Car Seat Loaner Program and Services
for Children ​in Spica Casts
​ A Nationwide Hospital-based Program

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The spica cast is a common treatment for Developmental Dysplasia of the Hip (DDH), a general term used to identify infantile hip instability or dislocation, and for femur fractures in children (Bitar et al., 2016; Yang et al., 2019). Spica casts are used to stabilize infants who have been diagnosed with DDH, young children with broken legs, or those children who have had pelvis or hip surgery. While Spica casts are the most common, the Pavlik harness is a second alternative treatment. Most of these children are treated and released home within 24 hours. Casts are used between 8 to 12 weeks.

Merritt Wallenberg Hip-Cast Car Seat (Rear-facing & Forward-facing)

NOTICE TO HOSPITAL DISCHARGE STAFF, PARENTS, AND CAREGIVERS, NEVER PLACE A CHILD WHO IS IN A SPICA CAST OR PAVLIK HARNESS INTO A TRADITIONAL CAR SEAT, AND DO NOT MAKE SEAT MODIFICATIONS TO FIT THE CHILD. THE CHILD NEEDS A SPECIAL NEEDS CAR SEAT TO BE TRANSPORTED SAFELY AND LEGALLY. WHILE THERE ARE VARIOUS TYPES OF SPECIAL NEEDS CAR SEATS THE MERRITT WALLENBERG IS THE GOLD STANDARD FOR CHIDLREN 5 AND YOUNGER WHO HAVE BEEN TREATED WITH A SPICA CAST OR PAVLIK NARNESS. TALK WITH A CERTIFIED CHILD PASSENGER SAFETY TECHNICIAN BY CALLING 323-491-6197.  ​

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Pro Car Seat Safety, a service of Pro Consumer Safety and division of Public Health Behavior Solutions, assists hospitals in developing a special needs car seat loaner program, and provision of patient services, for pediatric patients in temporary Spica casts or Pavlik harnesses.  An infant or toddler who has been treated with a spica cast or in a harness, in most cases, cannot be transported in a traditional car seat. Collins et al. (2020), found that some traditional, non-special needs car seats, are capable of fitting a child in a Spica cast, however, this should not be a standard of practice. In most cases traditional car seats do not provide sufficient support for the cast and child, putting the child at risk of injury (Mead et al., 2020). Additionally, if the available car seat is not appropriate to fit the child properly, the hospital is at risk of having to medically transport the child home. Unfortunately, the cost and availability of special needs car seats capable of securing a child in a Spica cast or Pavlik harness​ can be a financial barrier to parents (Sparks et al., 2004; Tisherman et al., 2018).  A special needs car seat can range between $1,800 to $2,600+. This cost is often unattainable for some parents, especially with added days off work during the 8-to-12-week duration treatment. Without an appropriate special-needs car seat, during transportation, the child is at risk of secondary injury or fatality, including liability risk to the parent and the hospital (Adams et al., 2019).

A hospital-based car seat loaner program is a safe and effective model to ensure that pediatric patients are safely transported while in a Spica cast (Gockley et al., 2015). An effective program must include a range of special needs car seats to accommodate restraint modalities depending on the types of casting needs, age, weight and height of child, type/size of motor vehicle, etc. A properly installed special needs car seat can help to avoid secondary injury while the child is restrained properly. If a hospital does not have a car seat loaner program, it is critical that hospitals are aware of the best practices and recommendations for transporting children in Spica casts postoperatively and be aware of restraint needs for children with orthopedic conditions (Collins et al., 2022; Talty et al., 1999; Zielinski et al, 2009).

​According to the International Hip Dysplasia Institute (IHDI), 1 in 100 infants require treatment for DDH. In addition, the annual incidence of femoral shaft fractures among children in the United States is between 16.5 and 28 fractures per 100,000 (Pediatric Orthopedic Society of North America - POSNA).  This is the second most common fracture after those of the forearm (Brousil & Hunter, 2013). Hospitals must assess their departments such as surgery, orthopedics, pediatrics, emergency department, etc. to determine the type and number of special needs car seats needed to accommodate their patients (Sparks et al., 2004). Children in Spica casts require a special needs car seat to safely and legally transport the child in a motor vehicle. When a hospital has a loaner program, it reduces the need for costly medical transport, reduces the risk of secondary injury and fatality, and provides an equitable service to provide safe patient care for children who are in Spica casts (Adams et al., 2019; Gockley et al., 2015; Herman et al., 2011).​

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​The Car Seat Loaner Program and Services for Children in Spica Casts - A Hospital-based Program (CSLP)

We assist hospitals in developing and implementing a car seat loaner program and provide educational services to the parent or caregiver. The CSLP is one of our Community Benefit programs and is also a service model, have become a provider and parent resource for the IHDI. The educational component to parents and caregivers incorporates a validated behavioral skills training and telehealth approach to effectively educate parents and caregivers (DeCarli, et al., 2024). The program also contributes to the Federal Highway Administration's Safe Systems approach, as an equitable joint effort to achieve zero deaths and serious injuries on our roadways to protect these vulnerable child passengers.

• Program Planning:  We assist the hospital in planning and implementing an effective special needs car seat loaner program by collaborating with various departments within the hospital. This ensures a customized approach to meet the needs of the hospital and care of the patient.

• Patient Service: As part of the car seat loaner program, we provide the hospital with a one-on-one patient service to educate the parent or caregiver on the installation and use of the special-needs car seat. This also includes educating the parent or caregiver on securing their child properly post-surgery.  The service ensures that the parent is confident in correctly installing, testing and using their car seat to make sure their child is riding safely while in a Spica cast when the vehicle. The service component is provided by a National Highway Traffic Safety Administration (NHTSA) certified child passenger safety technician (CPST), and a Master Health Education Specialist (MCHES) who is trained to assist the parent or caregiver throughout the duration of the car seat use. An additional part of the service also includes the CPST assisting the parent or caregiver with their personal car seat, once the child has completed use of the special needs' car seat.

