A hip spica (spy-ka) is a type of plaster cast that covers one or both legs from the ankles up to the belly button. An area around the groin is cut out for toileting. This type of cast is used to prevent movement for hip dysplasia, after hip surgery or for fractures of the femur (thigh bone), allowing the area to heal.

Your child may be uncomfortable in a hip spica at first, but you and your child will get used to it quickly.

Preparation in hospital

Plaster tends to absorb moisture, so it is very important to keep the hip spica dry. Nursing staff will apply tape (like electrical tape) to the edges of the plaster (called sleeking or taping) around the groin area to help prevent urine (wee) and faeces (poo) from soaking into the plaster.

The hip spica requires a great deal of special care – especially when it comes to toileting and bathing – and you'll be given a lot of education and preparation before your child goes home.

Nursing staff will demonstrate how to care for your child in a hip spica, including how to pick up and carry your child, position changes, nappy changes, feeding, bathing and transporting them.

You will be encouraged to participate in your child's care during their hospital stay. This will help you to feel more confident when you need to do it at home.

Transportation

Your child's car seat or booster seat, and pram or wheelchair will need some modifications to fit your child while they are in their hip spica. The nurses caring for your child are trained to make these adjustments, and an occupational therapist (OT) may also help with fitting your child into appropriate restraints.

• It is illegal for your child to travel in a car unrestrained. Car seats often need modifications such as padding with towels or extendable crotch straps so your child can fit when they have a hip spica.
• Where your child is in a very straight hip spica, the OT may prescribe an Eze-on vest, which allows your child to be transported in a lying position across the back seat.
• Most of the time, infants will fit into their prams with some small modifications – nurses on the ward will do this.
• Children who are too big for prams or strollers will need a wheelchair to get around. A Perthes trolley may also help your child to move around more easily. These look like very large skateboards and are available for hire.

Care at home

Toileting and nappies

Care of the toileting area of your child's cast is important, and needed to make sure your child is comfortable and to keep the cast dry.

• Nappies need to be checked and changed often (at least every two hours during the day and every three hours during the night). 
• Lift older children onto the toilet, making sure they are sitting as upright as possible. 
• Older children can also use a urine bottle or pan. If your child is using a bedpan, they need to be positioned with their head elevated above hip level. This will help prevent urine and faeces coming into contact with the plaster, and urine from running back inside the plaster.
• If your child wets the bed at night, or if they have special needs, ask the nurses to show you how to protect the plaster using nappies and sanitary pads. These will need to be changed as soon as they are wet to avoid moisture being absorbed by the plaster.
• If your child has loose bowel motions or if you are having trouble keeping the urine from running under the plaster, cotton padding can be used around the toileting area to help stop this. This will also need to be changed regularly. 
• If the hip spica does get wet, try leaving the toileting area uncovered so it can dry in the air, or use a hair dryer (on a cool setting). Positioning your child on their stomach with their nappy off will help to dry the back of the plaster.
• A hip spica will rarely be changed if it smells because of soiling and urine staining. A few drops of lavender or eucalyptus oil or Nil-Odour can be used on the plaster if a smell of urine or faeces develops.  Use only a very small amount so the plaster doesn't soften.

Bathing and hair washing

It's important to keep the hip spica dry when bathing and washing hair. Washing your child in a hip spica is done by using a bowl of water and a face washer (a sponge bath). 

• Wash hair over the edge of a sink or bath with a jug. You will need the help of another person. One person holds the child over the bath or sink, while the other washes the hair. 
• A larger child may be washed in the same way but positioned on the bed, floor or a Perthes trolley. A large dish may be placed under your child's head to allow for hair washing with a cup or jug. Or, one adult can support the child on their knees while seated beside the bath, while the other adult washes the child's hair.

Lifting

When lifting your child, it is important to support them and the weight of the plaster. Do not lift them under the arms without supporting the plaster as well.

