Surviving the Spica Cast Odyssey
“You can scale back the Rhino brace to just naps and night-time.”
We’d looked forward to those words from our pediatric orthopedic surgeon for five months. From the day she looked at an x-ray and told us our 13-month-old daughter’s developmental dysplasia of the hip (DDH) hadn’t been resolved. From the day the doc told us she’d need a spica cast.
What’s a spica cast? It’s a hard plaster contraption that runs roughly from a child’s ribs to their knees or ankles. The cast keeps kids’ hips and/or upper legs stationary as the bones are molded or healed. Children with DDH (aka hip dysplasia) generally spend 10-12 weeks in a spica cast.
I was terrified when we got the diagnosis—not so much for my daughter, but (selfishly) for me. How would we change her diaper when she’s in a nearly-full-body cast? How would we entertain an on-the-cusp-of-walking child who suddenly can’t move at all? How would we keep her clean? How would we fit her in a car seat? How would we both keep working if she had to stay home from daycare for three months?
We didn’t get many answers from our medical team. The nurses in our daughter’s recovery room after her procedure, for example, were awed by how much we knew about caring for a spica baby and asked where we learned it all.
“Learning it all” took a lot of time, raising our stress levels as we tried to manage our anxieties about the closed reduction procedure itself. I knew that eventually I wanted to do something to make that knowledge-gathering process easier for others who, like us, felt overwhelmed by the challenges that lay ahead. This post is that “something:” a download of the resources we turned to and products we used to stay sane.
Resources We Consulted
For all its flaws, Facebook is an excellent way to connect with support groups of parents and caregivers. I joined two groups—Spica Tables/Spica Chairs/Spica Gear – DDH – Buy/Sell/Donate – USA and DDH – Hip Dysplasia – Children Facing Surgery or Spica Casts. The former group includes only members from North America. The latter group is international, with significant representation from the UK and Australia.
These groups are great for sourcing free or low-cost used essentials to help care for your spica child. They’re also excellent places to ask for advice—or even just a pep talk—from those who’ve gone through what you’re enduring now. These parents and caregivers are incredibly generous with their time, wisdom, and resources.
The aptly named website Spica Life has a wonderfully broad overview of (you guessed it!) spica life. I used this site often, before and during my daughter’s casting. Also, the site sells cheeky merch like the onesie you see on my daughter below.
Finally, I relied a lot on this blog post from The Baker Upstairs for a preview of and advice for surviving life as a spica parent.
I will share a ton of information in this post, but I highly recommend checking out these resources, too.
Products We Used
Car Seat
Kids in spica casts cannot fit in most regular car seats because their legs are spread out wide and they can’t bend at the waist to sit.
We were able to secure a Wallenberg car seat for no cost during our daughter’s casting and bracing through a publicly funded program here in Maryland called Kids in Safety Seats (KISS)(and shoutout to Karen H!). The Wallenberg is one of the only (maybe the only?) car seat that’s been approved for use in automobiles and airplanes for children in spica or similar casts.
As you can see from the picture, it’s huge and hideous—but it was the only seat in which our daughter could sit with her back flush against the back of the seat, given the wide angle of her cast. And as you can see from the price tag, it’s insanely expensive. Once you know your child needs a spica cast, talk to your doctor and hospital about resources they know of that can provide you a compatible seat at low or no rental cost.
If renting a Wallenberg is not an option for you, lots of spica parents online recommended the Diono Radian because of its low sides, which can accommodate the cast. We did test the Radian with KISS, but we would have had to use a prop (e.g., a pillow) behind our daughter’s lower back because she couldn’t bend at the waist. We chose not to go with the Radian, but this is an option many parents consider, especially if their child’s spica cast allows them to hinge closer to 90 degrees.
Very important caveat: Car seat warnings advise strongly against putting anything in the car seat with your child because that’s not how these items are crash-tested. Talk with your doctor and your pediatrician about what the best options are for securing your child in a car while casted in the event you can’t purchase or rent a Wallenberg.
Diapering
Full disclosure: I dreaded this part.
Obviously, you can’t diaper a baby the normal way when they’re in a spica cast. The surgeon will cut a square or rectangle shape in the crotch area of the cast—and you’ve gotta work with what they give you.
There are many different methods for diapering a spica baby. Simply look up “changing diapers in a spica cast” on YouTube and you’ll find a buffet of videos to watch. (I liked this one a lot. Yes, it’s from Spica Life.)
For daytime diapering, we used an inner diaper one size smaller than our daughter’s pre-cast diapers (e.g., pre-cast she wore size 3, so in-cast we used size 2). We cut the Velcro tabs off the sides of the diaper to make it easier to stuff into the cast and avoid irritating her skin.
