What is Halo Traction?

Halo Traction is a procedure used to reduce the degree of curvature in the spines of
children with severe idiopathic or congenital scoliosis. Spinal traction is the gentle
pulling of the soft tissue (joints and muscles) to help straighten the spine. A scoliotic
curve allowed to reach high degrees of measurement may increase pressure on the
lungs and heart. The result can be a decrease in life expectancy by up to twenty
years.

Who Needs Halo Traction?

Halo traction is needed by children with severe curves in their spine (80+degrees),
who have not had success with other measures of correction, such as: serial corrective
plaster casting and serial bracing. Halo traction is also needed by those children
with high curves, who are not eligible for other measures of correction because of
congenital defects in their spines. Many of these children are already experiencing
stress to their heart and lung functions. Patients with severe infantile, juvenile and
adolescent scoliosis and Scheuerman’s Kyphosis may be considered likely candidates
for halo traction.

What is the Expected Outcome of Halo Traction?

Each child with severe infantile scoliosis will experience a different outcome from this
procedure. Many factors, such as the stiffness or flexibility of the spine and whether
congenital scoliosis with previous fusion is present, will affect the outcome. The
goal of treatment is to safely bring the curve to the smallest possible degree and
delay spinal fusion (if not already fused) until spine growth is close to finished, or
to maintain correction achieved via serial casting, bracing or instrumentation (boys
approximately 9-11; girls approximately 11-14). Typically, a curve is reduced by about
50%-60%. With halo traction, the emphasis is placed on the child’s heart and lung
health and not the number of degrees.

While the child is under general anesthesia, a horseshoe

shaped metal bar is secured to the skull with 4-8 pins.
These pins distribute the traction weight evenly. The
number of pins used is in relation to the child’s weight.
The halo will sit slightly above the eyebrows and reach
back to the child’s ears.  In some cases, it can go
completely around the child’s head. The pins will hold
the halo in place a short distance from the forehead.
Once the halo is secured, it is ready to accept the
traction weight. Traction is achieved by weights hung
from a rope woven through a precise pulley system to
the triangle and carabineer attached to the top of the
halo. The traction gently pulls against the child’s body
weight to straighten the spine. The amount of traction
View of Halo weight used is determined by the orthopedic surgeon
and depends on the child’s body weight (approximately
1/3 of the child’s weight).
 Traction weight starts light and increases slowly and
deliberately until the maximum traction weight for
the particular child is reached. The traction weight is
decreased at the same deliberate pace, working towards
the goal of halo removal, once correction is obtained.
Following the placement of the halo, the child
will remain in traction at all times. The apparatus
for traction is made to fit the bed. Maximum use of
gravity is obtained by placing the bed in the Reverse
Trendelenberg position, a downward slant of the bed
where the child‘s head is elevated and feet are lowered.
Newer beds have motorized controls to accomplish this.
On older beds a stabilizing block can be constructed
(see article).
Halo in Place
The child’s mobility is retained through the use of a wheelchair and a walker. The
wheelchair and walker should be large enough to accommodate the traction apparatus
and be adapted with wedges or extra wheels to prevent tipping. The walker is
especially important as it also incorporates the use of gravity. Be sure that the length
of the traction tubing and ropes allow the child to stand completely upright while using
the walker. Also be sure that any stabilizing bars do not get in the way of the child’s
feet while the child is walking. Therapy services will help the child adapt and resume
physical activities.

At first your child may feel awkward and unsteady in the traction. Once he or she gets
used to the traction, moving around will be easier. You will be helping your child move
from a wheelchair, walker and bed. Nurses and physical therapists will help you learn
which movements are safe for your child. Therapy services will help the child adapt
and resume physical activities. Maintaining strength while in the halo is very important
so the child can return to normal activities when the halo is removed.
child‘s head is elevated and feet are lowered.
Application of Halo Traction

Your child’s orthopedic surgeon will determine whether your child will achieve more
correction if wearing a cast during the halo procedure. Children who are scheduled
to undergo a VEPTR implant surgery may not require plaster casting during the halo
procedure, due to the necessity of maintaining healthy skin pre-surgery.

Possible Complications and Monitoring

Some possible complications from halo traction are: pain and weakness in the neck
muscles, swallowing muscles and tongue, pain and weakness in the eyes, infections
at the pin sites and neuromuscular complications. These are rare due to strict
monitoring of the child’s neurological functions through simple tests of the eyes,
facial muscles and movement in the arms, legs, toes, etc. Caregivers will be taught
how to keep pin sites clean, and nursing staff will monitor the appearance of the skin
around the pin sites daily. Check with your child’s orthopedic surgeon to see if physical
therapy might benefit your child during this process. Any cause for concern should be
discussed with your doctor immediately.

