Halo Vest

Important information:

The halo vest is designed to hold your child’s head and neck in a stable position after surgery or an injury. The halo is attached to your child’s skull using special pins. The vest is lined with soft wool to prevent any skin irritation. Since the halo will be in place for several months, below are some guidelines for managing at home.

Patient instructions:

Care of the vest

• Before your child goes home be sure that the vest is comfortable. Do not adjust or remove the vest by yourself. Adjustments must be made by the brace team. .

• Never pick up your child by any part of the halo vest

• Try to keep the vest dry. If it gets wet, you can dry it by using a regular hairdryer on the cool setting. Frequent wetting of the vest will cause it to rot and will damage your child's skin.

• Use a bib or apron when eating to keep food from falling into the vest

• If the liner gets vomit on it, smells, or gets soaked it will need to be changed. Call the brace shop, Boston Orthotics and Prosthetics (BOAP) at 215-634-9399 and Orthopedics at 215-590-1527 for further instructions. Pin care

• Check the pins daily for signs of infection. Look for redness or swelling where the pin goes through the skin, tenderness, or pus from the pin site.

• Some clear, yellow drainage is normal.

• Wash the pin sites every day with sterile water using a washcloth or cotton swab. You can also use mild antibacterial soap. Gentle daily washing will prevent any crust from building up.

• Your child may complain of mild pain or discomfort when the pins are washed. Vigorous washing is not necessary. Severe pain or an increase in pain may mean that the pin is slightly loose, or an infection is starting. You should notify your healthcare team if this occurs.

Bathing and hair washing

• Your child will need to have sponge baths while in the halo vest. The lining of the vest will get wet in the bathtub, even in a few inches of water.

• Your child may complain of itching under the vest if they do, use a hair dryer on the cool setting to blow cool air onto their skin.

• Shampoo your child’s hair with a no-rinse shampoo.

Clothing

• Use extra-large T-shirts. Stretch the neck of the shirt so that it will go over the halo.

• A regular size T-shirt with slits cut around the neck. You can close the slits with pins, tape, or Velcro.

• Shirts that button down the front. The top buttons will not be buttoned.

• Zip up tops or adaptive clothing tops

• Most children can wear regular-size pants or skirts.

Activity

• Your child should be able to walk.

• Children may need help going up and down stairs.

• Your child will not be able to turn their head. They will have to turn their whole body. Stand in front of your child when you are talking. Your child can lose their balance and fall if they try to turn suddenly.

• Your child may only do walking level activities.

• Your child can take walks, play video games, do schoolwork, color, paint, read, etc.

• Please do not let your child ride a bike or play on playground equipment, bounce houses, trampolines or other such activities--these are dangerous in a halo.

Travel

• Your child must be properly restrained while riding in a car. The halo vest is top-heavy, and your child needs support.

• Your child must always be in an appropriate car seat or wear a seat belt.

• Your child should wear a seatbelt while in a stroller or wheelchair.

Sleeping

• Many children are comfortable sleeping in their own bed. A pillow can be used but nothing should be placed between the bars and the head/neck. Your child can lie flat. If it is more comfortable for your child to have the head of the bed up, you can put some folded blankets under the mattress to raise it.

• Your child may sleep in any position that is comfortable.

School

Your child can return to school while in the halo vest. However, some schools prefer your child to be tutored at home for safety reasons. Please check with your child’s principal, nurse, and counselor, the school team will need halo education prior to returning to school.

Emergency instructions:

Loose pins

Signs that the halo pins may be loose:

• Clicking sounds

• Pain

• Redness

• Raised skin

• Increased drainage from the pin sites

• Head moving independently from the halo

If a pin becomes loose notify your healthcare team immediately. Have your child remain in bed until you can see the provider. Do not adjust the loose pins.

Medical emergency

If your child is having a medical emergency, call 911 right away. If the vest needs to be removed for the medical emergency, please follow the instructions given by the brace team. Keep the wrench taped to the vest at all times, as the wrench may be needed for a medical emergency.

Remember: Never remove the halo brace!

Call your CHOP orthopedic team with questions, concerns or if your child has:

• Extreme pain.

• Skin irritation or sores.

• Redness, swelling, drainage, and pain at pin site.

• Fever above 100.4°F (38°C) for more than 2 days.

• Changes in mental status.

• Loose pins: Clicking sounds, pain, redness, raised skin, or increased drainage from the pin sites.

Division of Orthopaedics

Weekdays:

215-590-1527

Nights, weekends, and holidays:

Call 215-590-1000 and ask the operator to page the orthopedic resident on call.

Reviewed April 2024 by Emily Stegonshek, CRNP