To start, we’d put our daughter on her stomach with her upper body on a Boppy to keep her supported. We’d push the smaller diaper through the hole in the back of the cast, then up as far as our fingers could reach. Then we’d flip her over, resting her shoulders on the Boppy to support her while we pushed the diaper up the front of the cast as far as we could reach, creating as close a seal as possible to her skin.
With the inner diaper in place, we used a large cloth diaper cover around the outside of her cast to hold everything in. (Another option is to use a disposable diaper 2-3x larger than your kid’s pre-cast size.) We’d use the same cloth diaper cover for a full day (if it didn’t get dirty), then toss it in the wash. We made it through our full spica journey with eight cloth diaper covers, which we got for free second-hand.
For nighttime diapering, we followed the same protocol—but we added a Poise pad inside the diaper to protect against pee leaking out onto the cast. Once you get pee on the cast, you're stuck smelling it for the rest of your spica experience.
Our surgeon did us a huge solid by giving us a sizable hole in our daughter’s cast. It wasn’t too hard for us to get a diaper up and in the cast with just our hands. If your surgeon isn’t as accommodating, you can try hip stix (Google them and you’ll find videos and posts demonstrating their use). We got a pair and did try them out (they work!), but because we were able to use our hands, we didn’t use the hip stix often.
This system worked well for us until our daughter caught the daycare stomach bug and … well—that’s a story for another post.
Sleeping
Because of the angle and stiffness of the spica cast, kids usually can’t sleep in their normal positions. If they sleep on their back, their legs will dangle in the air. If they sleep on their belly, their back and butt will arc upward because they can’t lie flush against the mattress.
Many of the resources I consulted suggested using a bed wedge. Because our daughter was still in the “don’t put anything in the crib with the baby” age range, we asked our pediatrician if this was a safe option. She approved as long as our daughter didn’t roll from back to belly.
Our full setup looked like this:
- The wedge (which we ordered from Amazon) sat at the top of her bed and covered nearly the full width of the crib.
- We rolled up a large beach towel to put under her legs to support them. (Note: Placing a leg prop directly under the feet can cause pressure sores. To avoid this, place the prop under the ankle part of the cast.)
- We stuffed a pillow below the towel at the crib's bottom to keep her from sliding down off the wedge.
- We rolled up two smaller towels and put them at her sides, roughly from her hips to her elbows (kind of like bumpers on a bowling alley). She could shift a little bit side-to-side, but not all the way.
And voila—we found our secret sauce for sleep.
Different sleep methods will work for different kids. Several sources recommended a supportive bean bag chair as a sleeping option. Our daughter tolerated the bean bag for naps but not for longer rests.
Whatever method you choose, know that it will take time for kids to adjust. It’ll also take some trial and error to find the combination of aids that makes up your secret sauce for sleep. Trust that your spica baby will eventually make their peace with their new sleep situation, allowing you to return to peace with yours.
Very important caveat: Make sure to talk to your pediatrician about the safest sleep option for your child. Especially for very young children (younger than 1 year) there may be additional precautions you need to take to ensure safe sleep. Your doctor will be able to steer you in the right direction.
Playing
If you have a spica baby, you need a spica table. It’s designed to hold your child in a semi-sitting position, similar to how they’d sit on a see-saw. You remove the tabletop (which has a semicircle hole on one side), place the child “in” the table, strap them in, then replace the tabletop. From here, your child can eat and play on their own, much like they could sitting on the floor pre-cast.
The pros of the spica table: It gives you some time to do things other than hold your kid: Dishes! Laundry! Taking care of your other kid(s) and pet(s)! All made possible thanks to the spica table.
The cons of the spica table: They’re big and expensive.
There are a couple of companies that will build you a spica table, and there are several plans you can purchase online if you’d like to try building one yourself. If you’re on a budget and/or DIY is not for you, tap in to the communities on the Facebook groups listed above or your local parent swap/buy nothing groups. Again, these communities are so generous—and, frankly, once your child is out of their spica cast, you just want the table out of your house.
We found two free, used spica tables (one for home, one for daycare) via one of the Facebook groups and a family connection. We've now passed both of those tables on to other families through Facebook groups, too.
Once you have the spica table, you need things for your child to play with on it. Our daughter was in her spica cast between 14 and 17 months, and her favorite activities when sitting in the table included plastic blocks, toy cars, and toys with buttons that made noise (a remote control, phone, V-tech activity center, dancing duck, etc.). Yes, it got loud, but it kept her happy—and we like her happy. Our at-home spica table had a chalkboard on the top's reverse side so she could (theoretically) draw on it. She wasn’t quite into that, but it's a fun option for older kids.
