There is no doubt that the plasters are cumbersome and uncomfortable both to the child and his/her parents. After all it is the parents that have to carry the largely immobile child about. It is very important that you are taught the correct way to lift your child while he or she is in plaster - otherwise it could be you could that's made immobile - with back problems!

Traditional plaster of paris is still used but lightweight waterproof casts are now more common. This obviously has advantages for babies and toddlers still in nappies, and for active children who are always damaging the plaster. And, being lightweight, it also has the advantage of making the child easier to carry . Some surgeons find it has some drawbacks such as moulding difficulties and sharp edges. It would be worthwhile asking for this type of plaster though, especially if you have had problems with the traditional type. The plaster is known under various trade names.

Although these lighter weight  plasters are waterproof, the linings that protect the child's skin from chafing are not. So try to avoid the lining coming into contact with a nappy. These casts can be abrasive where they come into contact with the skin, so make sure the edges are well padded.

Don't think for a moment that the child is completely unable to get about by him/herself, because even the youngest of them will soon be dragging themselves about the floor. Be warned, the child may come off better than any paint work and furniture they come into contact with!

TIP: There is huge variation in the types of casts used. Check with your consultant what your child will and will not be able to do in the particular type of cast used.

Check list for plaster care
Checks must be made on circulation, i.e. that the plaster is not too restrictive. Keep a special eye on the toes for signs of blueness and swelling.

TIP: Body Shop's Peppermint Foot lotion or similiar and a foot massage can help avoid cramp.

There may be some bleeding from the wound seeping through plasters put on immediately after the operation. These marks will normally be ringed in hospital and then regularly checked for signs of ongoing bleeding. If bleeding does occur after discharge from the hospital, again ring the stain with felt tip or biro adding the date and time. Telephone the hospital immediately for advice.

It is quite unavoidable with hip plasters that some smell will occur, especially in the younger child who is still in nappies. A certain amount of urine seepage is inevitable. If the plaster gets too soft it will be no good. SLEEK - a waterproof adhesive is usually recommended to help minimise this problem. Please check with the hospital first. Sleek is applied round the edges of the plaster, particularly in the nappy area. Sleek can be obtained from the hospital, or most doctors will give it on prescription.

Any strong unpleasant smell from the plaster, possibly accompanied by a fever should be reported at once to your own doctor or the hospital. These could be signs that the operation site has become infected or that a sore has developed.

If the plaster cracks or softens, contact the hospital for advice. They will probably advise a revisit for reinforcement. However, as you get more experienced in handling plaster you maybe able to do your own running repairs. These can only be done on plaster before it is too crumbly and soggy. The hospital will instruct you on applying the rolls of p.o.p. bandage. However, a useful hint is to score the old plaster before repairing as this gives a better grip for the new plaster.

Traditional plaster takes 48 hours or longer to dry completely, so great care must be taken in this time. It is important to keep it open to the air so that it will dry properly. The child will need to be turned regularly to dry all the plaster. As this is usually done whilst the child is in hospital you will be aided by the hospital staff. Don't wear any of your best clothes at his stage as plaster tends to get everywhere and will mark clothing.

The child will be rather fretful when the plaster is first put on, especially as they have just undergone surgery. Extra love, affection and reassurance are necessary. Cuddles are a bit awkward, but you will soon find the easiest way of holding your child.

Check the condition of the skin near the edge of the plaster for signs of rubbing of soreness.

TIP : To prevent skin sores over the spinal area, use a sticky back sheepskin material to line the plaster edges.

Nappies

Disposable nappies are ideal for use by a child in plaster. They tend to hold urine better than terry nappies and there's less chance of moisture seeping into the plaster. You may need to buy a larger size than usual in order to accommodate the plaster. Alternatively, you could cut off the side tapes and use the middle portion of the nappy with either popper or tie-on plastic pants.

If you do want to use terry nappies, the easiest way to put the nappy on is to fold it in half, then in half again lengthways. This gives a thick strip. This can be tucked just inside the plaster that should have been edged in Sleek. Use a one way nappy liner to act as a barrier between the plaster and nappy. Tie on plastic pants are easier as it can be difficult to find pop-up ones large enough to cover the plaster.