​For assistance (Parents/Caregivers and Healthcare Providers), contact Dr. James DeCarli, PhD, MPH, MPA, PGDip, MCHES, CPST, at 323-491-6197.

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Additional Hip Dysplasia Resources for Parents

You will see our website (PCSS) on the International Hip Dysplasia Institute (IHDI) as a resource. While we partner with IHDI, in addition to providing parents and caregivers with safely transporting children in Spica casts, IHDI, also provides Hip Dysplasia infant and child resources for parents and caregivers.

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References

Adams, A. J., Johnson, M. A., Ryan, K. A., Farrell, S. B., Morro, M., & Sankar, W. N. (2019). Safe transportation in-Spica following surgical treatment of infantile DDH: solutions and threats. Journal of Pediatric Orthopaedics, 39(7), e488–e493. https://doi.org/10.1097/bpo.0000000000001317

American Academy of Orthopaedic Surgeons. Treatment of Pediatric Diaphyseal Femur Fractures Evidence-Based Clinical Practice Guideline. www.aaos.org/pdffcpg. Published December 5, 2020. 

Bitar, K. M., Me, F., Ei, A., & Saw, A. (2016). Physical and Clinical Evaluation of Hip Spica Cast Applied with Three-slab Technique using Fibreglass Material. Malaysian Orthopaedic Journal. doi.org/10.5704/moj.1611.008

Brousil, J. J., & Hunter, J. A. (2013). Femoral fractures in children. Current Opinion in Pediatrics, 25(1), 52–57. doi.org/10.1097/mop.0b013e32835c20e0

Collins AC, Caskey S, Peck JB, Walter N, Atkinson TS, Atkinson PJ. Frontal Crash Injury Metrics Are Below Mandated Limits for a Spica Casted Child Dummy in Currently Available Restraints. J Pediatr Orthop. 2020;40(5):e394-e400. doi:10.1097/BPO.0000000000001477
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Collins, A., McKean, L., Ostrander, J., Nagarajan, S., Atkinson, P., & Atkinson, T. (2021). Crash Performance of Rear-facing Restraints With a Fracture Type Spica Casted 1-Year-Old Dummy. Journal of Pediatric Orthopaedics, 42(1), e1–e7. https://doi.org/10.1097/bpo.0000000000001978

Gockley A, Hennrikus W, Lavin ST, Rzucidlo S, Rieghard C. Transportation of children in spica casts in the USA. J Pediatr Orthop B. 2015;24(4):277-280. doi:10.1097/BPB.0000000000000169

Herman, M. J., Abzug, J. M., Krynetskiy, E. E., & Guzzardo, L. V. (2011). Motor vehicle transportation in hip Spica casts. Journal of Pediatric Orthopaedics, 31(4), 465–468. https://doi.org/10.1097/bpo.0b013e31821996b2
 
International Hip Dysplasia Institute. (2021, January 29). Infant & Child - International Hip Dysplasia Institute. https://hipdysplasia.org/infant-child/
     
Loos, M., Bakx, R., Allema, J. H., Bloemers, F. W., Bosch, J. a. T., Edwards, M. J., Hulscher, J. B. F., Keyzer-Dekker, C. M. G., Krug, E., De Ridder, V. A., Spanjersberg, W. R., Teeuw, A. H., Theeuwes, H. P., De Vries, S., De Wit, R., Van Rijn, R. R., De Boer, A., Edelenbos, E., Goslings, J. C., . . . Van De Putte, E. M. (2022). Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers. Pediatric Radiology, 52(12), 2359–2367. https://doi.org/10.1007/s00247-022-05378-8

Mead, M., Caskey, S., Walter, N., Atkinson, P., Atkinson, T., & Collins, A. C. (2020). Injury metrics are altered in spica-casted versus non-casted child ATDs in side-impact collisions with door intrusion. Traffic Injury Prevention, 21(6), 341–346. https://doi.org/10.1080/15389588.2020.1755969

Pediatric Orthopaedic Society of North America (POSNA). (2024). Femur Fracture: Physician Education Study Guide. Retrieved January 6, 2024, from https://posna.org/physician-education/study-guide/femur-fracture

Sparks, L., Ortman, M. R., & Aubuchon, P. (2004). Care of the child in a body cast. Journal of Orthopaedic Nursing, 8(4), 231–235. https://doi.org/10.1016/j.joon.2004.09.003

Talty JL, Keller MK, Chappelow M, Stroup KB, Bull MJ. Transporting children with orthopaedic conditions and surgeries. Orthop Nurs. 1999;18(6):29-35.

Tisherman, R. T., Hoellwarth, J. S., & Mendelson, S. A. (2018). Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures. Journal of Children’s Orthopaedics, 12(2), 136–144. ​journals.sagepub.com/doi/10.1302/1863-2548.12.170201doi.org/10.1302/1863-2548.12.170201

Yang, S., Zusman, N., Lieberman, E., & Goldstein, R. Y. (2019). Developmental Dysplasia of the Hip. Pediatrics, 143(1).  doi.org/10.1542/peds.2018-1147

 Zielinski J, Oliver G, Sybesma J, Walter N, Atkinson P. Casting technique and restraint choice influence child safety during transport of body casted children subjected to a simulated frontal MVA. J Trauma. 2009;66(6):1653-1665.  doi:10.1097/TA.0b013e3181a4c0f4

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