Hip spica Occupational Therapy guide

Positioning and seating

The hip spica cast will finish just above waist level. This means that your child will be uncomfortable or unable to sit on an ordinary chair. A great alternative is to sit your child on a beanbag as you will be able to mould the beanbag to fit your child’s cast, providing a supportive seating position.

Please do not leave your child unsupervised on a bean bag or use it for sleeping due to the risk of suffocation.

Varying your child’s seating position regularly (every 2 to 4 hours) will prevent pressure sores from developing. Check your child’s skin condition daily. Red, swollen or inflamed areas need to be monitored. If you suspect blisters or sores have developed you can ring the ward to gain advice about the next step to take.

Your child’s buggy or wheelchair should be brought in for assessment by an occupational therapist when your child comes in for their operation to ensure that they fit in it with their spica cast. If your child does not fit in their buggy a wheelchair can be provided by the Red Cross, if applicable details of where these can be picked up from will be provided by your occupational therapist.

Toileting

If your child is in nappies the nurses on the ward will show you how to apply the nappy. If your child is not in nappies they will not be able to sit on a regular toilet or commode due to the angle and position of the cast. We advise the use of bed pans or urinal bottles and the ward can provide these to you before you are discharged home.

Washing

It’s important to not get the cast wet. We would advise giving your child a strip wash with a damp flannel as an alternative bathing solution. Hair can be washed over a sink or using a basin.

Having a bath and showering will not be possible for the time your child is in the cast.

Moving and handling

The added weight and rigidity of the cast may make your child harder to lift. Lifting techniques will be discussed with you to find the best solution for you and your child. It is advised that 2 people are available for lifting and transferring your child.

If you predict that you will struggle with lifting and moving your child, assistive equipment is available and can be organised for your discharge home. Depending on the age and size of your child, downstairs living may be appropriate for the duration that they are in their hip spica cast.

Sleeping

It may take some time for your child to find a comfortable sleeping position. Pillows and rolled blankets can be used for positioning and comfort.

It is important to regularly check the rims of the spica cast to ensure that it is not leaving red marks or causing pressure on your child’s skin.

Mealtime and activities

Your child will be able to sit at the table in their buggy or wheelchair for mealtimes or alternatively sit on your knee.

Encouraging plenty of fluids and foods rich in fibre will prevent your child from suffering from constipation.

School

Contacting your child’s school prior to their surgery can help both of you to plan for your child’s return once in their cast. Some schools may not be prepared to care for your child in their spica cast, therefore having this conversation before the surgery will allow you to plan for child care.

Car seats

Please bring your child’s car seat in with you to the ward so the occupational therapist can assess its suitability for your child.

Car seats with low sides, shallow seats and ability to recline will make them more likely to suit your child when they have their cast on. High back booster seats may be an option depending on the height and weight of your child.

You can check the law on car seats on the Gov.uk website. Maxi-Cosi have a spica car seat scheme which allows you to hire a car seat specifically designed to be used for children with spica casts. For more information you can contact their happy hip service on 01284 413141.

Clothing

Due to the bar across the middle, trousers, shorts and underwear will need to be adapted by unpicking the seams and sewing Velcro or buttons along the edges. Your child can wear dresses and skirts that are wide enough to go around the cast. Alternatively you may want to keep your child in their nappy and use a blanket to cover them.