This is the question that I asked when I first found out about Natalie. I had no idea that this even existed in infants. That was until I thought back over the previous years and realized that my sister-in-law had said something about the doctor was going to check her son for a problem with his hips. She simply stated that they were going to try to force his hip out of place. The point was to see if it would come out of place easily. Her son’s doctor really didn’t explain to them what exactly they were looking for. I believe they were looking for DDH because they were concerned with how loose his hip was in the socket. This procedure was suppose be very uncomfortable possibly even painful for my nephew. This is a common practice that a lot of doctors do to determine if it is possible for DDH to be present.
Natalie’s doctor did the normal hip rotation test and never seemed to notice any thing until I brought up the fact that her leg was shorter than the other. I watched her do the same hip rotation that she did in the very beginning and she still did not mention DDH. I believe that is why it was such a shock when the orthopedist diagnosed her with DDH in the first five minutes of the visit. We were given pamphlets on DDH, but nothing that was in depth to really tell you about the condition. It really only stated that she had DDH and the surgery is commonly used to correct the condition. It showed an x-ray of a dislocated hip and a baby in a Spica Cast following the surgery. It did not say what could have caused it, how often does it happen, or risk factors involved. We went into the surgery with very little information available to us. The internet at the time did not really answer very many of our question because we really did not know what to look for.
One year after the surgery we have gotten more information. DDH is more common than most people realize. The numbers are somewhere around 1:1000 infants a year will be diagnosed with DDH. Depending on the age of the child will decide if surgery or a brace is required. Early detection is the key to save your child from the possibility of surgery.
Here are some of the most common causes of DDH:
• Female child
• First pregnancy
• Breech baby (feet at shoulders)
• Caucasian
• Previous child with DDH (possible that it can run in the family)
Children born after previous child diagnosed should automatically be screened with in the first three months of birth.
A few states require that a breech female baby be scanned for DDH before they leave the hospital or with in the first month of life. This condition can alter the life of your child if it is not diagnosed early. In many cases children developed osteoarthritis due a late diagnoses of DDH. I suggest if you have any concerns, you should schedule an appointment with your pediatrician as soon as possible. Do not delay if you suspect that some thing might be wrong.
DDH is an acronym for Developmental Dysplasia of the Hip. There are several ranges of severity of it. For example, in milder cases the thighbone (known as a femur) is allowed to move slightly within the socket due to ligaments and soft tissue not forming a firm hold onto it. The more extreme case, such as an example with our daughter, will allow the femur to move out of the socket all together. Children who are born with DDH may not even have a hip socket and the femur bone may try to form one for it self higher up on the hip bone. This requires surgery to correct to get the femur back in its proper position. A spica cast is normally used to hold it in the proper position.
Symptoms for a baby are:
A loose feeling within the hip as the leg is moved.
One leg appearing shorter than the other
Extra folds of skin on one side of the inner groin area (This can happen with both if both are affected).
One hip moves differently from the other.
If you feel that your child has any of these symptoms, you should contact your pediatrician as soon as possible. The earlier this is caught, the easier it is to correct.
When Natalie had her surgery we did not really go anywhere for about 10 days. She really did not feel up to going any where. It can be difficult for them to get comfortable while in the cast. You also have to reposition them every two hours. This is recommended so that they do not get sores on the pressure points caused by the cast. This can make it hard to travel for long periods of time. I would not recommend going more than thirty minutes to one hour from home because the ride can be tough on the child. The special car seats that are designed for the spica casts try to make them the most comfortable, but too much bumping around can still make them very unhappy. This was sometimes the case for Natalie.
It can be difficult to travel with a child in a cast especially if you plan on staying for a short trip at a family member’s home, church, or a hotel. This is because you pretty much have to bring your entire home with you. That is what it seemed like to me any ways. You have to pack plenty of diapers because you have to change them so often. I always brought a bean bag for Natalie to sit in so that she did not have to be held most of the time. We also brought extra pillows that I made for her. She had three pillows that we took every where. You never know when might need to give her more support. The bean bag would fit around her to support her cast so that she could sit up almost on her own and play. The bean bag worked well at my parent’s house and at church. I know it sounds like a lot to bring for one place, but she liked to be able to sit up with out being held all the time.
The first cast she was in was really too big for her to fit any where. We had to bring her stroller for her to sit in at restaurants because she no longer fit in the high chairs. She did not fit in any high chair or any normal sized chair for that matter. We carried her stroller with some special pillows that I made to support her and the cast every where that we went. The pillows that I made fit under her legs and behind her back to give her some extra support when she wanted to sit up.
We read some suggestions of using rolled up blankets, but they always came unrolled during the move. I ended up placing rubber bands around the ends to keep them from unrolling. The rubber bands helped save a lot of time.
Keeping your child entertained and happy while in a spica cast can sometimes be difficult. The fact that most babies are very mobile and all over the place at the age that our daughter had her spica cast on, it was just unnatural for her to be semi-immobile. However, there are several things that we have seen other parents do online and some of the toys we have used to keep Natalie busy.