• Keep your child as close as possible to your own body when picking them up. This helps prevent straining your back and helps make your child feel secure.
• Older children in hip spicas can be very heavy and an OT may be able to suggest equipment to help with lifting (e.g. a hoist). If you have any concerns about lifting your child or concerns about the amount of support you have at home, please discuss these with your child's nurse.
• If there is a bar across the legs, this can be used for lifting after the plaster has a fibreglass outer layer applied (scotching).

Positioning

Children in a hip spica cannot move easily, so you will need to change their position often to avoid sores developing under the plaster.

• Position changes should be made every two to four hours, during the day and night. You can do the changes during nappy checks.
• Positions include laying on their back or on either side using pillows or rolled up towels for support. Children can also be positioned on their stomach, supported by pillows, for short periods of time under direct supervision of an adult.
• Every time you change your child's position, check that the plaster is not digging in and is not too tight around the edges (tummy, ankles, groin and knees). Also check this when placing your child in the car.
• Make sure your child's heels, feet and toes can move freely after each position change. Make sure their feet are not pressed into the mattress or chair, as this could cause pressure sores, especially when positioned on the stomach. 
• If your child develops a reddened area on their spine, they may need to spend more time on their stomach.

Feeding/diet

• If your baby is breastfed, experiment with different positions to find one that suits you best.
• If your child is eating solids, you may need to feed them smaller meals more often because the plaster is tighter around the stomach.
• Sit your child as upright as possible when feeding. It is a good idea to do this in their pram or wheelchair, ensuring your child is well secured.
• Encourage your child to eat plenty of fruit and vegetables and to drink lots fluids to help prevent constipation and to promote healing.

Clothing

• Dress your child in larger clothing so it can fit over a hip spica.
• Smaller children may only need a T-shirt or jumper and socks. Pull socks up over the plaster so they are not tight around the ankles.
• Underwear for older children can be altered with Velcro, press-studs or ties on the sides. Where there is a bar between the knees, it may be easier to place the Velcro or press-studs on the inside of the legs.

Skin care

Skin around the edges of the plaster should be checked every day for redness, blisters, pressure areas or skin irritations.

• Your child will be growing, so check regularly to make sure the plaster is not too tight.
• Powders and creams should only be used on skin that you can see. Do not put any powder or cream under the plaster because this can cause skin irritation.
• Be sure your child does not poke things down the plaster, even if itchy. Items poked down the plaster can cause sores and may become stuck.

Entertainment

• Your child will adjust to being in a hip spica very quickly and should continue with their regular routines as much as possible.
• Toys should be placed within easy reach.
  

When to see a doctor

Call your GP or OT if:

• you notice any sores or blisters on the skin under the edges of the cast
• your child has a high temperature that cannot be explained by a cold, ear infection or other illness
• there are cracks, breaks or softening of the plaster
• your child's toes are bluish, reddened, swollen, very hot or very cold
• if there is an unusual odour (bad smell) coming from the plaster which cannot be explained by soiling (poo or wee)
• if the cast has become too tight.

Follow-up

You will be advised when your child needs to have a follow-up appointment with a doctor – this is usually six weeks after surgery. At this appointment an X-ray will be taken to see if the hip spica is ready to be removed.

Key points to remember

• Children in hip spicas need special care. Nurses will teach you how to care for your child once they go home.
• Hip spicas are not waterproof and should be kept dry.
• Nappies need to be changed as soon as they are wet or dirty to help keep the plaster clean and dry.
• Your child's position should be changed every two to four hours, and skin should be checked every day.
• If you notice an odour (not from urine or faeces) coming from the plaster, contact your hospital or visit your nearest hospital emergency department.

For more information

• Kids Health Info fact sheet: Developmental dysplasia of the hip (DDH)
• Kids Health Info fact sheet: Pressure injury prevention
• The Royal Children's Hospital: Orthopaedics department
• The Royal Children's Hospital equipment hire and sales: Equipment Distribution Centre (EDC)

Developed by The Royal Children's Hospital Orthopaedics department. We acknowledge the input of RCH consumers and carers.

Reviewed June 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.