This page explains about the halo vest system and what to expect when your child comes to Great Ormond Street Hospital (GOSH) to have this treatment.
Why does my child need a halo vest system?
Your child may have had a recent neck injury or may be having surgery to his or her cervical spine (the bones in the neck). Because of this, he or she may need to be in the halo vest system for a period of time in order to protect the bones from any damaging movement and/or allow the bones to heal.
The equipment used for the halo vest system is made up of two parts:
- A ring around the head, which is attached to the skull with pins.
- A special vest with a sheepskin lining which is attached to the halo ring with rods.
The halo vest system equipment is made from material that is strong and light so it is easy for your child to move around.
Because the equipment is not made from metal, your child can have a magnetic resonance imaging (MRI) scan while he or she is wearing it, if required, to view the spine.
What does the operation to fit the halo vest system involve?
Your child will have the halo vest system equipment fitted while under general anaesthetic. The halo part of the equipment will be fitted to your child’s skull using pins that are placed through the skin directly into the skull. The doctor will then put your child into the special vest and connect up the rods to form the complete halo vest system equipment.
Are there any risks?
Bumps and knocks to the halo can be painful, and traumatic and boisterous activity is best avoided.
Are there any alternatives to having the halo vest system?
This depends on the extent of your child’s injury or operation. Where possible, if your child’s neck can be held in place by a neck collar, this is what the doctors will suggest. However, there are some circumstances in which the halo vest system offers the best results.
What happens before the operation?
You will have received information in your child’s admission letter about how to prepare your child for the operation. Please bring shirts or jumpers that button up the front, as putting clothes on over the head is difficult once the halo vest system is in place.
Occasionally the sheepskin vest causes itchiness, so please also bring a cotton vest, which we can place next to the skin and underneath the sheepskin if necessary. The nurse and play specialist will help prepare your child for the halo system and inform you how best you too can help.
If you are being admitted on the same day as the halo fitting, your child should not have had anything to eat or drink for the amount of time mentioned in the instructions. It is very important that you follow these instructions, otherwise your child’s operation may have to be delayed or even cancelled.
Before the operation, the doctor will need to take various measurements to ensure that the equipment fits your child correctly.
The doctors will explain the operation in more detail, discuss any worries you may have and ask you to give your permission for the operation by signing a consent form. Another doctor will visit you to explain about the anaesthetic. If your child has any medical problems, particularly allergies, please tell the doctors about these. Please also bring in any medicines your child is currently taking.
What happens afterwards?
Your child will come back to the ward to recover.
The halo vest system can be a little frightening to wake up in so your child will need reassurance. The nurses and play specialist will be there to offer reassurance and guidance to you and your child. Your child will have been given some pain relief at the end of the operation, so should not be in pain when he or she wakes up.
The nurses will regularly make sure that your child has enough pain relief to keep him or her comfortable. After a few days, paracetamol or ibuprofen-based medications should be enough to deal with any pain or discomfort.
Learning to look after the halo vest system equipment
Once your child has recovered from the operation, the ward staff will show you how to care for the equipment.
There is a black plastic spanner attached to the front of the vest. This should not be removed at any time as it may be needed in an emergency to remove the halo vest system equipment.
On the day after the operation, a physiotherapist will visit your child. He or she will help your child to get used to the traction equipment. There are special ways of moving about, getting up or sitting down while wearing the halo vest system, and the physiotherapist will show your child how to do these things. At no time must you help your child move by pulling on the metal rods that join the halo ring and the jacket, as this will cause tension on the skull pins.
It may take you and your child some time to get used to the halo vest system. If you have any questions, either while your child is at the hospital or after he or she goes home, please contact a member of the ward staff.
Diet and eating
At first, the sensation of swallowing may feel different as your child will be unable to move his neck and it may take a little time for your child to adjust.
The sheepskin vest should be kept dry at all times. If it gets wet, dry it with a hairdryer on a cool setting. You should never try to remove the sheepskin from inside the jacket. If the lining does get dirty, please contact the hospital, as we may need to change it.
Skin care underneath the sheepskin is difficult. Your child will not be able to have a bath or a shower, but areas that you can reach should be washed and dried every day. Use water only – do not use any soap, oil or powder.
If you wish, you can bring a cotton vest to be fitted underneath the sheepskin (it may get damaged when the vest is removed so it is best not to use an expensive one or a favourite one). A cotton vest may be particularly helpful if your child is likely to be wearing the halo vest system equipment during hot weather.
This can also be difficult. The easiest way to do it is with a shower attachment fitted to your bath taps. It is important not to get the sheepskin wet so you should wrap a towel around your child.
If possible, try to lie your child flat on his or her back with the head over the edge of the bath, rather than asking him or her to lean forwards over the bath. Try not to bump the pins as this can be painful and may cause them to become loose.
Pin site care
If the pin sites are oozing or painful or the pins are loose, please contact your GP or telephone us on the ward.
We do not encourage routine cleaning of pin sites, just gentle showering when hair washing. Should the pin sites look red and inflamed please contact your GP or the ward for advice.
Big, baggy clothes with buttons or zips are easier to wear over the traction equipment than tight fitting garments. It may be best for your child to wear clothes a size or two bigger than normal.
Your child will take time to adjust to sleeping with the traction equipment on. Using one or two pillows for support should make him or her more comfortable. When your child needs to get out of bed, he or she should roll onto one side and then use his or her arms to push upwards.
Travelling and moving around
Your child may be unsteady and he or she may take time to adapt to the halo vest system equipment. While your child is in hospital, the physiotherapist will help him or her to adjust. It may be easier for your child to bend at the knees rather than the waist when he or she needs to pick something up. Your child should continue to wear a seatbelt in the car. Stairs and street kerbs are better negotiated sideways.
Reading and writing
Your child may find it difficult to read or work at a desk. Tilting the desktop may help.
Your child should be able to attend school while wearing the halo vest system equipment, but will not be able to take part in PE, games, swimming or any other ‘rough and tumble’ activities. If you are worried about how your child is going to cope back at school, please speak to a member of ward staff.
Bullying or unwanted attention
If your child is receiving unwanted attention, please contact the ward play specialist as he or she may be able to suggest some strategies for dealing with this. Honest explanations when your child returns to school wearing the equipment can ease any fears felt by other children, and answer their questions.
Removal of the halo vest system equipment
Your child will need to come back into the hospital in order to have the equipment taken off. He or she will have a scan and X-rays to check that everything is satisfactory before it is removed under a short general anaesthetic.
Afterwards, your child may need to wear a neck collar for a few weeks. His or her neck may feel weak because the muscles have not been used as normal while the halo vest system equipment was fitted. The physiotherapist will see you before you go home to give you some advice about this.
You should call the hospital if:
- the pin sites ooze or bleed
- the pins become loose
- the equipment becomes broken or loose
Please note this is a generic GOSH information sheet. If you have specific questions about how this relates to your child, please ask your doctor. Please note this information may not necessarily reflect treatment at other hospitals.