Spica Cast Advice

What to expect (and how to cope) when your child with
congenital hip dysplasia is placed in a spica cast.

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What to Know Before You Go to the Hospital

The following is information we figured out at the hospital, or stumbled upon the day before.

Some Terminology: Reductions & Arthroscopy

If your child has pediatric hip dysplasia and is therefore going to be fit with a spica cast, then their hip will have to be positioned properly so it winds up in the right position. This process is called a reduction (which is just a medical term that means the joint is returned to it's normal position). A reduction is often/always needed since a child with hip dysplasia likely has a dislocated hip (because the socket is too shallow).

There are two types of reductions: open and closed. A "closed" reduction is when the doctor is able to reposition the hip joint manually (without cutting the skin and tissue open to expose the joint). This is obviously less invasive. And therefore, an "open" reduction involves exposing the joint.

Your doctor will determine which your child needs. As with most things, you don't really get a choice here so we provide this information purely so you can better understand the discussion you will have at the hospital.

Finally, if you haven't heard it before, the doctor may need/want to perform an arthroscopy. This is like an endoscopy, where a scope/camera is inserted into the body in order to get a better picture of what is going on (xrays don't work well with infants since much of the joint is still cartillege and therefore not easily seen on an xray.

Before You Go to the Hospital

While there are some special items that we recommend you buy for diapering and cast maintenance, your hospital should provide you with everything you need to get home and manage a few diaper changes.

However there is one very important question that you have to answer before you elave for the hospital. Specifically... how are you going to get your child home?

As you will learn on the car seats page, children in spica casts DO NOT generally fit into conventional car seats.

The first thing you should do is check with your hospital to see if they have a loaner or rental program (the good people at Lucille Packard Children's Hospital spoiled us with a loaner).

If the hospital cannot help you, you can always buy your own. But beware... the current go-to solution from Snug Ride runs about $500 (see here). And we had no luck finding medical device rental companies that rent out these seats.

Before you Leave the Hospital

Once your child is fitted with the cast, there are two specific things you MUST do before you leave the recovery ward.

First... make sure that the nurses have taped over all of the sharp edges of the cast (a practice called "petalling"). While we have some tips on how to do this yourself, your nurses are professionals who I guarantee will do a better job than you. And a failure to petal these rough edges can result in pain and even lacerations for your little one.

So save yourself some physical and emotional pain and make sure that all edges are securely taped BEFORE you leave.

Second... (just like when you had your baby) tap your recovery and othopedics nurses for as much care and diapering knowledge as you can.

Video: Fitting the Cast

If you are curious, we found a pretty cool video that shows how the cast is applied (once the hip has been reduced). Please note... the child's legs can be put in several different positions, so the position this child's legs are being set in may not be the same position your child winds up in.