For extra absorbency a combination of a terry and disposable nappy can be used.

Nappy changing needs to be more frequent than usual but to some extent leaks are inevitable. It is advisable not to tuck the nappy completely underneath the plaster, as both nappy and plaster are absorbent, so this practice increases the risk of sores and the plaster softening and cracking. However, if the plaster, in spite of all the extra care is becoming soaked in urine, a thin strip of non-absorbent mineral wool can be tucked inside the plaster (not very far down as it would be difficult to retrieve) around the opening and renewed as necessary.

If your child is over the age of three you might be able to receive help with nappies from your Health Authority. Ask your GP or Health Visitor.

TIP: Deodorisers are available - e.g. Neutradol, Nilodor, Limone. Ask your local pharmacist for advice. Do not apply a deodorant directly onto the skin and be very cautious about applying it to the plaster. Do a skin test first on you baby.

If, because of the child dragging him/herself around on the floor, the nappy is continually slipping out of place you may find it helpful to put the stretch terry pants over the plastic pants.

Toileting the older child

You will have to adapt pants so that they undo down one side. Use Velcro or ties. Most children like to keep their independence. For urine, a funnel with a piece of tubing attached and placed in the plaster hole can help to preserve some independence and privacy. The tube can be placed in a potty or toilet to collect the urine. Products such as a Whiz (available to buy from STEPS) or Shewee or similar device are very useful for older girls.  Some mothers have found porta potties (available from camping shops) useful as they are small with a narrow seat. You will also need to obtain a bedpan and or urinal for boys. Ask your GP or phone the Red Cross.

Itches inside the plaster can lead children to drastic measures. You might find a ruler could help to soothe it but do take care. Any scratch or damage to the skin beneath the skin can quickly become infected. Don't insert anything into a plaster cast in case it cannot be retrieved. Your doctor may recommend antihistamine cream or Phenergan if your child is particularly affected.

Washing

Do not put your child in the bath!

Children can survive very easily without baths, but a daily sponge down will probably help to make them feel more comfortable. Talcum powder should be used sparingly around the plaster cast, as it can get inside the plaster and cause skin irritation. While washing the child, it is a good idea to examine all the plaster edges for any signs of chafing; these are most likely around the spine and ankles. Great care must be taken round the nappy area to prevent undue soreness.

Hair washing is one of the most difficult problems especially in the younger child who cannot support him or herself. Ideally two adults and a shower head for rinsing is the best solution. One adult supports the child whilst the other washes the hair. Cover the child with a large towel form the waist down, one-person holders the head over the sink whilst the other washes the hair.

Other methods for a single adult include sitting on a chair facing the bath or sink with the child lying face up across the lap with his legs on either side of the parent and the child's head overhanging the sink. (This would not work with a plaster with a bar between the legs) A shampoo shield (available from Mothercare) will stop soap and water going in the face. Some parents have also found dry shampoo helpful. Most chemists stock this.

TIP: Keep your child's nails short to prevent skin damage if the child scratches inside the cast.
TIP: Check the toes for crumbling plaster which can cause irritation.

Nights and sleeping

It seems that the younger the child the less likely they are to be affected by the plaster when it comes to sleeping. The exception though is in small babies who are prone to wind and colic, because the plaster prevents them drawing up their legs and the general immobilisation prevents them from being able to pass wind through their system easily. So a little more time spent in winding a child after a feed, perhaps by moving around with them, is time well spent. Medication can be obtained from your G.P. if this is a persistent problem.

Being in plaster does seem to affect the older child's sleeping habits. You may find they seem to sleep for short periods and become very restless and distressed at night. Some, if you are lucky, seem to be totally unaffected. However, for most the plaster can cause general discomfort such as cramp, itching and not being able to turn over can make for disturbed nights. It must also be remembered that the recent hospital experiences can make a child feel insecure, and nightmares do seem to be a recurrent problem in older children. Extra reassurance is therefore needed, and sleeping in the same room or bed as the child need not lead to permanent bad habits. Taking it in turn to do 'night duty' is one way to ensure that you at least get a good nights sleep sometimes. As a short term solution a doctor may prescribe medication.

