A hip spica cast covers the pelvis and one or both legs, sometimes with a bar between them. It’s used, among other things, after some hip operations, after thigh bone fractures and in the treatment of hip dysplasia. For families it usually means several weeks of a completely different routine: different nappy changes, different carrying, different sleep.
Post-operative care varies between centres, and not every child has a cast after hip surgery. If yours does, this article will help you prepare for what’s usually hardest. Your hospital’s instructions always come first.
Skin – the most important daily check
Under the cast and around its edges, rubbing and sores develop easily. With a child who can’t speak, you won’t hear “it’s rubbing”, so skin checks need to be routine.
Check every day:
- the cast edges – for redness, rubbing or blisters
- pressure points – sacrum, heels, around the knees if the cast edges rest there
- feet and toes – colour, temperature, swelling
A few rules:
- never put anything under the cast – not to scratch, not to adjust something. It’s easy to damage the skin, and a sore under the cast is hard to spot
- don’t use creams or powders under the cast edges unless the hospital advises it
- a smell, dampness or a stain on the cast is a reason to contact the doctor
Nappies and hygiene
This is usually the biggest challenge, because the cast must stay dry.
- a two-layer nappy – a smaller size tucked under the cast edges at the groin, a larger one on top. The hospital usually demonstrates this before discharge
- frequent changes – more often than usual, so moisture doesn’t soak into the cast
- slightly raising the upper body during changes can help stop urine running under the cast – ask the hospital whether this is fine for your child
- sponge baths – a bath is out of the question. Only wash what’s outside the cast
Carrying and lifting
- never lift your child by the bar between the legs – it isn’t designed for that
- support the whole body – trunk and cast, ideally with two people if the child is bigger
- change position slowly – in children with spasticity, sudden movement can trigger a spasm and pain
Transport
A child in a hip spica cast often won’t fit in a standard car seat. Ask the hospital before the operation how to transport your child home and to follow-up appointments safely. Don’t travel with your child without appropriate restraint.
Sleep
The cast changes everything your child knew about sleeping. A few things usually help:
- regular position changes – day and night, as the hospital advises. This reduces pressure on the skin
- support under the cast – rolls and pillows so the weight is spread evenly and the heels don’t rest directly on the mattress
- watch the breathing – if your child has difficulty breathing, snores or chokes in a position, change it and tell the doctor
- lying on the tummy – sometimes recommended for pressure relief, but in children with breathing or swallowing difficulties or epilepsy, it needs the doctor’s specific approval
Poorer sleep in the first days is common – pain, spasms, a new position. If it doesn’t improve over time, mention it.
Eating and digestion
- feeding semi-upright with the back supported, unless the doctor advises otherwise
- smaller, more frequent meals – the cast presses on the tummy
- fluids and fibre – immobilisation and pain medication make constipation more likely. Ask about prevention before discharge
When to contact a doctor urgently
- feet or toes are pale, blue, cold or very swollen
- your child cries in a way that doesn’t settle despite repositioning and pain relief
- a fever develops
- there’s an unpleasant smell from under the cast, or a stain or discharge on it
- the cast cracks, softens or clearly shifts
- your child vomits, has a swollen, hard tummy or hasn’t opened their bowels for several days
- breathing is difficult
After the cast comes off
The end of the cast isn’t the end of caution.
- stiffness – joints are stiff after weeks of immobilisation. Movement returns gradually, ideally with a physiotherapist
- skin – often dry and flaky. Gentle washing and moisturising help
- bones – children who don’t walk often have lower bone density, and immobilisation lowers it further. After the cast is removed, bones are more prone to fracture, even during routine care. Movement and weight bearing are reintroduced carefully, as advised
- positioning – surgery changes bone alignment but doesn’t remove spasticity. It’s worth agreeing straight away with the orthopaedic surgeon and physiotherapist how your child should lie and sit from now on
I write more about the whole surgical period in the article on hip surgery, and about night-time positioning in the article on sleep positioning.
Key points
- check the skin at the cast edges, feet and toes every day
- never put anything under the cast
- the cast must stay dry – two-layer nappy and frequent changes
- never lift your child by the bar
- change position regularly, including at night
- ask about transport before the operation
- after the cast comes off, watch for stiffness and fragile bones
This article is for educational purposes only and does not replace the advice of your doctor or hospital. Cast care is determined by the treating team, individually for each child.