What to expect.

The following is our experience of traction and the operation and cast both on a practical and emotional level. It is very detailed but that is what I felt I was missing - so please forgive me! Hope it helps.

Traction

" It wasn't at all as bad as we thought it was going to be - Rhianna was really happy and normal for the entire time in traction and was no harder to look after than normal. It was harder on the parents - being stuck in one room, although we were lucky to have it (at Maidstone they do try to give babies under one a room to themselves), and only seeing each other in the evening after a very long day. We did manage to go out for a meal together once to try to get out and left Rhianna asleep with the nurses - but I felt too guilty really to enjoy it and rushed back!

Breast feeding was remarkably easy - just swung her round to the side of the cot and fed her when her legs were straight up. We'd got her used to one bottle of formula a day for two weeks before going into hospital to make sure we would have the option when in traction, but in the event we only needed formula when I needed a break at the weekend and my husband stayed in hospital. It was harder when her legs were changed to a different angle after 9 days as it added extra stress to the traction - and it came off (mostly due to her acrobatics in the cot though rather than feeding itself).

When we did do formula - the nurses got the amount of boiled water wrong - so check before you make up each feed.

Due to recent changes in health guidelines the nurses would only boil the kettle half an hour before you needed it to feed her - which meant cooling the bottle in cold water to make sure it was cool enough on time - a bit of a faff

The nurses provided us with a daily Milton tank which was surprisingly convenient to use. Steam sterilisers were not permitted - for health and safety reasons.

The ward didn't feed the parents - we had either food in the staff canteen or a microwave meal which the already busy nurses had to cook for us (again health and safety reasons). You feel guilty asking, but you have to eat something and even the nurses avoid the canteen as much as possible! Lunchtime food was ok there, but the evenings- euch!

She did get constipation for the first time in traction - and the hospital was keen on drugs rather than giving more natural remedies - fruit juice etc.

We were still able to follow her routine - feeding every 3-4 hours, and the extra noise and light at night didn't seem to bother her - going from a quiet room at home with black out blinds to a children's ward wasn't that disruptive which really surprised me after all the baby books I'd read!

Noisy and chewy toys, toys with lights and music worked well. A helium balloon was an absolute winner in hospital and at home afterwards. The hospital play specialist gave us toys which were a great help to give her and us a bit of a change!

She continued to play happily on her own in the cot as she did at home without needing constant attention.

Whilst in traction it was easy to zip her into her Grobag baby sleeping bag - much easier than wrapping blankets around her as it didn't come undone and fall off.

Bodysuits worked well to wear in traction - as you could get them done up properly, even sleepsuits - you just couldn't do the legs up. Her cot could be wheeled round the hospital and even outside into the garden, so we needed a coat and hat for her. She needed socks too.

We changed her nappies on the change mat from her change bag.

The nurses seemed to have a varying understanding of what the correct height of the traction would be - she started off with her bottom a good 2 1/2 inches off the bed - and her feet went purple and freezing cold. The consultant advised that you just had to have enough room to get your hand under her bottom without pushing, and we had to become the experts - making sure the nurses didn't put her to high or too low. Its not easy to get right, even if they know the correct height, as the ropes slip a little when the acrobatics start again, so it wasn't unusual to ask several times a day for her to be re-strung!

The acrobatics seemed innocuous enough at first, and seemed amusing, giving her something to do, but after a week she pulled the traction off completely - it was adhesive traction stuck on her skin. The new traction adhesive goes straight back where the last bit came off, and given babies delicate skin, she developed severe sores from having pulled it off three times (I'd assumed it would either stay put or that if it did come off it wouldn't have done any damage) so in retrospect I would have gently tried to keep her from twisting and turning quite so much (whether that is realistic I'm not really sure). She ended up being sent home after twelve days, two days before the operation, with weeping sores on her legs to heal before she was put in the cast. Remarkably, she didn't seem bothered by the sores at all. I'm not convinced they did heal, as she had an infection in her leg in the cast after a couple of days needing antibiotics to bring the swelling and infection down.

The operation and cast

The two hardest elements were when she was put to sleep (hard for us) and getting her from theatre (horrid for her and horrid for us).

Chris went into the anaesthesia room, they gave her a mask and a gas blower - she sucked on it excitedly and fell asleep whilst Chris sang a nursery rhyme to her. He found it very hard as it didn't look like "normal" falling asleep but she didn't scream or get upset. Many babies don't like it much but we were told that if they cry they take more gas in and go under quicker. It took around a minute for her to go to sleep but it can take as long as 5 minutes.

The consultant at Maidstone usually operates on the children in age order - the smallest first - luckily Rhianna was the youngest so we were first - at 9am. We were told that last food is 6 hours before with water 2 hours before, although the hospital could not confirm what time the operation was (even the night before), so we could have had to wait longer but still could not have fed her after 3am. I decided to delay her usual 10pm feed the night before and woke her at 3am to feed her and hoped she'd be operated on at 9. Remarkably she lasted really well, with a little boiled water 2 hours before the operation and didn't seem hungry at all which had been a huge concern for me. The second child was put to sleep at around 11.30 - which is a long time to wait if you have last fed them at 3am.

