Caring for a Child in a Hip Spica Cast

What Is a Hip Spica Cast?

A hip spica cast is a cast that covers the body. It starts at the chest, goes around the waist and hips, and continues down the legs. It has an opening cut out for diapering or toilet use.

A hip spica cast may be applied after different types of hip or leg surgeries, tendon releases or a broken bone. It serves a very specific purpose: to immobilize the hips and legs, and to maintain the corrected position for healing.

Position & Comfort

Keep your child’s head and upper body in a semi-sitting position at all times. Do this by propping your child’s head up on pillows. Your child may need frequent position changes for comfort, including tummy time. Do not use the crossbar or the cast to lift or move your child. Do not let your child’s feet and heels rest directly on the mattress. This can cause pressure sores. Place small pillows or a rolled towel under the calves to keep heels and feet off flat surfaces.

Most clothes can be fitted to keep your child comfortable. Button-down or large T-shirts and loose dresses slip on and off easily. Baggy shorts or pants can be split on one side (you may want to add Velcro or ties so that your child can fasten his pants). Even loose dresses can be worn easily.

If the doctor tells you that your child can stand, follow these directions:

  • Stand your child against a wall, facing you.
  • Sit on a chair in front of your child to make sure they do not fall.
  • Do not leave your child standing without supervision.


There is an opening in the diaper area of your child’s cast for toileting. Your child may have skin and odor problems if this part of the cast gets wet.

Using a Bedpan

Older children may come home from the hospital with a bedpan and urinal.     

Prop your child in a semi-sitting position to use the urinal. To use the bedpan, gently turn your child to one side and place the bedpan under his buttocks. Then turn his back onto the bedpan. Check between your child’s thighs to make sure the bedpan is in the right place.

A “wick” can be made using several pieces of toilet paper guiding the stream of urine into the bedpan for girls. A long sheet of plastic food wrap may be placed inside the rear edges of the cast and hung into the bedpan. This will also help guide urine or bowel movements, keeping the cast and bed dry. Make sure to dry the buttocks after using the bedpan to prevent rashes.

Using the Toilet

If your child is light enough, you may be able to lift him on and off the toilet. A long sheet of plastic food wrap may be put under the rear edges of the cast and hung into the toilet. This will help guide urine or bowel movements into the toilet. Remove the plastic wrap as soon as your child is finished. Make sure to dry the buttocks afterward. Use a bedpan if your child is too heavy and you cannot lift him safely.


Place a diaper inside the edges of the rear part of the cast. Use disposable diapers only. Keep the plastic side facing the cast and absorbent side next to your child’s skin. Change the diaper as soon as your child urinates or has a bowel movement. Put a smaller diaper, sanitary napkin or a disposable incontinence pad inside the diaper at night. This makes sure all urine will be absorbed. One-piece T-shirts that snap at the diaper area seem to work best holding the diaper in place inside the cast. Always try to keep your child’s head higher than his feet. Gravity helps keep urine and bowel movements out of the cast and in the diaper.


Cast Care

It is important to keep the cast as clean and dry as possible for your child’s comfort. Cover the cast with a towel, large T-shirt or bib when your child is eating. This will help prevent food and drink from spilling on or into the cast.

To keep the cast clean, use a slightly damp cloth and mild soap to remove dirt and grime. Allow the cast to air dry.

Bathing Hair Washing

Sponge bathe your child only. Do not use a tub to shower or bathe. Wash all of his skin not covered by the cast with soap and water every day. It is important not to get your child’s cast wet. Protect the cast with towels during the sponge bath.

If your child is small enough, you may be able to wash their hair by laying them on the kitchen counter. Hang their head over into the sink, using towels for comfort and to keep the cast dry. You can use a shampoo basin or inflatable sink with older children in bed. These are sold at some drugstores or medical equipment dealers.

