Caring for a child in a hip spica cast can be challenging, but it is totally doable! I’m sharing everything we’ve learned from our spica journey.
Psst… I don’t normally share much about my family here because I like to keep my private life separate from my blog, but I felt like this was important to share in the hopes that our story could help someone else in the same situation! Please be kind and respectful.
Hello friends! It has been nothing but tumbleweeds over here for the past few months, but for good reason. In April my daughter Bee (who was six months old at the time) was diagnosed with development dysplasia of the hip (DDH). She underwent surgery to correct the problem in June, followed by twelve weeks in a hip spica cast. It has been a very challenging summer for us (to say the least!) but the end is in sight! My daughter’s cast will be removed this Wednesday, and she will graduate to wearing a supportive brace for a few months, and then will be done with treatment!
We are so glad that our spica cast journey is FINALLY ending, but I wanted to share all of the things we’ve learned this summer, in case my experience can be of help to anyone else. When Bee was first diagnosed, I spent many a late night scouring the internet for information, and personal blog posts were a lifesaver to me! It is so helpful seeing other families not just surviving, but actually thriving. I’m hopeful that our story can be a help to someone else going through the same thing!
What is hip dysplasia?
Hip dysplasia is a condition in which the bones of the hip joint are not aligned properly. In my daughter’s case, she was born with her left hip dislocated. Sometimes hip dysplasia can be caused by breech positioning before birth, and may be more common with multiples, but in our case there weren’t any risk factors before birth. It’s generally not painful in children before adolescence, and we probably wouldn’t have even noticed unless Bee started to walk with a limp. From the outside, her hip looked normal, and she was scooting, sitting, and rolling over like any typical child her age.
Bee was diagnosed during a routine well baby visit when the resident examining her noticed a clunk in her hip. If you have any concerns about your baby or child’s hips, I would definitely recommend getting an ultrasound or x-ray (depending on the child’s age) to rule out hip dysplasia. In general, the earlier it is treated, the easier and shorter the treatment (although obviously every child/situation is unique).
What is a hip spica cast? How does it help with hip dysplasia?
A hip spica cast is used to hold the hip in place so that the bones can mold each other and create a more normally shaped hip socket. In my daughter’s case, her acetabulum (the cup shaped area on the pelvis that holds the head of the femur in place) is very shallow, which means her femur was able to slide in and out of place. During surgery, her hip was aligned the way it should be (called a closed reduction) and then the cast was put on to hold the hip in place so the bones can shape each other. She had her first cast (pink) for 6 1/2 weeks, then had a cast change under anesthesia, and had a second cast (purple) for 6 1/2 weeks. (There’s a fascinating video of how a spica cast is applied here.) My daughter’s cast weighs somewhere around 3-ish pounds (about 15-20% of her body weight) and it has definitely made it a little more challenging to pick her up and carry her around.
What is life with a spica cast like? How do you change her diapers? Give her a bath? Feed her?
Obviously pretty much everything is a little more challenging with a spica cast! We’ve had to adapt and get creative in lots of areas, but I feel like we have done a pretty good job of it. Here are some things that have gotten a little trickier with the spica cast:
– Feeding –
I was very worried about how we would keep her cast clean, and keep messy food out of it. We had started baby led weaning a few months before she got her cast, and the spica table made it pretty easy to continue. I covered her cast with a kitchen towel, added a bib (I love these ones from Tiny Twinkle because they cover so much), and put her in the table. She stayed clean and dry while exploring lots of different foods. Even when she dumped spaghetti on her head or flung applesauce all over the room, her cast stayed clean and dry.
I was worried that breastfeeding would be significantly harder, but we adapted pretty quickly and easily. I know lots of people have struggles in this area with a spica cast, but we were pretty lucky! If you are able to make it work and keep breastfeeding, I think it is definitely worth the effort. On days when Bee was uncomfortable and upset, it was such a comfort for both of us to be able to snuggle and nurse.
– Car Seat –
We had to borrow a car seat from the hospital (a Wallenberg), since she couldn’t fit in her infant car seat after she was casted. As much as we loathe this gigantic brown slab of a car seat, we are so grateful that we had the option available to us so we were able to get out as much as possible this summer! At first the rough straps on the car seat were scraping up the back of her head and causing sores, but we figured out pretty quickly that the padded insert from her infant car seat could fit on top of the straps to protect her head.
– Spica Table –
I heard people say over and over that a spica table was a lifesaver, and I was like, “Really? How much difference could it actually make?” They can be expensive (often several hundred dollars) but I found ours to be totally indispensable. My daughter ate all of her meals in hers, played with toys in it, and got pushed all around the house by her sisters in it. It was the perfect solution to hold her when I was cooking or cleaning and just needed her to be in a safe place. She had been using a bouncer seat and swing before her cast, and didn’t fit in either of those afterward, so the spica table was a lifesaver when I needed my hands free! My husband is a fantastic carpenter and was able to build one for her (in one day!) but if you’re not handy, you can buy one from Ivy Rose (they have so many fun designs!) or borrow/rent/buy one from this Facebook group.
– Diapering –
This is the area I was most worried about with the spica cast, but it turned out to not be as hard as I had imagined it would be. Our surgeon left a big enough opening in the cast for us to position her diapers easily, and we had very minimal problems with diapers leaking. We used her normal diapers (size 2) on the inside of the cast with the tabs ripped off so they didn’t irritate her skin.