Pursuing Halo Traction Treatment

Each hospital equipped to provide halo traction treatment will have specific protocols
for patient acceptance for the procedure. The following is a general outline of what
you might expect:

•         Undergo an assessment by your pediatric orthopedic surgeon and be identified

as a candidate for halo traction treatment.

•         Meet with your surgeon again to review what halo traction is, its purpose, and
the intended outcome for your child.

•         Meet with the anesthesiologist to discuss sedation methods and any allergies
your child has had to anesthesia or medication in the past.

•         Meet with the pulmonary department to discuss whether or not there is a need
for Chest Percussive Therapy (CPT) or other breathing therapies such as Bi-Pap.

•         Meet with physicians to discuss pain management. Many hospitals have a pain
team that will discuss with you the various pediatric medications used and their
side effects.

•         Review teaching material on patient preparation and patient care.

•         Tour the orthopedic floor of the hospital and see an example of the traction
apparatus mounted to a bed, wheelchair or walker. See examples of the casts and
braces used.        

•         See photos of other kids in halo traction to prepare yourself for what your child
will look like. Immediately after application, your child’s head may be bruised, red,
swollen, and there may be drainage from the pin sites until they have healed.

•         Share your child’s health history and medical portfolio with the orthopedic
surgeon and his team, so unnecessary x-rays and tests are not repeated.

•         Pursue an assessment by the physical therapy department to determine your

child’s pre-traction capabilities and strength.

•         Meet with hospital social work staff to discuss psychological implications of
being hospitalized for up to three months. Discuss the importance of an emotional
support system, and their involvement in helping you and your child maintain a
positive outlook and successfully complete the long stay in the hospital. Discuss
services that may be available to your family within the hospital, such as referral
to hotels offering a medical rate and discounted vouchers for meals in the hospital
cafeteria.

•         Meet with child life specialists to discuss activities to divert your child,
educational services available for school age children, and tour the playroom,
movie check-out closet, library, etc. Many hospitals have scheduled activities for
the children and Pet Pal programs, where specially trained dogs visit the children.

Preparing the Family for the Halo Traction Procedure

A caregiver should plan to stay with the child at all times. Your child could be in the
hospital for 8 -12 weeks, depending on the severity of the curve, your child’s overall
health and strength, and the intended outcome for your child determined by you and
your surgeon. Halo traction is meant to be a gradual process to limit overstressing
your child’s body.

Your child will need help daily with personal care, toileting, eating, transferring in and
out of bed, transferring from the wheelchair and walker, pin care and physical therapy.
Be willing to learn how to care for your child. Communicate with doctors and nurses
regarding your feelings about participating in your child’s care. Practice transferring
your child before the halo application. Also practice holding the weights and traction to
prevent injury.

Your child will also need emotional support and encouragement. Children will react
to being away from home. They will react to having their movements changed and
restricted. They will react to the pain felt during the first week of traction. Some
children will not want to see themselves in a mirror or a photograph. How you respond
to your child will largely shape his or her attitude toward the traction process. The
first and last weeks of traction are typically the hardest. The caregiver staying at the
hospital should prepare to support the child through these difficult times. The support
of family and friends during this time helps tremendously. Friends and family can
provide special meals, presents and cards to cheer the child, or maybe even sit with
your child so the caregiver can take a break. Have someone outside of the situation
that you can talk to about your feelings without upsetting your child. 

Parent sleeping rooms, showering facilities and laundry facilities are available in many
hospitals. Many hospitals are also near hotels that offer a medical rate and charitable
housing, such as the Ronald McDonald House.

Plan to bring some of your child’s favorite things to decorate his/her room. A favorite
blanket or stuffed animal, music CDs and movies are helpful also.

Preparing the Child for Halo Traction At Home

Seeing pictures beforehand of other children in halos may be helpful. If possible,

talk with other families who have gone through the process. Encourage your child to
ask questions and make sure those questions are answered. Make sure your child
understands the necessity and purpose of the halo traction procedure. Emphasize
the fact that the treatment is a short-term hindrance or frustration compared to the
lifetime affect it will have on their health and the degree of their scoliosis.

In the Hospital

•         Clothing: Your child will be most comfortable in loose fitting clothing. Button-
down tops work best. If your child is in a cast, elastic pants are recommended.

•         Bathing: When bathing, only baby shampoo should be used. The chemicals in
other products can react with the metal used in the halo and pins.

