Contents

Introduction

Taking care of a child in a hip spica cast can be a difficult experience for you and your child. This pamphlet has been prepared to answer some of the questions you may have. Also included is information about what to expect if your child is going to be hospitalized and have surgery. If you have additional questions, please write them down so you will remember to ask your doctor.

Your child will go home from the hospital in a hip spica cast. Both the cast and your child will require special care as long as the cast is in place. A hip spica cast will be applied by your doctor after different types of hip or leg surgeries, tendon releases, or after a broken bone. Although the cast may seem bulky and awkward, it serves a very specific purpose: to immobilize the hip(s) or broken bone, and maintain the corrected position. The instructions reviewed by your doctor, and those in this booklet should be followed to assure your child's maximum comfort and safety.

Cast care provides not only for the general welfare of your child, but also for the prevention of sores caused by irritation and pressure of the cast against the skin. Close observation is needed to check for cast tightness and circulatory changes caused by swelling or by the normal growth process. You will receive information about the follow-up appointment and a telephone number you may call if you have questions or concerns.

Individuals providing your child's care, such as other family members or babysitters, should also be given the instructions in this booklet to assure that proper care of your child and his/her cast is maintained.

Before Surgery

Work-up Day

You will be scheduled to bring your child to the Orthopaedic Clinic for an examination sometime prior the scheduled surgery. This appointment may take several hours to complete. Several routine procedures will be performed prior to surgery that ensure that your child is in good general health. The doctor will listen to your child's heart and lungs, and check his/her ears, throat, etc. If your child is sick, has an ear infection, a cold, or is running a fever, please notify your doctor prior to this visit. The doctor may decide to postpone surgery until a later date.

A nurse will ask you many questions about your child to obtain an adequate medical history. You will also be asked to fill out an admission form. Please include anything that you feel will help the staff plan for the best care of your child.

Your child's temperature, pulse, blood pressure, and weight will be recorded as well as obtaining blood and urine samples. X-rays may also be ordered by your doctor at this visit.

You will see the anesthesiologist (the doctor who puts your child to sleep) to discuss the anesthetic that will be used during surgery. Your child should not have anything to eat or drink after midnight (the night before surgery) unless told differently by the anesthesiologist. The anesthesiologist will tell you what time to arrive on the day of surgery.

A blood transfusion is sometimes necessary after surgery. If there is a possibility of a blood transfusion, your child will be typed and cross matched for blood. A blood identification band will be applied to your child's wrist or sent home with you. It is important to keep the band clean and dry so we can read the name and number. Bring this band with you the day of surgery or another blood sample will need to be taken. In some cases, a parent may be allowed to donate blood for the child if the parent has the same blood type. Your doctor will discuss this prior to surgery.

Coughing, deep breathing, and clearing of secretions from the lungs decreases the chance for development of pneumonia after surgery. If your child is able to understand, he/she will be instructed on coughing and deep breathing exercises. He/she may also be instructed on using a small breathing device after surgery to assist with coughing, deep breathing, and clearing of lung secretions.

You will be given information on helping your child with pain control. See pamphlets: "Helping Your Child With Pain Control" and "Pediatric Use of Patient Controlled Analgesic." We want you to take an active role in making sure that your child's pain is minimal.

Night Before Surgery

The night before surgery, you will be instructed to use iodine surgical soap scrubs to the areas where the doctor will make the incision. (If your child is allergic to iodine or soap, please inform the nurse.) This decreases the bacteria on the skin to reduce the chance of infection. The scrub should be repeated again in the morning before you come to the hospital for surgery. Your child may eat and drink until the designated time given to you (usually nothing to eat or drink after midnight before surgery). Avoid salty foods the evening before surgery to prevent waking up extremely thirsty.

Morning of Surgery

You should report to the anesthesia pre-op area at the designated time. The nurse will take your child's temperature, pulse, respiratory rate, and blood pressure, apply an identification band, and visit briefly with you. At the appropriate time, the operating room transport person will take your child to the Presurgical Care Unit (PSCU). You may choose to accompany your child there and remain until he/she is transported to the operating room. While your child is in surgery, you will be directed to wait in the Boulware Day of Surgery Lounge on the 6th floor of Pappajohn Pavilion, across from H elevators. Surgical time will vary for each procedure. The doctors will talk to you in the Day of Surgery Lounge after surgery to report how your child is doing.

After Surgery

The hip spica cast will be applied in the operating room after surgery is completed and while your child is still asleep.

After the cast is completed, your child will be taken to the Post Anesthesia Care Unit. Recovery time varies depending on how fast your child wakes up from the anesthetic or how much pain medication he/she requires in the recovery room. You will be allowed to be with your child in the recovery room when the nurse feels is appropriate.