I expressed milk whilst she was in her operation, and she came back from theatre at 12. Her first milk feed was at 2 when she had kept enough water down to show that she had not reacted to the anaesthetic. I did manage to breast feed her at this time - with both of us lying down on the hospital put-me-up bed, supporting her cast and head with propped pillows. (afterwards breastfeeding was actually easier with the cast than bottle feeding as she seemed to be just the right size to tilt at a 45 degree angle with her cast resting on my thigh - it didn't trouble my bad back as I thought it would - bottle feeding on my lap seemed to put more strain on my back as you had less hands to help. I think I would have done it with her on a bean bag or lying down)

Rhianna was kept in theatre recovery room without us until she was fully awake, which I think upset her a lot. When we finally got to see her she seemed pretty traumatised, crying and shivering, clearly cold, scared and thirsty - and needing her parents. She wasn't as heavy as I expected when I took her off the nurse, so I carried her back to the ward which seemed to calm her (she was 6.3kg without the cast and was around 8.3kg with it. It was a mixture of fibreglass and plaster). The cast felt totally alien to me and it was difficult to adjust to it whilst trying to calm her - but you do manage it. The cast was from her ankles to just under her armpits.

Chris sat on the hospital chair with her for two hours, and we wrapped her in extra blankets to warm her up.

We initially gave her 5-10ml of cooled boiled water that we'd bought from home and sprinkled boiled water on a dummy which she took and helped to calm her down remarkably quickly. We gave her around 10 ml of the boiled water every 10 minutes to make sure she kept it down, and though she was really drowsy, we gently woke her to do it as I was so worried about how thirsty and dry mouthed she was. After an hour we gave her 75ml of water, then fed her milk after 2 hours. The hospital advised us to give her her first feed no later than 2.5 hours after she came back from theatre.

For the first four hours she mostly slept and drank and cried very little which was unexpected. By 3.15 (3 ¼ after the op) she did play for 15 minutes or so and even smiled.

We could have gone home that day, but we decided that as we would have been discharged late on, it was more stressful for her to go home and stayed overnight. The next day she was fine and we took her to Mothercare to fit her into a new car seat - we'd bought the harness recommended by steps to get her there but weren't happy that this was a long term solution. We tried her in several and strangely bought one that she hadn't seemed to fit in first time. Britax First Class. I also bought her clothes that fitted round her enormous waist - age 18-24 months and she was 6 months at the time (but a skinny 6 months). Mothercare had a tape measure and I used this to measure her waist and the size of the clothes.

Rhianna really didn't seem at all bothered by the cast - and played quite happily as normal, and slept as normal.

I did wake her to change her in the middle of the night, but I'm not sure how long I would have continued with this. I tried to check inside the cast with a torch each day to check for sores but found it difficult to see anything. Her skin did seem to be getting very dry inside but as we had read that you shouldn't put oils or moisturisers inside the cast (it softens the skin and makes it more prone to rubbing and damage) I didn't put anything on it. I'm not sure this was the right thing to do as when she came out of the cast her skin was very flaky and dry, but it did heal.

Nappies - following advice from steps discussion forum and other parents (the nurses had very little idea), we put a mini Tena Lady folded in half inside a newborn nappy, which we stuffed into the nappy hole as far up as it would go, having torn off the nappy's sticky tabs. Within a couple of days it was a lot easier to do as the cast became much more loose pretty quickly. We changed her every couple of hours (or immediately we thought she had pooed!) instead of the usual 4 hourly changes. However, even this didn't contain the v runny breast fed poo which leaked immediately. We ended up getting a fleece blanket and cutting it into strips, and then rolling that up and placing four sections inside the newborn nappy, but up inside the cast - one up the front, one up the back, and one up each of the sides to form a complete barrier. We changed the fleece each time we changed the nappy. The consultant advised us against this as it is easy to cut off circulation or to lose one up the cast (with the resultant risk of infection) but we counted them in and out, and kept a check on her feet as we considered that the risk was less than the effect of constant escaping poo. The fleece helped and really cut down the number of leaks. We were lucky she was old enough to wean a week into the cast, but her cast came off anyway before it had an effect as her hip dislocated again inside.

You cannot 100% clean up leaks when they occur - you just have to do your best - and we did pretty badly! You can't get the cast wet, so water is out, we just used baby wipes to try and get the worst off, but the cast was still stained inside with yellow poo and became a bit wiffy even after a couple of days. Rhianna's leg infection made it worse as we couldn't elevate her head above her legs which is what the advice seemed to be so that wee/etc runs down into the nappy rather than up into the cast. When changing her she seemed to be particularly keen on weeing when the nappy was off and that went straight up the cast - so having something handy to stuff in the way to try and catch it was always necessary (but not 100% effective). When she did wee in the cast, we tried to clean it ineffectually with baby wipes and then put the hairdryer on a cool setting and dried it with her both on her front and on her back. Febreze helped but I was always concerned about it getting too near her skin.

When Rhianna's cast came off after two weeks, her skin was very dry and a little burnt from escaping urine etc. but with the infection in her leg I think there was little we could have done.

Rhianna had a scan the day after the operation, and the consultant was happy that the operation had been a success and the hip was in the right place. However, he did ask to see us for another scan after two weeks as he wasn't 100% sure that the procedure would be effective. At that scan it was clear that the hip had redislocated itself (which is very rare), and they tried again under anaesthetic to correct it. They decided it was likely to come out again and that she needed to wait for open surgery at the age of 1.