Bath time is back with cast change

Like most babies, eight-month-old Eliana loves bath time. But when faced with three months of being in a hip spica cast, her family feared washing her would be a challenge.

That was before they found out about the waterproof hip spica cast.

The waterproof hip spica cast is an innovation from the Orthopaedic Physiotherapy team at Sydney Children’s Hospital, Randwick (SCH), designed specially to allow kids like Eliana to be washed and reducing the need for a full cast change.

Eliana was diagnosed with hip dysplasia at five months old and recently had a left-hip reduction surgery, requiring her to be in a hip spica cast for 12 weeks. The cast helps to immobilise the pelvis and thighs to aid the healing process post-surgery.

Traditional hip spica casts are made from cotton liners that cannot be washed. This often resulted in skin irritation, trapping of bodily fluids, and in some cases, a return to the operating room for a cast change under anaesthesia.

Natalie Tannos, Orthopaedic Physiotherapist at SCH, said the transition to waterproof casts has made an enormous difference to patients and families alike.

“Now with the waterproof hip spicas, it is quite a relief for parents that they can bathe their child. It also helps the emotional well-being of the patient, as lots of babies like to bathe before bed and it reduces skin irritation as well,” Natalie said.

“The other outcome is we have had no re-presentations due to soiled casts because the patient can just be washed through, meaning these children haven’t needed to go under another anaesthetic, which can be very distressing”

Eliana is now seven weeks post-surgery. Her mother, Catherine, said for them, one of the main benefits of the waterproof material is being able to maintain a bathing schedule.

“Despite being restricted in a cast, we have been able to maintain her bath routine. This has allowed her to continue the joy of bathing and maintain a new sort of normality,” Catherine said.

“When she is restless and frustrated from being restricted in the cast, bath time really helps soothe and relax her. It’s also extremely useful being able to wash her when she has a messy nappy.”

Waterproof casts were introduced as routine practice at SCH following the success of a six-month trial in mid-2018.

“The main outcome of the trial was the parent satisfaction, which is the most important thing. For many parents, saying you cannot bathe your child for three months can make them quite anxious. Imagine the smell and how uncomfortable they are going to be,” Natalie said. 

"Now, we're giving education about the waterproof hip spica which allows for bathing and that's quite a relief for parents. It seems like a little thing, but it's big for parents being able to do that. They report being really happy."

Since then, the SCH Orthopaedic Physiotherapy team have also begun training staff from other hospitals in using these casts, including The Children’s Hospital at Westmead (CHW).

Amy Hickey, Senior Orthopaedic Physiotherapist at CHW, said the team are excited to introduce this new management practice.

“The collaboration with SCH has been great. We have been able to discuss some practical issues, and some tips and tricks for the best results,” Amy said.

“Now that Natalie has familiarised me with the application of the waterproof spicas, I can start training the physios at CHW and one day offer this to our patients too.”

The Physiotherapy Department at CHW now plan to extend on the study by the SCH counterparts, trialling waterproof padding on different age groups and hope to soon introduce waterproof products as routine practice for managing femoral fractures.

For Eliana’s family, they can’t thank the team enough for effort they have gone to, to provide the very best care and treatment options for their little girl.

“Since her diagnosis, we’ve become very familiar the Hospital and the multiple teams who treat her. The care we continue to receive is truly second to none, every decision made is to the benefit of our daughter,” Catherine said.