm.

To speak with an orthopaedic technologist call (416) 813-5785





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