Your child will be taken to a hospital room when the doctor decides he/she is ready. Once your child is in his/her room, a full assessment will be done by the nurse which includes: temperature, pulse, respiratory rate, blood pressure, IV (intravenous line) site check, cast check, assessment for pain, etc.

Things you can expect:

  • Your child will be lying on pillows in the hip spica cast. Smaller children will be propped sitting upright, which allows for optimal positioning of the hips down into the cast.
  • Your child will have an IV (intravenous line) that was started in the operating room. The IV will be continued until the child is able to take an adequate amount of fluids and is eating solids. Please ask your nurse before giving your child anything to eat or drink. Your child will be given clear liquids (ice chips, water, 7-UP, or popsicles) first after surgery; then gradually advanced to his/her regular diet.
  • The nurses will be measuring how much your child drinks and the amount of urinary output.
  • Your child may experience pain or muscle spasms. The nurse will give pain medication via the lV or by rectal suppositories. Pain medication will be started as soon as possible and given as often as needed. It is important that you, and if possible your child, take an active role in assessing and reporting pain to the nurse so that effective measures can be taken.
  • Your child may be nauseated or may vomit. Medications will be available to control this if the problem persists.
  • The nurse will be monitoring your child's vital signs frequently and checking the child's toes for color, movement, sensation, and warmth. Toes should remain warm and pink with good blood return.
  • Your child may have some drainage coming through the cast. This is normal and the nurses will be monitoring increases.
  • Your child may have swelling/edema in the genital area. This is normal due to the close proximity of some surgical incisions to the genital area. Ice and elevation may reduce the swelling and discomfort that may accompany it.
  • Routine x-rays (or tomograms) may be taken while your child is in Post Anesthesia Care Unit or after returning to the hospital room.

Care of the Hip Spica Cast

Keep the Cast Clean and Dry

Cast care and skin care are closely linked. If urine or bowel movements are allowed to remain in contact with your child's skin (such as under a wet or soiled diaper or beneath the edges of the cast), diaper rash and subsequent skin breakdown are likely.

This is not only uncomfortable and painful for your child, but can also impede the corrective process if the cast must be removed due to skin problems. Therefore, it is essential that all precautions be taken to prevent development of skin irritations.

Shortly after your child returns to his/her hospital room a waterproof plastic tape will be applied to the cast around the genital area to help prevent soiling. The waterproof tape can be washed with soap/water, then dried if soiled. To prevent the edges of the cast around the stomach from irritating the skin and to eliminate plaster crumbs in the bed, the edges of the cast will be sealed with adhesive tape petals. A colorful fiberglass covering is sometimes added to the cast before you take your child home. This provides an additional layer of protection to the cast.

After demonstration by the nursing staff about how to clean and maintain this plastic barrier, you will participate in its maintenance during your child's hospital stay so you will be able to continue to do it at home.

In addition to the plastic strips, incontinence pads should be used to further protect the cast and skin of the child who may be incontinent. Place a pad across the diaper area, tucking it under the front and back edges of the cast. Then, diaper the child as usual. Remember, no cast opening or child's surgery is the same. Experiment with various pads, newborn preemie diapers, folded cloth diapers, and incontinence pads until you find the right one for your child. Every child's urinary and bowel routines are different. Children come in "all sizes" and casts vary due to the type of surgery performed.

In any case, frequent, regular checks must be made (at least every two hours during the day and every three to four hours during the night) to make sure the pad/diaper is changed as soon as it becomes wet or soiled.

Remember: A cast that feels dry on the outside is not necessarily dry on the inside.

During the night, the pad/diaper should be checked and changed, if necessary, with each position change. This should be done at approximately three-hour intervals during the night and more often if needed. It may be necessary to set an alarm clock to make sure that none of these position/diaper changes are skipped.

Positioning the child on pillows so that the head and shoulders are higher than the buttocks will also help keep the cast dry. To protect the pillow, plastic wrap or a disposable diaper may be used inside the pillow case.

Using the Bedpan

Elevate your child's head and shoulders with pillows when he/she is placed on the bedpan. This will help prevent urine from running backward and inside the cast. A gauze or cloth pad or a small folded towel placed on the back rim of a bedpan will absorb any moisture and help keep the cast dry. The pad is removed with the bedpan. A plastic bedpan can be sent home with your child if needed.

Cleaning the Cast

If the cast becomes soiled from stool, it may be cleaned by using a damp cloth and a small amount of cleanser, or toothpaste may be applied with a small brush. The latter may also help to remove any accompanying odor.

Drying the cast

If the cast becomes damp, it can be dried by exposing it to air during the child's nap time. Remove the child's diaper, leaving the incontinence pad in place. A hair dryer may also be used to dry the cast on a warm or cool setting (not hot) for l0 to 15 minutes. The hair dryer should be l0 to 12 inches away from the area being dried and should not come in contact with the skin.

