Hip Spica Cast Care

A hip spica body cast is used to keep your child's hips and legs from moving after an injury and / or operation.

It is not a walking cast; your child should not stand, bear weight or walk while in this cast.

Follow these guidelines to ensure the best care for your child.

Whenever there is a cast in place, it is important to check the function of the nerves and blood vessels. Check the following three to four times a day:

  • The color of your child's toes should be pink and warm to the touch.
  • Your child should be able to feel all sides of his / her toes when touched.
  • Your child should have little swelling of the toes.
  • Your child should be able to wiggle his / her toes the same as before casting.

If your child has a spica cast with a Gore-Tex liner:

  • Do not petal the cast with petaling tape, only with Hy-Tape.
  • Handle the Gore-Tex liner gently to prevent tears.
  • Keep cast dry.

If your child has a standard spica cast (without a Gore-Tex liner):

Once the cast is dry, you may "petal" the cast as instructed below to keep it clean and dry, and to avoid rough edges. (Do not "petal" the cast if it has a Gore-Tex liner.)

  1. Cut several strips of petaling tape to a length of about 4 inches.
  2. Tuck one end of the tape under the edge of the cast, and apply the tape to the cotton lining. Place the free end of the tape onto the cast's outside surface.
  3. Continue to overlap the strips until a complete edge is formed.
  4. Cover all edges of the cast, paying special attention to the diaper area opening.

Check the cast daily for cracks and dents, and for a change in the amount of room your child has between his / her skin and the cast.

To control odor and soiling, use a slightly damp cloth and mild soap to remove dirt. Allow the cast to air dry. Odor-Eaters may keep down odor if taped on the cast. If the cast becomes extremely soiled or wet, call your doctor's office for additional instructions.

Do not pull your child up by the arms or the armpits. Instead, hold your child by supporting the bottom of the cast. 

  • Check your child's skin every day. Press his / her skin back around all edges of the cast. Use a flashlight to give more light, and carefully look for reddened areas under the cast. Feel for blisters or sores under the edges of the cast.
  • Rub the skin under all edges of the cast with rubbing alcohol two to three times each day. This practice will help toughen the skin. If your child's skin becomes cracked or very dry, stop using the alcohol until the skin is clear again.
  • Do not use lotions or powders on your child's skin. These tend to irritate the skin.
  • Do not allow your child to stick any objects (coat hangers, pencils, coins, erasers) under the cast because it may injure the skin. If your child does put an object down the cast, call the nurse immediately.
  • Call your child's doctor if your child has unbearable itching.
  • Cast must be kept dry.
  • You may use a hair dryer on a cool or cold setting to blow cool air under the cast edges. Make sure the dryer air is cool. Warm and hot settings can cause burns.
  • Position your child so his / her head / upper body is elevated at all times. (Gravity will pull urine and stool away from the cast).
  • Prop him / her on pillows or elevate the entire head off the crib mattress.
  • Turn your child from front to back or side to side every two to four hours during the day, and as often as you can during the night.
  • If your child will not fit safely in his / her present car seat, there are special loaner car seats and safety vests for transporting your child in the car. Talk to your child's nurse or doctor about how to get one for your child.
  • Beanbag chairs can be used to help position your child.
  • An outdoor lounge chair may be used as a portable bed so your child can be a part of family activities.

You can transport your child in several ways:

  • Smaller children may fit in a stroller or a wagon using pillows and a seatbelt.
  • For older children, you may rent a reclining wheelchair from a hospital or medical supply vendor listed in the phone book.
  • A vehicle similar to a mechanic's dolly can be made. Preschool children can wheel around on their stomachs using their arms to move themselves.
  • When positioning for sleeping one option is to lay your child on his / her belly, placing a pillow under the thigh / hip line and under the chest. This can help prevent muscle spasms in the groin area while sleeping.
  • Your child should stay on the ground floor whenever possible in case of fire. A bed may be moved down to the first floor to allow sleeping at night.
  • Keep side rails up on cribs.
  • Use safety belts on strollers and highchairs.
  • Prevent small objects, such as toy parts, coins or crumbs from getting down into the cast.
  • Put a bib or T-shirt over the cast.

If your child must remain in bed:

  • Plan for quiet play activities. Books and crafts can be fun. Having friends visit and play board games or video games can help pass time.
  • A reclining wheelchair or reclining lawn chair can be easily moved to different parts of the house, or even outside, for a change of scenery.
  • If your child must remain at home while in the cast, contact the school principal or counselor to arrange for home teaching.
  • To prevent constipation, offer your child more fluids, fruits and vegetables, whole grain cereals and breads, and any other fiber foods.
  • Avoid overfeeding. Offer smaller, more frequent meals.
  • It may be easier for your child to eat lying on his / her stomach while propped with a pillow under his / her chest.

When choosing your child's clothing, think about the following:

  • A fiberglass cast takes about one hour to dry thoroughly.
  • Shirts, dresses and skirts may be worn normally over the cast once it dries completely.
  • Pants, shorts and underwear can be adapted by splitting the side seams of the clothing and inserting Velcro strips to fasten at the sides of the cast.

Using a Bedpan

Your older child will be discharged from the hospital with a bedpan and urinal. Remember:

  • When girls use the bedpan to urinate, a "wick" can be made using several pieces of toilet paper to guide the stream of urine into the bedpan.
  • Make sure to dry the buttocks well after using the bedpan to prevent rashes.
  • Make sure the bed sheets or pants stay dry.

Using Diapers

  • Use a size smaller than usual, and tuck the diaper between your child's skin and the cast.
  • Do not place the diaper over the cast because the urine from the diaper will absorb into the cast which may cause odor and / or soften the cast.
  • Use disposable diapers if possible.
  • Keep plastic backing next to the cast surface.
  • A sanitary napkin may be inserted into the diaper to absorb more urine, especially at night. For children over 1 year old, lining the diaper with adult incontinent pads (Serenity, Poise) is especially effective in keeping the cast dry.
  • The diaper may be held in place with an elastic belt that encircles the waist and comes between the legs. One-piece T-shirts with snaps at the crotch (Onesies) can also hold diapers in place.
  • Your child's toes or fingers are cold to the touch or appear pale or blue.
  • Your child complains of tingling and / or numbness of toes or fingers.
  • Your child cannot move his / her toes or fingers.
  • Your child's toes or fingers become very swollen.
  • Your child has pain not relieved by elevation and acetaminophen (Tylenol) or other prescribed pain medication.
  • Your child complains of rubbing or burning under the cast. It can be a sign of a pressure sore.
  • Your baby experiences continuous, unexplained fussiness.
  • Your child has a foul smell coming from the cast or if staining of the cast occurs that was not present when your child went home. This can be a sign of a pressure sore, especially if the patient is complaining of heel, calf, or knee pain.
  • Your child has a breakdown of skin under the edges of the cast.
  • Something falls down into and becomes lodged in your child's cast.
  • Your child's cast is too tight or too loose.
  • Your child's cast breaks, cracks or becomes soft.
  • You have any other questions.

To reach the orthopaedic nurse before 4 pm Monday through Friday, call 513-636-4567. After 4 pm and during weekends and holidays, call 513-636-4200 and ask that the orthopaedic resident on call be paged.

Last Updated 07/2013