Kids Health Info

Hip spica plaster 2: Care at home

  • This factsheet provides parents of children treated in hip spica casts with information and ideas about ways to manage at home. After demonstration by the nursing staff about how to care for your child in a hip spica, you will be encouraged to participate in your child's care during their hospital stay so you will feel more confident to do it at home.

    A hip spica is a type of plaster that covers both legs from the ankles up to the level of the belly button. An area around the groin is cut out for toileting. It is used to prevent movement after hip surgery or fractures of the femur (thigh bone) so the affected area can heal. Coping with a hip spica may at first appear difficult, but you and your child will get used to it quickly.

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    Care at home

    Toileting and nappies

    • Care of the toileting area of your child's cast is important. Care is needed to make sure your child is comfortable and to keep the cast dry so it can work effectively. A hip spica will rarely be changed because it smells due to soiling and urine staining. You will be instructed on how to best care for this area from the time your child returns to the ward.
    • Nappies need to be checked often (at least every two hours during the day and every three hours during the night).
    • Nappies need to be changed as soon as they are wet or soiled.
    • Tuck sanitary or incontinence pads (mainly used for larger children with special needs) into the front and back of the toileting area. Cover with a disposable nappy to keep the plaster dry.
    • Older children can use a urine bottle or pan for toileting. They can be lifted onto the toilet, making sure they are sitting as upright as possible. The nurses on the ward will demonstrate how to position your child on the bedpan so that the urine and faeces do not come in contact with the plaster. Plaster is like blotting paper and tends to soak up moisture, so it is important to keep your child's head well elevated while they are on the pan or toilet so that the urine will not run back inside the plaster.
    • A few drops of lavender or eucalyptus oil or Nil-Odour can be used on the plaster if a smell of urine or faeces develops.  Use only a very small amount so the plaster doesn't soften.
    • If your child has loose bowel motions or if you are having trouble keeping the urine from running under the plaster, cotton wadding can be used around the toileting area to help stop this. Of course this will also need to be changed regularly. A wet spica is difficult to dry. Try leaving the toileting area open to air, or use a hair dryer on a cool setting only. Positioning of your child with their head elevated above the level of their hips can also prevent urine or faeces from soiling the cast. Positioning your child on his or her stomach with their nappy off will help to dry the back of the plaster if it gets wet.
    • If your child wets his or her bed at night, ask the nurses to show you how to protect the plaster using nappies and sanitary napkins. These will need to be changed as soon as they are wet to avoid moisture being absorbed by the plaster.


    • When lifting your child, it is important to support them and the weight of the plaster. Do not lift them under the arms without supporting the plaster as well.
    • Keep your child as close as possible to your own body when picking them up. This helps prevent straining your back and helps make your child feel secure.
    • A small child can be cuddled in the same way as before they went into plaster without fear of hurting them.
    • Older children in hip spicas can be very heavy and an occupational therapist may be able to suggest equipment to help (e.g. a hoist). If you have any concerns about lifting your child or concerns about the amount of support you have at home, please discuss these with your child's nurse.
    • If there is a bar across the legs, this can be used for lifting once the plaster has the fibreglass outer layer applied (scotch cast or scotching).


    • Children in a hip spica cannot move easily, so you will need to change their position often. Position changes are necessary to avoid getting sores under the plaster.
    • Position changes should be made every two to four hours day and night, including nappy checks.
    • Children can be positioned on their back and on either side using pillows or rolled up towels for support.
    • Children can also be positioned on their stomach, supported by pillows, for short periods of time under direct supervision of an adult.
    • Every time you change your child's position, check that the plaster is not digging in and is not too tight around the edges (tummy, ankles, groin and knees). This also includes when placing your child in the car.
    • Make sure your child's heels/feet can move freely after each position change. Ensure their feet are not pressed into the mattress or chair as this could cause pressure sores, especially when positioned on the stomach. Also check their toes.
    • If your child develops a reddened area on his or her back at the spine, he or she may need to spend more time on their stomach.

    Bathing and hair washing

    • The hip spica is not waterproof so avoid getting it wet. 
    • Washing your child in a hip spica is done by using a bowl of water and a face washer (a sponge bath). 
    • Hair washing can be done over the edge of a sink or bath with a jug. You will need the help of another person. One holds the child over the bath or sink while the other washes the hair.
    • Always make sure the plaster stays dry when bathing and washing hair.
    • A larger child may be washed in the same way but positioned on the bed, floor or a Perthes trolley. A baking dish may be placed under their head to allow for hair washing with a cup or jug. Alternatively, one adult can support the child on their knees while seated beside the bath, while the other adult washes the child's hair.
    • The first few bathes are the worst. You will probably feel awkward and your child may be apprehensive, but practice makes perfect and you will be surprised by how easily you will both adapt. Some parents find it easier to leave hair washing until there are two adults around.