•         Diet: Maintaining your child’s weight during traction is important. A regular
diet may be resumed soon after surgery. Supplemental items may be used to add
calories if needed. Because the traction limits movement of the head and neck, it
will be necessary to encourage your child to take small bites and chew them well. 
Use a straw for drinking. Small, frequent meals that are nutritious and high in
calories are best.

•         Sleeping: Your child will be in traction while sleeping. A rolled towel or small
pillow can be used for head and neck support. An egg crate or foam pieces can be
 added to the hospital mattress for more comfort. The bed should also be tilted in
Reverse Trendelenberg, so the head is higher than the feet. This adds the pull of
gravity to the traction while your child is lying down.

•         Physically handling your child: At first your child may feel awkward and
unsteady in the traction. Once he or she gets used to the traction, moving around
will be easier. You will be helping your child move from a wheelchair, walker and
bed. Nurses and physical therapists will help you learn which movements are safe
for your child.

•         Pain management: Each child will experience pain in varying degrees.
Medications are used to control your child’s pain. Good pain control is crucial
to your child’s recovery from the halo application. Pain medication may also be
used at night, so your child can sleep. Rest is important to maintain strength
and a positive attitude.  Your child’s pain should decrease over time. Discuss all
pain medications and their side effects with your doctor. Many pain medications
cause constipation. Laxatives, high fiber food and plenty of fluids help counteract
this side effect. Never hesitate to communicate your concerns about your child’s
recovery with his/her doctor. Communication with your child’s doctor is crucial in
ensuring your child has a quick recovery.

When Halo Traction is Finished

When your orthopedic surgeon feels the intended outcome has been reached or that
maximum correction has been achieved, the halo (and, in some cases, the cast) will
be removed. If your child will be braced, a mold of your child’s body will be taken to
make a brace. There are many different kinds of braces with many specific purposes.     

After the brace is made, your child will wear it for approximately two weeks, while the
traction weights are systematically decreased. Frequent brace adjustments may be
needed based on the complexity of the brace.

Your child may experience some aching and discomfort during the weight decrease
and transition into the brace.  A slight loss in correction may also occur.

After the halo is removed, your child’s neck muscles will be weak and need support.
A soft, removable neck collar is suggested to support those muscles until they are
regained through physical therapy.

Before being released from the hospital, your child must feel comfortable in the brace.
(Caregivers must also feel confident about taking care of their child while in the
brace.)

Your physician will tell you how many hours per day the brace is to be worn. It is
important that those instructions be followed to maintain the correction achieved
through halo traction. Your physician will also inform you of how often to come in
for follow up visits to check the fit of the brace and how the curve is maintaining.
New braces will be made as your child grows. A brace should be worn as long as it is
successful in maintaining your child’s improved scoliotic curve. 

Brace Care

Caregivers should be taught how to properly put the brace on and take it off. Make
sure you feel comfortable doing this before leaving the hospital.
•         Bathing and skin care: The brace may be removed for bathing. It is best to wash
your child’s hair at this time as well.  No lotions, creams or powders should be used
on your child’s back. These items can irritate the skin. Alcohol can be wiped on your
child’s skin to toughen it up and prevent itching, rashes, sores, pimples and smelly
odors.

•         Clothing: Necklines may need to be larger to fit over the brace.

•         Diet: As with casts, food should be cut into small bites and well chewed, and
straws used for drinking. The brace may also put pressure on the abdominal wall, so
small, frequent, nutritious meals, high in calories are best. Some weight loss may be
expected, and supplements can also be used to help your child maintain weight and
strength.

•         Movement: Continue to follow the precautions you learned in the hospital for
lifting your child and helping him/her sit up or get out of bed.

•         Exercise: Your child may require physical therapy or some type of respiratory
therapy. Caregivers should be familiar with these exercises and how to perform them.

  
Note: This information is provided by the parents of children with infantile scoliosis to other
parents, not by physicians. It is for general informational purposes only and cannot substitute for
the advice of a medical professional. The information provided on this website should not be used
for diagnosing or treating any medical condition. ISOP disclaims any responsibility whatsoever for
the results or consequences of any attempt to use or adopt any of the information provided on
this website. Nothing on the ISOP website should be construed as an attempt to provide a medical
opinion or otherwise engage in the practice of medicine. Please consult your child’s physician for
diagnosis, medical advice, and answers to your personal questions.

The Infantile Scoliosis Outreach Program is a service of Cerebral Palsy of Colorado

801 Yosemite Street · Denver, CO · 80230
Phone: 303-691-9339 Toll-free: 866-417-4873 Fax: 303-691-0846
www.infantilescoliosis.org