The following practical hints from other parents may prove useful:

';Some parents found that removing the opposite bars on a cot provided extra width and enabled the child's feet to stick out on either side.
';A mattress on the floor avoids the fear of a child failing out of bed awkwardly.
';Use plenty of pillows under the body and the plaster to make the child more comfortable. The most vulnerable areas in the frog plaster are the ankles and the waist, particularly around the spine. The plaster edge often digs in here causing greater discomfort.
';Some children often wake up screaming in pain which can be very worrying particularly when a young child cannot explain. But for the most part, it is usually cramp. Just massage and flex the ankles and feet.
';Your child may well be too hot. The plaster is like cavity wall insulation and your child may need fewer blankets.
';In certain plasters, the knees are bent and angled inwards causing a bend in the spine if the child lies on his or her front. Improvising may be the key; one parent found a large foam block for the top half of the bed helped the child lay half kneeling / half lying. It sounds awkward but it worked well for her. She even managed to rest a bedpan on the mattress in the vital position so the child slept without nappies.
';In a heatwave a lambskin rug can help soothe and prevent heat rash because it absorbs a third of its own weight in moisture.
';If in nappies, raise the head end of the cot to help urine run down into the nappy and not up the back.

Transport and mobility

Getting out and about can be one of the biggest problems you'll face. It is essential for your own emotional well-being to be able to get out of the house and lead as normal a life as possible. Prepare your self for lots of stares, a child in plaster does attract the curious.

Travel is complicated by the problems of finding suitable car seats, prams and buggies. For up to date information about these our equipment list: car seats, buggies etc at http://www.steps-charity.org.uk/links/4-66-downloads.php?mode=docequiplib

There is good news about parking, however, as the Department of Transport made changes to the Blue Badge scheme which came into force on 15th October 2007 and extend the scheme to children under two who, because of their specific medical conditions, need to travel with bulky medical equipment or be close to a vehicle for emergency treatment. This will include children who suffer from hip dysplasia. To find out about applying for a blue badge in your area use this link

Without some form of adequate weather-proofed buggy or pram, it even becomes difficult to take your child in plaster on ordinary everyday outings, such as to the shops. When you are shopping in a large supermarket, ask for help from customer services. Because your child won't fit in the shopping trolley, you will need an extra pair of hands.

Small babies in plaster often fit into their prams with the help of a few cushions for support. If the plaster is still too wide an old carry cot (with soft sides) can be adapted by cutting out a portion of the sides for the legs to stick out. However, support is needed for the plaster, so this is only suitable for a child who is slightly too big for the carry cot.

Pouches of waterproof nylon can cover these holes for added protection.

TIP: A cycle cape is a flexible way to keep odd sizes and shapes dry.

Some children can fit into a reclining buggy supported by cushions. This might be most suitable for a small child or an older child in a single hip spica (with the leg at an off angle).

For larger babies and toddlers one of the best forms of transport available is the twin side by side trolley. These are very expensive, although second hand chairs can be picked up at a more reasonable price. Some authorities will provide double pushchairs through social services or the health visitor. Again the child will probably need supporting with cushions. A tri-pillow is very suitable for this.

Download the steps Equipment List from here for more information on buggies and carseats.

Children over the age of three will probably need a lie back wheel chair. These are not commonly available for loan, so special arrangements may have to be made. Contact your hospital or community health service well in advance of admission.

Siblings

The smaller baby might still fit in a baby sling and this would be a useful way to carry a baby around the house or on short journeys. Choose one which keeps the legs apart, not squeezed together. For older babies use the backpack type of carrier.

Do remember though a child in plaster is very heavy, so there might be considerable strain on your shoulders and back.

Travelling by car

Before you leave the hospital try to make sure that you have a suitable car seat. It is neither safe nor legal to travel with a baby on your knee unrestrained. It is even less safe to share an adult diagonal harness with your baby. The best advice is to find a car seat suitable for the age of your baby that has a wide seat and/or flat sides. Car seats that accommodate babies from birth to 4 years are most likely to accommodate babies in splints.