On the outside of the cast, we used these reusable diaper covers to hold everything in place. (I also like that they look cuter and more like clothing, come in lots of fun colors and patterns, and are easy to wash and reuse!) We were also lucky to have a gore-tex liner inside the cast, so it was super easy to wipe clean. On a few occasions we needed to use a blow dryer to get her all clean and dry, and Bee thought that was hilarious.
– Bathing –
This was probably my least favorite thing about having the spica cast. It was such a pain to bathe her! The way I found that worked the best was to lay her down on her back on a towel next to the kitchen sink, with her head hanging over the sink, and use the sprayer to gently wash her hair. I then did a sponge bath for her chest, back, feet, and diaper area. I can’t wait until she is out of the cast and can take a real full-body bath! (Almost 13 weeks without a real bath is way too long.) I generally used Burt’s Bees baby shampoo and a soft infant washcloth, but when I was short on time, a quick wipe down with Mustela no rinse cleanser was super helpful.
– Entertainment –
We didn’t own a baby gym before my daughter was in the cast, but it was incredibly helpful in keeping her entertained and happy, and it was worth every penny. We got this one from Target and it provided hours of entertainment. Our surgeon was a little concerned about us putting her on her tummy (for fear of suffocation), but she pretty quickly learned to scoot all around in her cast and even managed to roll over a few times. I just scattered various toys all over the floor for her, and she scooted over to them and played. When she wanted to sit up but didn’t want to be in the spica table, this little chair from Target was very helpful.
– Positioning –
Positioning was challenging because a child in a spica cast can’t sit in a typical seat, reposition themselves when they’re uncomfortable, or sit up when they are on the floor. We often used a Boppy pillow for support and positioning when she was on the floor, as well as random pillows from around the house.
We also bought a bean bag chair from Pottery Barn and it was helpful for getting her up off the floor and giving her a different point of view. Occasionally she even napped in it (although obviously I stayed close by to keep an eye on her)!
For on the go, a modified Bumbo chair (with the sides and front cut down using a serrated knife) was really helpful. It was lightweight and easy to throw in the back of the car so the baby had a place to sit when we were out on adventures. We took ours to the beach and on little road trips, and it made feeding on the road much easier.
– Sleeping –
I had the best of intentions that she would sleep in her crib every night, but she had a really hard time getting comfortable and wouldn’t sleep on her own. After reading lots of other spica mom blogs, I bought a wedge pillow to help with positioning and added another pillow under her legs to boost her up comfortably. Still no luck! She has slept nearly every night in the bed with me (my husband has been sleeping in the guest room) and has more or less given up on naps. She only wants to be nursed to sleep, and won’t fall asleep on her own. I’ve done my best, but there’s only so much I can do! Sometimes you just have to do what works and not feel guilty that it’s not perfect. I’m hoping that in the next few weeks I can coax her back into sleeping in her own bed, even if it’s still in my room.
How are y’all still smiling all the time?
Honestly, I think the number one reason that we have survived all of this mostly in one piece is that I have made it a point to get out of the house pretty much every day. We go for walks (usually twice a day) and we have a few different stroller options that work. I really like her Chicco Mini Bravo stroller (with a pillow underneath her bum to help position her), and she also has a tricycle stroller that works great.
Besides the spica table, the one piece of gear that has been completely indispensable is my Ergo carrier. She fits perfectly in it in her cast, and it’s what I use 95% of the time when we leave the house. She doesn’t fit in shopping carts or most strollers, so it is definitely the easiest way to lug her around. We’ve done everything from visiting the coast to shopping to berry picking in it, and it has made life so much easier. I bought it in December, way before we knew that she had hip dysplasia, but it just so happens to be perfect for carrying her around in the cast!
I realized at the very beginning that these twelve weeks were still going to pass whether I enjoyed them or not, so I might as well make the best of them! It has definitely not been all smiles here all of the time, but for the most part we’ve still enjoyed life and had lots of fun. If you are just starting your hip spica journey, be assured that there is hope! Things will be okay. You know your child best of all, and the two of you will work together to make things work. You are stronger and more resilient than you think you are, and you will get through this! (Those are the things I wish someone had told me.)
What are some good resources for hip dysplasia parents, grandparents, and friends?
Some of my favorite sites for information about DDH and spica casts are hipdysplasia.org and spicalife.com. Spica Life has a series of videos for how to do just about everything related to cast care, and I found them really helpful. I have also found this Facebook group for spica parents to be wonderful. Pretty much any question or problem I’ve had, someone else has already asked the group and I can find an answer within a few minutes. It’s so nice to know that other people have been through the same things I am going through, too!
If you are in the Portland Oregon area, we have been so pleased and impressed with the care we have received from Doernbecher Children’s Hospital and our orthopedic surgeon Dr. Scott Yang. I would recommend him highly! We have received such compassionate care, and have always felt like our questions were answered and that we were partners in our child’s care. The nurses and staff at Doernbecher were wonderful during both of our procedures, and despite a few inconveniences related to Covid restrictions (which I totally understand!), they really did their best to make it as pleasant an experience as possible for all of us. I am so grateful we were able to receive such excellent care!
If you have any questions about spica cast care (or just need a listening ear!) I’m happy to help! Please feel free to email me at thebakerupstairs (at) gmail (dot) com or find me on Instagram @thebakerupstairs.