    • Breastfeeding infants can and should continue to breastfeed. You may need to experiment with different positions to find one that suits you best. 
    • If your child is eating solids, instead of giving them three larger meals you may need to feed them smaller meals more often because the plaster is tighter around the stomach.
    • You should sit your child as upright as possible when feeding, probably in their pram or wheelchair, ensuring your child is well secured whatever chair you use.
    • Do not give your child new foods as this may cause loose bowel actions (diarrhoea) and soil the plaster.
    • Encourage plenty of fruit and vegetables and fluids to help prevent constipation and to promote healing.


    • Your child will probably need to wear larger clothing so it can fit over a hip spica.
    • Smaller children may only need a T-shirt or jumper and socks.
    • Pull the socks up over the plaster so they are not tight around the ankles.
    • Larger children can be dressed in pants that have been altered with velcro or press-studs down the side to fit over the plaster.
    • Underwear for older children can be altered with velcro, press-studs or ties on the sides.
    • Where there is a bar between the knees, it may be easier to place the velcro or press-studs on the inside of the legs.

    Skin care

    • Skin around the edges of the plaster should be checked every day for redness, blisters, pressure areas or skin irritations.
    • Your child will continue to grow with a hip spica on, so check regularly to make sure the plaster is not too tight.
    • Powders and creams should only be used on skin that you can see. Do not put any powder or cream under the plaster because this can cause skin irritations.
    • Be sure your child does not poke things down the plaster. Items poked down the plaster can cause skin grazes and may also become stuck.


    • Your child will adjust to being in a hip spica very quickly and should continue with their regular routines as much as possible.
    • Toys should be placed within easy reach.
    • Frequent scenery changes will help with boredom.
    • A Perthes trolley may help older children with their mobility and therefore their independence.


    • It is illegal for your child to travel in a car unrestrained. The nurses caring for your child are trained to fit children with hip spicas into suitable car seats to provide the safest possible solution. Please bring your child's car seat, booster seat and pram to the ward as soon as possible so that your child can be fitted into them promptly.
    • Remember, the plaster increases the weight of your child. This might mean that they are too heavy for their current car seat and may need to graduate to the next restraint option. We often seek the help of an occupational therapist (OT) to fit your child into an appropriate form of restraint.
    • Where your child is in a very straight hip spica the occupational therapist may prescribe an Eze-on vest which allows your child to be transported in a lying position across the back seat.
    • Ambulance transport is sometimes needed. However, if your child will fit into another restraint option, this is encouraged. Ambulance transport has the disadvantage of meaning you will not be able to travel anywhere by car. Non-urgent ambulance transport needs to be pre-booked by a medical officer, care manager or registered nurse. For transport back to The Royal Children's Hospital for any appointments, an ambulance would need to be booked by your local doctor a day in advance.
    • A Perthes trolley may also help your child to move around more easily. These look like very large skateboards and are available for hire from the Equipment Distribution Centre at the RCH.


    • Your nurse will tell you when your child's follow up appointment with a doctor will be; usually six weeks after surgery.
    • An X-ray will be taken to see if the hip spica is ready to be removed.

    Key points to remember

    • Hip spicas are not waterproof and should never be placed in water.
    • Nappies need to be changed as soon as they are wet or dirty to help keep the plaster clean and dry.
    • If you notice an odour (not from urine or faeces) coming from under the plaster, contact the Orthopaedic Outpatient Department (phone number below) or visit your nearest hospital emergency department.

    When to call your doctor

    • If you notice any sores or blisters on the skin under the edges of the cast.
    • If your child has a high temperature which cannot be explained by a cold, ear infection or other illness.
    • If there are cracks, breaks or softening of the plaster.
    • If the plaster is causing your child irritability and redness for a long time and you are not sure why it is happening.
    • If your child's toes are bluish, reddened, swollen, very hot or very cold.
    • If there is an unusual odour/smell from the plaster which cannot be explained by soiling (poo or wee).
    • If the cast has become too tight.

    More information


    Factsheet produced by Ward 4 Main (formerly North), Department of Orthopaedics.  First uploaded Aug 2005. Updated June 2011.

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