Download the steps Equipment List from here.

For details of purchasing or hiring a specially adapted hip spica car seat click here

';Make sure the plaster and back are supported properly.
';Keep the car cool, babies can get very hot in plaster.
';Park in parent and child spaces, you will need the space for manoeuvring.

Children must be restrained where rear seat belts are fitted unless they hold a seat belt exemption certificate. An application for exemption certificate should be submitted as soon as you know your child is going into plaster. Remember, this will not make your baby safe. You should approach your GP or the ward sister for help with this

To a certain extent it requires a degree of adaptability and imagination to secure your child as safely as possible in the car. It is useful though to have some ideas as a starting point but be prepared to adapt them.

Small babies can travel in the carry cot strapped in with the normal harness. Some children can still fit in certain types of car seat with a cushion as support.

Mobility

Most children will eventually be able to pull themselves around the floor in spite of their plaster. Some even manage to walk and climb stairs! However, all this activity causes wear and tear on the plaster .Not to mention on furniture and carpets which will be covered with white trails of plaster. So some kind of aid for mobility at home can be useful.

Tummy trolleys
These can be made out of a padded piece of wood on castors designed to fit your child's shape. The child can paddle themselves around with their arms.
Tyres on castors - This consists of an old car tyre mounted on a wooden base with castors underneath. It works on a similar principle to tummy trolleys.

Eating, Drinking and Activity

Breastfeeding
Many mothers continue to breast feed their baby in plaster. You will need to find a position that suits you both, so be prepared to experiment at first. Some mothers have found it most comfortable to breasfeed the baby with the baby's body resting on a cushion under the arm, a method often used in twin feeding. Others prop the baby on a V shaped cushion. Do ask for help from breastfeeding counsellors or ask to be put in touch with another mother who has successfully breastfed a child in plaster.

Diet and mealtimes
Children in these kinds of plasters tend to get constipated as they're spending so much of their time lying down. So it is best to give them plenty of roughage like wholewheat bread, fruit and vegetables. Also make sure they have plenty to drink.

Most children are happier with small meals and snacks. They soon feel full because there is not much room in the cast to accommodate a full tummy. They may also need less food because they are not moving around so much. You may have to use a bit of trial and error to find the best foods that suit your child.

It is not advisable to leave any young child alone while they are eating and drinking but this becomes even more important when improvised seating arrangements exist. Even with supervision it is best to make sure that the child is securely strapped in if there is any danger of falling. Do remember to check the circulation in the feet if the child is propped upright as the plaster could be cutting in.

Some children are quite happy eating off the tummy trolley with a place mat on the floor. It's probably best not to make the food too mushy, and a closed cup with a drinking straw might help to avoid spills.

Many children prefer to eat as part of the family group. Some parents have found that their child is happiest eating at table level, propped up with cushions lying on their tummy on an old fashioned pram.

Seating
It is often a question of make do and adapt to find seating that is suitable for your child. Some hospitals will provide you with a seat or a "perch".
A commercial "hip spica" chair is available, details from here or you can download instructions on how to make a chair from the downloads page

Parents have found the following seats useful:
';Bouncy chairs with multiple positions are useful for small babies.
';Adapting a conventional high chair (usually the wooden type).by hinging one of the wooden arms to make it easier to slide the baby into.
';A Bean Bag is very useful as it can be moulded to any shape.
';Some parents have made special chairs, (with castors useful for mobility).

Handling your baby
The plaster protects the hip, so even after surgery and child may be safely carried and positioned in the plaster. Treat you child as normally as possible, but when positioning make sure the feet are not restricted or that the plaster is not cutting into the skin. Your child's balance in plaster will be impaired so they will need more supervision.

TIP: In hospital, a child's position may be changed every two hours to prevent sores developing. It's a good idea to continue this at home.

Children in hip spicas are heavy and can be difficult to lift safely. You are in danger of injuring your back when you lift your child, particularly in awkward situations like from a car seat. The best solution is to always be careful and ask for some advice from a physiotherapist.