We have seen some parents with children who have created or found special desks. They are typically wider, and look similar to coffee tables where they can sit in a bean bag or umbrella chair to play with their toys.
Another popular type of toy for a child in a spica cast would be those that the child can ride on. Most are designed in ways that are not obstructing from sitting on it while in a cast.
We also have seen a mother who had a nice blown-up ball pit. Their daughter was able to sit in it in her bean bag chair and play. They said that it worked really well for their child.
Keep in mind that most children who are old enough to crawl will quickly learn that they can pull themselves along to different places in the house when they want to. Putting things down low that they enjoy playing with will help them feel more independent. Just keep in mind not to allow them to play with toys that can fit down into the spica cast. You should always keep a lookout for items that could potentially fall down into their cast. Also remember to keep clothing on them to help prevent that.
It was only a 24 hours after Natalie received her spica cast that she would endure more difficult moments. The following day we found out that she had a stomach virus. This was a huge problem. She was making a mess of her cast. I had cleaned and cleaned and it was still gross. I did not know what to do because there is no information on what to do if your baby develops a stomach virus while in the cast. The poor baby was stuck in a cast that was full of you know what. That is when I cried for the first time. I was alone with a baby in full body cast who could not even sit up alone and she was stuck with no where to go. My husband had gone back to work, my mother was gone, my sister worked, every one worked. I felt terrible like I had let her down because I could not stop it or make it better for her. I used the blow dryer on cool air for hours to dry her out. That did not work at all and nothing else seemed to work.
I was so tired already and this was just the first week. I thought how in the world am I going to make it for 11 more weeks. I thought to myself she is already covered in poop, the cast stinks, and I can not make the diapers work. I was about to lose my mind until I remembered that the pamphlets suggest that you use a feminine pad inside the diaper for extra absorption. I thought this is what I forgot to do and this will make it all better. Well I was so wrong that I was out of my mind. This not only made her even madder because it was so uncomfortable, and it did not work good at all. I thought what in the world am I going to do to survive 11 more weeks of this. So I decided I was going to try to use the pads in a different way. I noticed that any extra moisture was going up her back and down her legs. I placed the pads in these areas. This was the best thing that I could have done for her and myself. The cast was no longer getting wet or soiled from extra moisture that the diaper did not catch. The second diaper is supposed to catch the extra moisture but guess what, it doesn’t. The only thing the second diaper does is hide the first diaper. I placed the pads with the cotton side to the skin and used medical tape to hold them in place. It was soft like wearing pants to her. This completely changed the whole experience for me.
It took three pads for one diapering session. Every morning I would change out the pads, but if they needed through out the day they were replaced as needed. I only changed the ones that were wet not all of them. I would cut one in half and place them on the inside of the legs. I would place them so that half was taped inside the cast and the other half was taped to the outside the cast. The other two where placed on the inside of the back of the cast. I would feed them through from the top and out the bottom. I would then tape them in place on the outside of the cast. This keeps them in place so that they do not fall off or rub her back causing an irritation. You can also spread butt paste to the ones on the back to keep her skin from getting irritated from sweating. The morning diaper change will take about ten minutes if not more to complete, but it is well worth the time.
I figured this method out about the time that the stomach virus was over. The stomach virus lasted like two whole weeks. I think some of it was linked to the anesthesia. I wished there had been this information available to me because it would have saved so much heartache. Natalie would not have suffered so much discomfort as well. By the third week she had figured out how to crawl, roll over on her own, and she was completely dry by this time. She still had to stay in the stinky cast for another three weeks, but we could survive the smell that slowly faded over time. A little baking soda on the outside of the cast helped a lot.
I hope that writing out our families experience will help you through the times that are about to come. There are going to be trying time, but just remember that you can and will survive if you remember to keep the baby dry. If the baby is dry everyone will most likely be happy.
When we were getting ready to leave the hospital after Natalie’s surgery she decided she wanted to be held for the first time. I did not realize I would have to be taught on how to hold her.
The cast makes it very difficult to hold them close. The nurse had to show me ways that would be comfortable to her and me. A little time passed and we found out how to hold her comfortably. The cast can make it difficult to hold them close to your chest so that they can lay their head on your shoulder. You have to place a pillow at first under their chest to make it even with the cast. That is how the nurses wanted us to hold her. She did not like to lie down like that at all so we had to find other options. After about five minutes of twisting and turning Natalie was able to find something comfortable for her. This was also something that I was not prepared for. It is hard to not be able to hold your baby close to you like you have since they were born. That was one of my difficult moments.
It was a month after seeing the doctor for the first time about Natalie’s hip that she would have her surgery. They had given us pictures of what the spica cast would look like, but that really does not prepare you for seeing your own child frightened and scared. She was so little and this thing was so big. I was in no way prepared for the shock of how little and helpless she looked. I almost fell apart in the hospital, but I couldn’t or that would have frightened her even more.