Even with the spica table and a ton of toys, be prepared to spend more time keeping your child occupied than you’ve had to pre-cast. Our daughter had an attention span of about 20 minutes by herself in the spica table, after which she’d cry for one of us to play with her or take her out. It was exhausting having to be “on” all the time. When I’d get frustrated, I’d remind myself that this phase was temporary. And I allowed myself to enjoy the excuse for extra snuggles with her knowing that, once the cast came off, she’d be off to the races again.
Bathing and Keeping Clean
You can’t stick a baby in a bathtub with a plaster cast, so your bathing options are (A) sponge baths or (B) rinse-free soap. If your child likes sponge baths, that’s great. Our daughter hates sponge baths, so we chose Option B.
We followed the recommendation of several spica parents and purchased this Mustela micellar water cleanser. It’s a little pricy, but a little bit goes a long way: one bottle lasted us ~6 weeks. We used circular cotton pads (you could also use a facecloth) and swiped the “soap” across her body from the neck down. It did a decent cleaning job and kept her skin moisturized, too.
To clean her face, we used lukewarm water and a little bit of her normal bath soap on a face cloth. For her hair, we would wrap her in a towel and hold her over the bathtub to wash and rinse. Was this the most pleasant experience for her (or for us?) No. Did it get the job done? Yes.
If this method doesn’t seem feasible for you, YouTube is your friend. Type in “spica cast bathing” and you’ll find a host of videos showing different methods parents have tried.
That covers cleaning kiddo’s body—then there’s the cast itself. Keeping the cast clean and non-stinky for three months is t o u g h. The most important tools in keeping our daughter’s cast clean were apron bibs, which we used for every meal. We purchased/were gifted two kinds (this one and this one) and they worked like charms to keep food and drinks from falling or spilling onto or into her cast. They're easy to wipe down between meals and machine-washable (just make sure to line-dry, don't put in the dryer). We had two apron bibs on hand so that when one was in the wash, the other was available.
Clothing
Sartorial choices for spica children are limited (shocking, I know). Our daughter’s operation was in November, which was a blessing of sorts because spica casts are heavy and hot. She was essentially wearing a pair of perma-pants, so we just needed to cover her top and her feet.
At our daycare provider's recommendation, we bought several dresses that were one size larger than her pre-cast size (she was in 12M pre-cast, so we went with 18M). We also bought several pairs of toddler knee socks (18M-2T) that covered her feet but also stretched a bit up the cast, which kept them from falling down. Then we used a pair of Zutano booties to keep her feet warm over the socks. This was my favorite spica outfit because it made changing her diaper very easy.
But there are also pants specifically designed for children in spica casts! You can find some on Etsy (examples here and here). Target sells adaptive pants, too, but last I checked there were only two color options. We got four pairs of the Target pants and matched them with 18M or 2T onesies (big enough to go over the cast). Those pairings, plus the dresses, were enough to get us through her time in the spica and full-time Rhino bracing.
What We Brought to the Hospital
The level of intervention your child needs during their operation (closed reduction, open reduction, osteotomy, etc.) will determine how long you will be in the hospital and whether you stay overnight. The following advice is based on our daughter’s operation, which was a closed reduction. The procedure was about an hour and a half long from the time she went under anesthesia to the time we were able to see her in the recovery room. Arrival to departure time was about six hours, and we didn’t stay overnight.
For you: Wear comfortable clothes and shoes. Dress in layers so you can adjust to different temperatures. Bring all paperwork related to your child’s operation. Bring drinks and snacks you like (hospital food sucks, and even if it doesn’t, it’s expensive). Bring something to keep you busy—a book, work, podcast, movie, whatever. Most of all: Bring your patience.
For your child: Bring a lovey, blanket, and/or small, non-noisy toys for them to play with during the pre-op period. This can last a while, so you want them to be comfortable and occupied, not focused on all the machines, tubes, and beeping around them. For after the operation, bring a small non-allergen-containing snack you know they’ll like in case they wake up and want to eat. If they drink formula or milk, bring some, because the hospital likely only has water or juice. Bring two sets of whatever diapering supplies you’ve decided to use, as well as comfortable clothes for them to wear home from the hospital.
And That's About It!
Those are the most important things I learned, either through research or hard knocks, that made the biggest difference in our spica odyssey.
Last point: if you’re a parent or caregiver of a soon-to-be-spica-casted child, be kind to yourself. What you’re about to embark on is a significant physical, mental, and emotional challenge. Your child will probably acclimate to their new situation faster than you will—and that’s OK. When you’re feeling frustrated and overwhelmed, take a break. Consider reaching out via the Facebook communities I shared above (we spica families gotta stick together!). If you need an extra pair of hands or just a sympathetic ear, reach out to friends or family; this shit is hard, and you don’t have to go through it alone.
Like the newborn period, the days are long, but the weeks and months are short. The end of the tunnel will come, probably faster than you expect it to. Until then, hang in there. You can do this.