Caring for a child in a hip spica

A hip spica is a type of orthopaedic cast used to immobilise the hips, spine, or thigh to assist with healing after surgery or injury. It may be used for:

• developmental dysplasia of the hip (DDH)
• hip or femur (thigh bone) fractures
• spinal fractures
• post-operative recovery from hip or femoral surgery.

There are 4 types of hip spicas:

• bilateral (both legs in cast)
• unilateral (one leg in cast)
• one-and-a-half
• half spica.

This guide offers general advice. Your child’s needs may differ—please follow the guidance of your treating team.

Key considerations

• Always support the cast when lifting.
• Reposition your child every 2-4 hours.
• Keep the cast dry and clean.
• Seek help early if you are concerned.

Moving your child

• Always support the cast when lifting your child.
• Ensure you “scoop lift”—one hand under the spica, one under the back.
• Never lift your child by the arms without also supporting the cast.
• Hold your child close to your body to protect your back.
• For larger children, a two-person “top and tail” lift or hoist may be needed.

Best positions for comfort and safety

Change your child’s position every 2–4 hours to prevent pressure areas.

Positioning tips

• Always support the weight of the cast—legs should not hang unsupported.
• Ensure your child is in a safe and secure position.
• Use pillows or towels for support.

Safe positions

• Reclined sitting in a beanbag, stroller or propped up with pillows.
• Lying on back with a rolled towel under the legs.
• Side-lying with pillows behind the back and between the legs.
• Tummy time (prone) only with supervision and after speaking with your occupational therapist.

Pressure area care

Children in a hip spica are at risk of pressure injuries from the cast. Signs include:

• redness or irritation
• skin breakdown or foul smell
• increased pain or irritability.

To prevent pressure areas ensure you:

• reposition regularly (every 2–4 hours)
• use soft padding or rolled towels under pressure points
• seek medical help if you notice any of the above signs.

Transport and travel

During your child’s stay, please bring a car seat and stroller. An Occupational Therapist will check if these need modification.

Car seat compatible brands for modification include:

• Britax
• Baby Love
• Hipod.

If unsuitable, a loan car seat may be provided.

Stroller preferred features include:

• a wide seat
• minimal side struts
• reclining backrest
• adjustable straps.

Note: Loan strollers are not available. Older children may be assessed for a wheelchair.

Sleep guidelines

• Place your child on their back to sleep.
• Use a rolled towel or small pillow under the legs for support.
• Never leave your child on their tummy while sleeping.
• Check on your child every 4 hours overnight
  • reposition between back and minimal side-lying
  • check for safe positioning
  • change nappy if required.

Learn more about safe sleeping guidelines on the Red Nose website.

Toileting and nappies

For young children:

• Use the double nappy technique
  • smaller nappy inside the cast
  • larger nappy on the outside
• change nappies immediately when soiled
• clean any soiling with baby wipes and allow the cast to dry.

For toilet-trained children:

• support your child securely on a toilet or potty
• consider urine bottles or bedpans as they may be more convenient.

Play and entertainment

• Continue your child’s usual routines.
• Use lap trays for drawing and play.
• Change scenery often.
• Encourage interaction with friends and family.

Feeding and diet

• Breastfeeding can continue—try different positions.
• Offer small, frequent meals to reduce bloating.
• Sit your child upright and is well supported while eating.
• Avoid large meals before sleep to limit overnight toileting.
• Encourage a healthy, balanced diet to reduce constipation and aid healing.

Dressing your child

• Use larger-sized clothing or alter pants with velcro or press-studs.
• Avoid overheating—monitor blankets and layers.
• Cover the unaffected leg with loose pants or a sock to prevent rubbing.

Bathing and hygiene

• The cast is not waterproof.
• Use a damp cloth for sponge baths.
• For hair washing
  • lay child over a sink or bath edge
  • use a jug of water
  • have a second person to help.
• Avoid powders, oils or lotions near the cast.

Returning to school or daycare

Speak to your treating team if your child is returning to school/daycare. The occupational therapist can provide advice on how to support your child’s return safely.

When to seek medical help

Seek medical advice if:

• you notice redness, skin breakdown or foul odour
• your child has increased pain or is more irritable
• the cast becomes wet or damaged
• you have any concerns about positioning, sleep or toileting.

Contact us

Orthopaedic Outpatients—Orthopaedic CNC (Clinical Nurse Consultant)

Location
Level 1, Queensland Children’s Hospital
501 Stanley St
South Brisbane 4101 Qld

Phone
07 3068 2579

Email
chq_cnc-ortho@health.qld.gov.au