Bathing

Give your child a sponge bath daily. Be careful not to get the cast wet. Using a damp cloth, reach under the cast edges to remove plaster crumbs, food particles, and the like.

You may apply rubbing alcohol to the skin around the cast edges to prevent skin breakdown. Do not use lotions, powders, or oils under the cast or around the edges. Powders have a tendency to "cake" and lotions and oils will soften the skin, making it easier for the skin to break down. Do not apply alcohol to blistered areas or to any incision.

Skin and Cast Inspection

Check carefully beneath the cast edges morning and evening for skin irritation, redness, blistering, open or draining areas, or pressure spots. A flashlight may be helpful.

Observe the cast for cracks, dents, softening, increasing tightness or looseness, or drainage on the cast.

Do not permit your child to poke crayons, small toys, or other small objects beneath the cast edges as they may cause pressure areas or skin breakdown.

Diet

Avoid introducing new fruit juices or foods which could cause loose stools. If age appropriate, have your child drink plenty of fluids and eat a variety of fruits and vegetables to prevent constipation and promote healing.

Clothing

Velcro can be used on legs of clothing to ease in dressing.

Pain Medication at Home

Appropriate pain medication with instructions will be sent home with you.

Positioning and Turning

The child in a hip spica cast must be positioned properly and turned regularly to prevent skin problems and to provide maximum comfort. Position the child with head and upper body elevated at all times. This allows for better positioning of the hips down in the cast and allows gravity to pull urine/stool away from the cast. Reposition the child on pillows at least every 2 to 4 hours including nighttime hours. Turn your child from side to side, on his/her back, or on his/her stomach. Make sure the cast is not too tight at the waist or chest. Heels should be free of pressure when your child is on his/her back. Protect the toes from touching the mattress when your child is on his/her stomach by placing a pillow or rolled towel beneath the ankle.

In some instances, a wooden crossbar is placed between the legs of the cast and incorporated into the cast with plaster when the cast is applied. The purpose of the crossbar is to stabilize the legs. DO NOT use the crossbar to turn your child, as it may break off. When turning your child, encourage him/her to keep arms extended above the head.

If reddened areas appear near the base or the top of the spine or on the heels, your child must stay on his/her stomach for longer periods of time.

Transporting

Your child may be out of bed in a stroller/wagon if cast size allows. For the larger child, a reclining wheelchair with elevated leg rests may also be used. Always use proper methods of positioning as previously discussed in this booklet. Remember to use proper safety measures at all times (side rails, seat belts, and safety straps as appropriate for age and size). Please consult the nurse in charge of your child's care for assistance with rental of a hip spica car seat or hip spica vest restraint for safety in automobile transportation. Also remember to return the car sear or vest restraint af your next appointment.

Telephone Numbers

How to Reach the Orthopaedic Doctor or Nurse

  • For nursing questions about your child's care call the Orthopaedic Clinic at 319/356-3844.
  • If you would like to talk with your doctor, call the Orthopaedic Clinic, 8:00 a.m. to 5:00 p.m., Monday-Friday at 319/356-3844. After 5:00 p.m. and on weekends or holidays call the hospital operator at 319/356-1616 and ask to speak to the Orthopaedic resident on call.
  • Feel free to call any time - day or night - if you have questions or problems.

Return Appointment

It is important that you return for your scheduled appointments. Your next appointment in the Orthopaedic Clinic is _________ at ___________. If you need to make or change an Orthopaedic appointment, call Scheduling at 319/356-2223.

Helpful Suggestions

The following are suggestions from parents of children in hip spica casts:

  1. Diapers:
    • Use adult incontinence pads in the genital area. This also works for the abdominal area if child perspires. (Brand names mentioned were Dignity Pads, Super Tranquility Pads, and Poise Pads by Depend.)
    • After wiping buttocks and blow drying, apply a thin layer of Vaseline or diaper rash ointment to child's bottom. This helps coat skin and prevent diaper rash.
  2. Mobility and travel:
    • A wagon with removable sides can be used to transport a child around the house. The child should be propped with pillows and restrained securely.
    • Travel with several extra pillows to aid in positioning in restaurants and other places.
    • Position the child in a recliner.
    • Bean bag chairs are comfortable and work well for propping children for activities.
    • We can assist in arranging a reclining wheelchair for older children.
  3. Diet:
    • Avoid any fruit juices or foods which cause loose stools or diarrhea.
    • The first few weeks after surgery may not be the time to introduce new foods to child's diet.
    • Decrease amount of fluids in evenings before bedtime.
  4. Parents' phone numbers are available to you if you wish to talk to a parent who has cared for a child in a hip spica cast. Remember: be patient, you will get through this!

Department of Nursing, Orthopaedic Nursing Division
Creation Date: September 1994
Last Revision Date: February 2012