Natalie had a rough time with the anesthesia. She would jerk herself awake every few minutes causing her to cry for about a minute then she would slowly go back to sleep. This happened all night long. I read later that in babies the anesthesia can make them feel like they are falling. This was apparently what had happened to her because she was scared when she would wake up. She was probably in pain as well since she would make her entire body jump awake. She also had an upset stomach and was soon being treated for dehydration. Luckily, she recovered the next morning, and we were able to go home as planned. We packed up all of her stuff, and headed home.
We went to see the orthopedic doctor who was the top in his field. The doctor was able to diagnose her within five minutes of seeing her. He sat down next to us, placed her knee together, and pushed them towards her chest. Here it was obvious that one knee was shorter than the other. Her knees did not match up with one another. The doctor sent her off to have x-rays. They came back with proof that a baby can be born with hip dysplasia. I was completely shocked. I was thinking we would go in see the doctor and he would suggest some kind of brace for her legs because we thought that it was her legs. She was slightly bow legged as well. I was not prepared to sit in the room and listen to three different kinds of surgeries that could be used to correct this problem. I still could not believe it when it was time to go and I had to call my husband and tell him that the only solution to correct it was going to be surgery. I was so very thankful that my dad had drove us to the doctor appointment that day. There was no way I could have made it home in one piece. My world felt out of control and scary all at the same time. I had no idea what to be prepared for because I did not know any one who had a child that had gone through any kind of surgery not to mention one that would leave them in a body cast afterwards.
Our daughter Natalie was born on February 12, 2006. She was the average healthy baby that every parent hopes they will be. The pediatrician checked her from head to toe and found that nothing was out of place. At least that is what every one thought at the time.
It was when Natalie was around four months old that we noticed that her right hip was not as flexible as the other. My husband is not flexible at all and we thought that she had inherited this from him. Little did we know that can be a sign of a dislocated hip. I did not even know that babies could have a dislocated hip or hip dysplasia. We did not really think any more about it for awhile. This was our second child, but because our first was the picture of health we did not even consider that there might be something wrong. Actually no one in our entire family really thought that anything was wrong.
Two months later I was playing with Natalie on the floor and decided to measure and see how much she had grown since her last check-up. This is when I noticed that one of her legs was shorter than the other. Her right leg was actually shorter than her measurement from her last check-up which had been a month prior to this time. Natalie’s legs were ¾ of an inch different. She was about six months old by this time. She has an appointment with her regular doctor two weeks later so I waited to for her appointment thinking that it was all in my head. I thought I was a paranoid mother who constantly finds things wrong with children. You know the kind where their children always have the symptoms of every new disease or sickness. I talked to the doctor anyway and found out that I was right it was shorter and Natalie was scheduled to see an orthopedic doctor the following day. Natalie’s doctor also found that she had torticollis.
Torticollis is where one side of the neck muscles will grow shorter than the other side. This causes the head to lean to one side or the other. Natalie was scheduled to start physical therapy for this condition two days later. We would go through three weeks of physical therapy to see no improvement at all. I even did extra therapy to make sure that I was doing my part to make her better. It did not work, but there was a reason why. A study showed that 5percent of babies who have torticollis also have hip dysplasia. We did not know that at the time either and apparently neither did the physical therapist. The physical therapist had no idea why the therapy was not working. After Natalie’s surgery, her neck was perfectly fine. We decided that she was using her head to balance the rest of her body so she could sit up. She no longer needed physical therapy, she needed surgery to correct her dislocated hip.
This stomach virus was our first trouble or obstacle to tackle. It is recommended that you change your child’s diaper every time they are wet. That means about every hour when they are this age, but with a stomach virus it could be every fifteen minutes. I know that sounds crazy, but I have been there. The hardest part was keeping the cast dry. A stomach virus makes that completely impossible with out the proper precautions. I am going to tell you what no one told me to do and it was what saved me and Natalie a lot of pain.
The most important thing for your child is stay dry while in the cast. If the cast becomes wet, it can cause it to break or a rash can develop. Breaking the cast means it will need to be replaced and the risk of the hip coming out of place. Moisture in the cast will also cause the skin to become irritated. This can lead to a severe rash which we unfortunately found out. Dressing your child too warm will cause them to sweat making the skin wet and more likely to break out. Natalie had a severe rash due to her Halloween costume that caused her to sweat too much. She had small little blisters from the cast on her back. This could have been prevented if I had better information on how to keep her dry.
I used Stayfree Ultra Thin feminine pads to soak up any extra moisture inside the cast. I lined the insides of the legs and the back side of the cast with these pads. I cut one pad in half to fit on the inside of the legs where you change their diaper. I placed two whole pads on the inside of the back so that the soft side was against her skin. I used medical tape to keep it in place. I also placed butt paste on the pads if I thought that any of her skin was irritated. I changed them once a day in the morning or before bed if needed. I used this method to prevent any leaking from the diaper to stay on her skin. Most of the pamphlets recommend that you use a pad on the inside of the diapers, but this was uncomfortable and really did not work as well. It took a while to figure out the best placement, but Natalie’s second cast was completely clean when they removed it. The first cast was not clean at all. It smelled very badly because I did not have good information. I hope that this will help any one else who is about to take the journey with a child in a Spica Cast.