Last Saturday was our oldest daughters birthday party, she turned nine. Wow she is growing up so quickly. For her birthday party we were able to rent out the Oklahoma Baptist University swimming pool and they furnished a room, etc. My wife went to one of our cousins birthday parties there and said it was extremely nice. I had no idea it was as nice as it ended up being.
Natalie had been swimming before, but this kind of stood out in my mind as I was thinking about some of the active things Natalie has done in the last few weeks. She is actually an extremely active child now days. I am constantly having to tell her to slow down as she runs through church, or make sure to hold onto her tighly in parking lots and stores because she will try to run away. However, while swimming she seemed to really enjoy it. For a couple of hours we had lifejacket on her and she was kicking around the pool, with a little help mind you, but still doing a lot of the work. I was really impressed with her stamina. You would think that with her hip displaysia it would become sore or would be quicker to tire out. She held up with everyone just fine and this is a promising sign that she will be able to play sports if she decides she wants to.
We have had a few comments and we don’t want the readers to get annoyed with the same old content up. Therefore, I wanted to just acknowledge at what part of the process we are still at.
Our daughter recently went back to the doctor for another check up. Her hips are slowly moving to the proper angle that the doctors want them to be at. Note that I said hips as in plural. Yes, I suppose it is common in kids who have this condition to favor one side. I’m not sure if this is the reason, but its the only thing that comes to mind. We have heard from the doctor that even though one hip was the one not in place at birth, the other is often altered a little bit too as they learn to sit up and do ordinary things. Therefore, both are being adjusted back to normal through the use of her brace that she received after getting her spica cast off.
She has recently been sick and it was a little bit of a concern of ours that in her small bed she would be unable to roll over if she vomited in the middle of the night. Therefore, we left it off of her until she got to feeling better. Once you break the routine of putting it on her, she tends to realize she feels more comfortable with it off. The odd thing is that she sleeps exactly how she would sleep with it on. Her legs are spread and nearly at a 90 degree angle from her torso much like the brace keeps them when she is in it.
Lately we have just been getting back in the routine of her wearing it. She doesn’t often sleep all night in it. However, the doctor told us that the more she is in it, even if it is for an hour or two is better than nothing. My advice would be to not break the routine if you can keep from it.
Natalie just went back for her latest checkup. We received rather good news. According to the doctor everyone hips have a specific angle that they need to be at. They would prefer that Natalie’s hips are less than twenty degrees. Currently, the one that required surgery is at 26, which is about six degrees less than what it was at a year ago. The other is at 23. This one is two degrees less than it was. So things are improving!
The doctor says that she will need to wear her brace at night still for at least another six months. This is fine though as long as her hip problem continues to improve.
One other thing that I found interesting that the doctor said is that when she had her surgery she had no ball for her hip. This is usually built as pressure is put on it and it naturally forms. Since her leg was never in the socket, it didn’t form. After the surgery and everything was in place, this was supposed to put it in a good position to form properly. It did and everything was fine. However, the doctor noted that on some children that part of the bone can actually die. I’m not sure exactly what is required to correct that, but it sounds like another surgery would be required.
If your child has experienced this, please let us know so we can provide others with more information about it.
We had a reader make a suggestion on how they kept their baby dry in a spica cast. We wanted to pass it along to others who might be preparing or trying different methods. I personally have not tried these, but it does make logical sense. According to Garren (our reader), she said that instead of using feminine pads to keep a child in a spica cast dry, she used TENA male guards. I had never personally heard of these but I did a quick search and found that they are available at lots of stores, including Wal-Mart.
Since spica casts are not pre-made, each one is unique. According to the reader these male guards are wider and a little bit shorter than a feminine pad. However, according to Wal-Mart there are different sizes, I suppose it may just take some experimenting to find out which ones will work for your childs cast.
Again, I just want to make the comment that I can not really vouch for these as we never tried them. However, you may find that for your baby’s cast that they are easier to use. The process is done the same when it comes to tucking them into the cast in a way that is safely done, but will hopefully protect your child from a skin rash and the cast from smelling bad.