Clothing
It is not strictly necessary to put clothing over the cast, but most parents like to dress their children, as they would usually do.

You child's feet are more likely to be cold, so thick socks or bootees over the plaster help to keep them warm.

For small babies, the stretch baby suits a few sizes larger are probably the easiest type of clothing to deal with.

Girls' dresses usually fit over the plaster with no problems. But sometimes the child's legs are plastered too far apart for trousers or tights to fit properly. For the older child you could buy a large size of trousers, split them and tie them with tapes or use poppers or Velcro.

In dry weather it is a shame to keep the child indoors but it is difficult to keep the child on a rug out of doors and the plaster would soon become cracked and worn if dragged around on concrete and tarmac, so some kind of protective 'garment' is needed. One way to protect the plaster is to tie bits of carpet around the plaster and let them crawl on this.

Older children love to play with sand or water and while this can keep them occupied, sand and water must not be allowed to get into the plaster. So the plaster will need protecting carefully. Plastic aprons and dustbin bags wrapped around the plaster will do the job, although the child will need supervision given the obvious danger of large plastic bags. Do not leave the child wrapped in plastic for too long because this can cause excessive sweating.

Play activities
Play should not be limited for a child in plaster and indeed should be actively encouraged. Play is the language of childhood, it helps the child express him/herself and helps in coping with the all the strange situations.

A child in plaster is obviously restricted physically from very active play and so they have to rely on more craft activities and imaginative aspects of play. A wedge to help prop the child up can make play on the floor easier, or use one of the special seating chairs with a table.

There are many suitable toys on the market today and a lot of toy catalogues, many via mail order, are available to give you some ideas. It's a good time to encourage an interest in books too. A lot of play ideas can be improvised from materials found around the home and need not cost a lot of money. You could also try to join a local toy library.

TIP useful toys and activities:
';Miniature play people e.g. Playmobil
';Construction toys e.g. Lego
';Manipulative toys, e.g. fuzzy felts, jigsaw puzzles.
';Messy play e.g. painting, finger painting, printing, play dough, gluing etc.
';Junk modelling
';Cooking
';Growing things e.g. cress, carrot tops etc.
';Musical activities e.g. drum, clapping & singing along to nursery rhymes.
';Collecting things
';Games.

TIP if your child has been playing with small toys or items check that they haven't "posted" any items down the front of the plaster!

A positive affect of being restricted in plaster is that your child's language development often leaps ahead. They will concentrate more on language because they can do little else. Use books, story tapes, videos/DVDs, TV, drawing and creative art to interact with your child.

A child in plaster is in danger of missing the company of children of his or her own age group. There are obvious dangers and limitations to having friends round to play with a child in plaster; the children might go off and play by themselves or suggest games that would be impossible for the immobilised child to join in. This type of situation is only likely to lead to resentment and tears, but there are ways to try to avoid it. It is best to only have one or two children round at a time. Encourage the children to play games that everybody can join in. Consider involving an older child in the group to supervise this. Also make sure that an adult is always handy to assist or direct the game.

Children who have been through the trauma of hospital treatment often act out their fears and emotions with their toys. So the play hospitals and doctors kits are a good investment. A toy dressing up medical kit with plenty of bandages for teddy would probably get a lot of use. In fact, the child might quite like you to be the patient occasionally. Such toys can also help to explain to a child what is going to happen when they go into hospital in a non-threatening way.

Outings
It will do you and your child a great deal of good to arrange special outings as treats through the weeks or months of immobilisation. It might seem a daunting prospect at first, but many parents have managed it and say it has been well worth it. One mother said that she only survived this time because she was always going away, not just on day trips but overnight stays as well. So don't necessarily feel that you have to rule holidays out, but do check with the doctors first though.

Train operators may be able to provide help at the start and end of your journey by telephoning in advance. They may provide assistance when changing trains too.

Some local bus companies have special services for those with disabilities - albeit that the disability may be temporary in nature.

Tourist Information Centres can advise which destinations and attractions are accessible to those who are incapacitated