Much like a fiberglass cast holds a broken arm or leg in place, a "halo" with vest holds a child's head and neck in place after a spinal injury so that spinal bones, or vertebrae, can heal.

This brace lets children who have been injured or are recovering from spinal surgery walk, move around, and participate in many regular activities instead of being confined to bed rest while they recover.

What's a Halo?

The halo gets its name from the metal ring that surrounds the head, which looks like an angel halo. The ring — which keeps the head fixed in a level, forward-facing position — is attached to the head with small pins that hold it in place. To keep the halo from moving in any direction, vertical rods connect it to a person's shoulders, where it's fastened to a vest. The vest (usually made of plastic or plaster, like a cast), wraps around the neck, over the shoulders, and down to the belly button. It's lined with soft material to make it more comfortable and prevent skin irritations.

When properly fitted, a halo brace keeps a child's head and neck completely still, even during movement.

Is a Halo Painful?

While the brace may look painful, it should not cause any pain to the head, neck, or shoulders. Some kids do experience a little forehead pain or a headache, particularly while eating, but this usually goes away soon after a child has gotten used to wearing the brace.

If the pain continues or gets more severe, the pins that secure the halo might need to be adjusted. Never attempt to adjust the pins or rods on your own, or to remove the vest. If your child is experiencing pain or discomfort, call the doctor right away. Also seek medical care if the area around the pins (or anywhere else) becomes red, swollen, or irritated.

How Long Is a Brace Worn?

Depending on the severity of a child's injury and the duration of recovery, the brace may be worn for a couple of months. Your doctor can tell you how long your child needs to wear a halo brace.

Are Some Activities Off Limits?

Many kids with halos can continue their everyday activities, like going to school, doing schoolwork, and participating in extracurricular clubs, as long as they're feeling up to it and the doctor says it's OK.

Your child's doctor will tell you what activities your child should avoid while in a halo brace. Sports will have to be put on hold for a while, and running — which can increase the chance of a fall — will have to be avoided, as well. Other activities to limit:

• any sort of quick or jerky movements, like jumping or dancing
  
• pulling or tugging on the halo or attached bars
  
• bumping the halo into other objects (when avoidable)
• getting the vest or vest liner wet

Since kids with a halo cannot look down while walking, it's important for them to take precautions while walking and moving about. Clear the floor of anything that might cause your child to trip or fall, and offer assistive devices, if needed. For example, a cane or walker might give your child the confidence to get around on his or her own, rather than relying on you, a family member, or friend to help with walking.

How Will My Child Sleep at Night?

Let your child sleep in whatever position feels most comfortable. Usually, this is the position used prior to getting the halo brace. Kids with halo braces can sleep on their backs, stomachs, or sides. Some prefer to sleep on a slight incline, with pillows supporting the brace from underneath. You also can use pillows to support the back, stomach, or side as your child finds a comfortable sleeping position.

Can My Child Take a Shower?

No. Showers are not permitted, since water can damage the halo or vest. But kids can take a bath as long as there's a shallow amount of water in the tub and it does not wet the vest. However, since it can be difficult to get kids in and out of the tub safely, most parents opt to manually bathe their child with a damp towel.

During bathing, have your child sit in a chair while you cleanse the arms, legs, hands, head/neck, and feet using a mild soap and damp towel. Avoid using sponges that trap water and can easily leak onto the halo brace. Protect the edges of the vest with a dry towel or plastic bag (which can also be worn over the vest; cut a slit for your child's head and arms).

To shampoo hair, lay your child's head over the edge of the tub or sink. Small kids can lie on the kitchen counter with their head over the sink. Wash and dry as usual, protecting the vest and liner from any moisture. If you prefer, a dry or powder shampoo (that requires no water at all) also can be used to cleanse and condition the hair.

If, at any time, the skin beneath the vest becomes wet, dry it with a hairdryer set on "cool."

Caring for a Halo

Besides keeping the halo vest free of any moisture, it's also important to keep the site of the pins clean to avoid infection. Your doctor will give you specific instructions for cleaning the pin areas, including what type of cleaning solution to use. Run a cotton swab along the pin and surrounding area, and be sure to use a new swab for each pin to avoid spreading any germs. If you notice that any pins have come loose, call the doctor right away.

Caring for the Vest

Some vests come with removable liners that are washable. Buying more than one liner means you can wash one while your child wears the other. If you only have one liner or if it is not washable, use a cornstarch-based baby powder around the edges of the vest to keep your child and the liner cool, dry, and comfortable.

To clean a non-washable vest liner, try using a long piece of surgical gauze dipped in witch hazel. Wring out the gauze so that it is barely damp. Then, feed the gauze under the edge of the vest and liner and, with one end in each hand, slide back and forth. This can also be done in case your child's skin becomes itchy.

The liner should always be worn against the skin, with the vest immediately over it. Regular clothes can be worn over the vest, although they may need to be adapted to fit over the halo rods.

You will be instructed on how to switch the liner.

Helping Your Child Cope

Managing any sort of physical challenge, however temporary, is difficult for anyone — especially a child or teen who is dealing with the pressures of growing up and fitting in with peers. Kids who have to wear a halo brace may feel angry, frustrated, and even depressed, especially if they're no longer participating in activities with their friends.

In the meantime, find ways to maintain normalcy in your child's life. Many kids can continue going to school with a halo and, if not, they can do schoolwork at home or with a tutor. If your child does go back to school, a nurse or social worker from the doctor's office may be able to visit your child's classroom to talk about the halo. This might make your child feel more comfortable about wearing the brace in school.

If you're worried about your child going out with friends, encourage them to come over to your house so that you can supervise.

In time, your child can return to his or her favorite activities. But if your child continues to feel angry or depressed during recovery, consider talking to a school psychologist or counselor, who may be able to help your child cope and look ahead to better days.

Reviewed by: Colleen P. Ditro, MSN, CRNP
Date reviewed: August 2010