Here is a list of helpful tips to keep everyone happy
1. Keep the cast dry - If the cast becomes wet, I suggest you use a blow dryer on cool so that you do not burn their tender skin. I did this often those first two weeks, but she was so sick that you just couldn’t keep it dry. So I came up with a different solution. Remember that your child’s cast can become wet from excessive sweat so dress them lightly even during the winter months. It is best to carry around a blanket then for them to be dressed in layers. Natalie developed her sores because of her Halloween costume. It was made of a thick material that made her sweat while indoors. It was perfect for outside unfortunately we were indoors most of the evening.
2. StayFree Feminine Pads - I placed stayfree ultra thin feminine pads on the inside of the cast. The pads would get wet or soiled instead of the cast. You can remove the pads, and the child stays dry and happy. Natalie developed sores before we could figure out the solution with pads. She now has scars on the outside of her hip from where she had either soiled the cast or it did not dry from the excessive sweat that her Halloween costume caused. They are in a place that while in the cast it was impossible to reach. I know this because I tried every possible way to get every inch of her cast dry and clean. Sometimes it is just not possible. Placing the pads on the inside of the cast may be slightly difficult for parents with larger hands. Detailed directions for this are at the end.
3. Baking Soda - You will want to keep some baking soda around for the smell if you cannot get the cast completely clean. This will help a whole lot with the smell. ONLY place the baking soda on the outside of the cast because their skin can be easily irritated.
4. Support Blankets - we did this because there are commonly weak spots in the cast that can cause breaks. If the cast breaks, a new will be needed to replace the broken one. This means more anesthesia for your child and the possibility of the hip coming out of place. This is unnecessary if you take the extra precautions.
5. Cast and Food - Do not allow food to fall inside the cast while your child is eating. A large t-shirt or a one piece outfit is the best solution for this particular problem. If food or small toys fall inside the cast, you child’s skin can become irritated or could possibly cause an infection.
Taking care of child in a spica cast can be difficult. I found that the one thing that kept everyone happy was to keep the cast as dry as possible. If the cast becomes wet or soiled it will become very uncomfortable for your child. Natalie’s cast was wet off and on because of a stomach virus in the first two weeks. I found once she was dry, she was a lot happier and everyday life became a whole lot easier. She was more willing to play by herself for about 30 to 45 minutes at a time before she became bored.
Directions for placing the pads on the inside of the cast are a little complicated to explain so I will try my best. You will need a total of three pads to fully protect your child’s skin.
1. Take a pad and cut in half. Take half of that pad and place on the inside of the leg so that half is inside the cast and half is on the outside of the cast. You will want it to be long ways. Then use white medical tape to tape it into place. The sticky part of the pad will only help a little bit that is why you will want more tape. Repeat this step for the other leg.
2. Now take the two remaining pads and slide them through the back side of the cast. The soft cotton side should be to their skin. You should have enough left over so that you can tape the pads into place on the outside of the cast. That means you will want them to be taller than they are longer. If that explains it, like I said it is somewhat difficult to explain. You will want to tape the pad into place so that they do not slip around and irritate your child. This may not be very pretty, but your child will be a lot happier if they are dry.
I have been trying to read up on this topic for other parents and came across several other parents who stated that they had a child who was older than Natalie (my daughter with DDH). One thing that I noticed was that all stated they had children who had difficulty walking. In fact, several made comments that they were commonly “drifters”.
Drifting can mean that they walk to the side more times than not, or perhaps all the time. They typically use furniture or other stable things to pull themselves to a standing position. After this, they will walk alongside of it, but rarely let go and walk for themselves. Many were doing this for quite sometime, up to close to a year for some prior to discovering why they were not actually walking normally yet.
If your child is a constant drifter or side stepper, you should consider taking them to a pediatrician to take a good look at their hips. Also, do not be afraid to get second opinions. Although delayed walking is not an uncommon thing, it is important to catch hip dysplasia at the earliest stage possible.
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.