If a plaster cast gets wet and soft, call your child’s caregiver. Sometimes you can dry the wet part of a plaster cast using a hair dryer set on cool. A wet fiberglass cast can also be dried using a hair dryer set on cool. If your child has a pantaloon protective liner, please follow the hip spica care instructions and make sure that contaminants are not introduced into the cast, including oils, oil based lotions, powders, sand, dirt, grease or solvents.

Skin Care

Do not use powder or oil on the skin around the cast. They can cause skin irritation which may lead to infection. Do not give your child small objects or toys that can fall down inside the cast. 

Do not use anything to scratch under the cast. If itching is a problem, use a blow dryer on a cool setting to blow air under the cast.

Do not remove the padding that is inside the cast. Do not get the cast wet.


Caregivers will tell you how long your child needs to stay in bed. Follow their instructions carefully. Books, board or video games, music, TV and visiting friends can all help lessen your child’s boredom.

When caregivers say it is ok for them to get out of bed, involve your child in family activities. Changing rooms and going outdoors may help your child cope better with not being able to get around on their own.

Your school age child may be in a spica cast from four to eight weeks. Call your child’s teachers before they leave the hospital. This will give them time to plan for home study and other services as soon as possible.

Encourage your child to do as much as they can for themselves. Doing things for themselves will help them to feel some control over their life.

Moving & Traveling

To move around at home, smaller children may fit into a stroller or wagon padded with pillows. Use a seat belt, if needed, to make sure your child will not fall out.

Older children will be able to use a reclining (moveable back) wheelchair. You can rent one from a medical supply company.

A reclining outdoor lounge chair may also be used as a portable bed. This helps keep your child involved in family activities. Use pillows and towels for support and to cover any rough edges.

There are various ways to move your child safely:

  • Carry him as close to you as possible.
  • For one-person lifting, cradle your child under the arms and the buttocks, supporting the weight of the cast.
  • For two people, one person lifts under the shoulders and the other lifts the legs at the same time. Talk out loud to each other or count “1-2-3” so you both lift in a smooth motion.
  • Bend your knees and keep your back straight when lifting.

There are special car seats and safety vests made for children in spica casts. Ask caregivers before you leave the hospital about how to get one for your child.


It is important for you to know the types of problems that can occur when a child has a cast. Please call your child’s doctor if any of the following problems occur:

  • Pain that is severe, constant or not relieved by medicine
  • Numbness (loss of feeling) or tingling of toes
  • Swelling of toes that does not go down when the legs are raised on pillows or blankets
  • Color or temperature changes in the toes; the toes should feel warm when you touch them, and they should be pink rather than blue, purple or grayish-white
  • Drainage or foul odor under the cast
  • Inability to move toes
  • Constant fussiness or irritability
  • A broken or cracked cast; if this happens, try to reinforce the cast with tape before you bring your child to the doctor

Safety Tips

The part of the body that was in the cast may be sore and weak for several days or longer.

Try to keep your child on the first floor whenever possible in case of fire. You can move a small bed there for sleeping at night. Have an emergency plan and practice it.

Keep side rails up on cribs and always use safety belts on strollers and high chairs.

Do not leave your child alone at anytime.

Dieting & Eating

Increase your child’s intake of high fiber foods, fresh fruits, vegetables and fluids to prevent constipation.

Prop your child up on pillows when eating. Smaller, more frequent meals may work better for your child. Try cutting food into bite-size pieces and using straws for drinks.

After Spica Cast Removal

Once your child’s cast has been removed, you should not try to scrub away the flaky skin all at once.

Gently soak the skin with the soap and water, let the soapy solution remain on the skin for five to 10 minutes, then rinse it off thoroughly. Pat the skin dry; do not rub. After the skin is dry, apply a moisturizing cream. If you repeat the cleansing and moisturizing every day, the skin will soon be back to its normal condition.

The part of the body that was in the cast may be sore and weak for several days or longer. Your child may also need to take a mild pain medicine, such as Tylenol, for a day or so to relieve the soreness.

Remember, it takes time for muscles and joints that have been casted to regain their strength, flexibility and full function.

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