Kids Health Info

Hard collar (Aspen collar)

  • If your child has had a neck injury – either a soft tissue injury (e.g. muscle, ligament, tendons) or a stable fracture of the cervical spine (neck) – they may need to wear a hard collar (a rigid neck collar) while they heal. A hard collar is also sometimes referred to as an Aspen collar or Philadelphia collar.

    Your doctor will determine how many weeks your child needs to wear the collar. This will depend on how quickly the injury heals, which will normally be checked with an X-ray or an assessment in hospital. In most cases, the collar will be worn full time for six to 12 weeks.

    Hard collars are sometimes used for children who have been discharged from a hospital emergency department with ongoing neck pain, but their X-rays are normal and a bone injury is not likely. In these cases, your child may be given a referral to a fracture clinic for an appointment in around two weeks. Until this follow-up appointment, your child should wear their collar as directed by their treating doctor.

    Care at home

    Soft tissue injuries and fractures are painful. Although immobilising the neck with a collar will help to reduce the pain, additional pain relief (e.g. paracetamol) is often needed. Give pain relief medication regularly for the first few days, following the directions on the packet, or as directed by the doctor.

    Wearing the collar

    Your doctor will let you know if your child needs to keep their collar on all the time or if it can be removed for short periods. Your child may need to wear the neck collar 24 hours a day without removing it at all, or the doctor may say that you can remove the collar to wash the neck while the head is immobilised.

    Some children with less severe injuries may only need to wear the hard collar for comfort, as it often provides pain relief following soft tissue injuries.

    Sleeping

    Unless your doctor has told you otherwise, your child will need to sleep in the collar. It is important that your child keeps their neck in a normal alignment while their injury heals, and this includes during sleep. When sleeping, your child should be encouraged to sleep on their back without pillows, to keep the neck as straight as possible.

    Bathing

    The collar will affect your child’s ability to move their neck and this can increase the risk of slips and falls while bathing. To help prevent falls from happening:

    • Use a non-slip shower mat and place it on the bath floor away from drain. 
    • Help your child get into the empty bath and sit down. 
    • Use a flexible shower hose to wash and rinse your child’s body. Shower hoses that fit over existing taps are available from many hardware stores.
    • Make sure the collar does not get wet. Do not wash your child’s hair – instead use dry shampoo products (available from pharmacies).   
    • Help your child to get out of bath to ensure they are stable and do not slip or fall. 
    • Help dry and dress your child, if required.

    Washing the neck

    It is very important that you only remove the neck collar to wash your child’s neck if your doctor has allowed it.

    When washing your child’s neck, it is best to have another adult helping, especially for younger or less cooperative children.

    • Lay your child on a towel on a firm surface without any pillows.
    • One adult should keep the head still by holding it on either side above the ears, while the second adult removes the front chin piece by undoing both Velcro tabs. 
    • Wash around the front of the neck and under the chin with a soft, damp face washer. Use a soap-free wash or plain water to avoid a rash caused by soap residue.
    • Dry the skin gently with a soft towel. Do not apply any powder or moisturiser. 
    • Replace the front section by scooping the collar along the breast bone to ensure the chin piece sits firmly under the chin for support. Leave the Velcro tabs undone. 
    • Remove the back section of the collar by sliding it out sideways between the neck and towel. Do not lift the head or bend the neck. Wash and dry the back of the neck as best you are able to without moving your child’s head. 
    • Replace the back section of the collar by sliding it under the neck until there is an equal amount of the collar visible either side. Continue to keep the head and neck still. Close the Velcro tabs, ensuring that both sides are equal. The collar should fit firmly around your child’s neck and the plastic chin section should not come forward of the chin.
    • Help your child to get up and get dressed, if required.

    When to see a doctor

    Take your child to your GP or local hospital if there is increasing pain, or any pins and needles or weakness/numbness in the arms or legs, following a neck injury.

    If you are allowed to take the collar off for washing, take the opportunity to check the skin for any areas of pressure. If there are any areas of broken skin under the collar, have this reviewed by a doctor.

    If you are concerned the collar is not fitting properly, or there any marks on the skin that may have been caused by pressure, make an appointment to see your orthotist or treating healthcare provider. 

    Follow-up

    Your child may need to have an X-ray and review after their injury. The doctor will tell you when your child should have their follow-up appointment. Once the doctor has confirmed your child’s neck has healed, the collar can be removed.

    After the collar is removed

    If your child needed to wear their collar for 24 hours a day without removing it, after the collar is taken off the skin may be dry and itchy. Bathe the skin with warm water and soap, and apply a plain, non-perfumed moisturiser. 

    After their neck collar has been removed, your child’s neck may feel stiff and sore. This will improve with time and gentle stretching, if advised. Physiotherapy is usually not needed. 

    Your doctor will give you specific advice regarding when your child can return to sport.

    Key points to remember

    • Hard collars are rigid neck collars worn while injuries or stable fractures of the neck are healing.
    • Your doctor will tell you whether your child needs to keep their collar on all the time or if it can be removed.
    • Your child should sleep on their back without pillows.
    • Take care to prevent slips and falls while bathing, and do not get the collar wet.
    • If you are allowed to remove the collar to wash your child’s neck, ensure their head and neck do not move.

    For more information

    Common questions our doctors are asked

    Why was my child told to wear the collar when no fracture was seen on x-ray?

    Your child may have been told to wear the collar to provide pain relief and as a precaution in case a small, subtle fracture occurred, which cannot always be seen on an X-ray. Your child will be reviewed during a follow-up clinic appointment, usually within two weeks.

    We’ve had a hard collar for few weeks and it is looking dirty and beginning to smell a bit. Can I clean it?

    The collar contains soft pads to protect the skin and minimise discomfort. These pads should be washed or changed daily (but only if your doctor has allowed the brace to be removed for brief periods). Use a mild soap and water to clean the pads by hand, then pat them dry with a towel and let them air-dry. Replacement pads can be purchased if needed. 


    Developed by The Royal Children's Hospital and the Victorian Paediatric Orthopaedic Network. We acknowledge the input of RCH consumers and carers.

    Reviewed November 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

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Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.