Halo brace

Halo orthosis

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Description

A halo brace holds your child's head and neck still so that bones and ligaments in the neck can heal. Your child's head and torso will move as one when your child is moving around. Your child can still do many activities when wearing the halo brace.

There are two parts to a halo brace:

The halo ring that goes around the forehead. The ring is attached to the head with small pins that anchor it into the bone of your child's head.
A stiff vest that is worn under clothes. Four rods go down from the halo ring and connect to the shoulders of the vest.

Talk to your health care provider about how long your child will wear the halo brace. Children usually wear the brace for 2 to 4 months, depending on the injury and how fast it heals. The halo brace stays on at all times. Only the provider will take it off. Your provider will do x-rays to see if your child's neck has healed. The halo brace can be removed in the office.

Putting On the Halo Brace

It takes about 1 to 2 hours to put on the halo.

Your provider will numb the skin where the pins will be put in. Your child will feel pressure when the pins go in. X-rays are taken to make sure the brace is keeping your child's neck straight. Your provider may have to readjust it to get the best alignment of your child's neck.

Help keep your child comfortable and calm so that the provider can make a good fit.

Wearing the halo brace should not be painful for your child. When they first start wearing the brace, some children complain of the pin sites hurting, their forehead hurting, or having a headache. The pain may be worse when your child chews or yawns. Most children get used to the brace, and the pain goes away. If the pain does not go away or gets worse, the pins may need to be adjusted. Do not do this yourself. Call your provider.

If the vest is not fitted well, your child might complain because of pressure points over their shoulder or back, especially during the first few days. You should report this to your provider. The vest can be adjusted, and pads can be put in place to avoid pressure points and skin damage.

Taking Care of Your Child's Skin

While your child is wearing the halo brace, you will need to learn to care for your child's skin.

PIN CARE

Clean the pin sites twice a day. Sometimes, a crust forms around the pins. Clean the area this way to prevent infection:

Wash your hands with soap and water.
Dip a cotton swab into a skin-cleaning solution, such as hydrogen peroxide, povidone iodine, or another antiseptic your provider recommends. Use the cotton swab to wipe and scrub around one pin site. Make sure to remove any crust.
Use a new cotton swab with each pin.
You can apply antibiotic ointment daily at the point where the pin enters into the skin.

Check the pin sites for infection. Call your provider if your child has any of these signs of infection at a pin site:

Redness or swelling
Pus
Open or infected wounds
Increased pain

WASHING YOUR CHILD

Do not put your child in the shower or bath. The halo brace should not get wet. Wash your child by hand following these steps:

Cover the edges of the vest with a dry towel. Cut holes in a plastic bag for your child's head and arms and put it over the vest.
Have your child sit in a chair.
Wash your child with a damp washcloth and mild soap. Wipe off soap with a damp towel. Do not use sponges that can leak water onto the brace and vest.
Check for redness or irritation, especially where the vest touches the skin.
Shampoo your child's hair over a sink or tub. If your child is small, they can lie on the kitchen counter with their head over the sink.
If the vest and skin under the vest ever gets wet, dry it with a hairdryer set on COOL.

CLEAN THE INSIDE OF THE VEST

You cannot remove the vest to wash it.
Dip a long strip of surgical gauze in witch hazel and wring it out, so it is just a little damp.
Put the gauze through from top to the bottom of the vest and slide it back and forth. This cleans the vest liner. You can also do this if your child's skin is itchy.
Use cornstarch baby powder around the edges of the vest to make it feel smoother next to your child's skin.

Activities

Your child can do their usual activities like school, schoolwork, and nonathletic club activities.

Your child cannot look down when they walk. Keep areas clear of things that can trip your child. Some children may use a cane or walker to help keep steady when walking.

Do not let your child do activities like sports, running, or bike riding.

Help your child find a comfortable way to sleep. Your child can sleep the way they usually do, such as on their back, side, or stomach. Try a pillow or a rolled towel under their neck to give support. Use pillows to support the halo.

When to Call the Doctor

Contact your provider if:

Pin sites are red, swollen, or have pus or pain
Your child can nod their head
Any parts of the brace or vest become loose
Your child complains of numbness, changes in feeling in their arms, hands, or legs
Your child complains of new neck pain
Your child cannot do their usual non-sports activities
Your child has new difficulty walking
Your child has a fever
Your child has pain where the vest might be putting too much pressure on their body, such as at the top of the shoulders

References

Koutsogiannis P, Dowling TJ. Halo brace. [Updated 2021 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. PMID: 32491478 pubmed.ncbi.nlm.nih.gov/32491478/.

Lee, D, Adeoye AL, Dahdaleh, NS. Indications and complications of crown halo vest placement: a review. J Clin Neurosci. 2017;40:27-33. PMID: 28209307 pubmed.ncbi.nlm.nih.gov/28209307/.

Niu T, Holly LT. Principles of orthotic management. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

Warner WC. Pediatric cervical spine. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 43.

Review Date: 10/25/2021

Reviewed By: Luc Jasmin, MD, PhD, FRCS (C), FACS, Department of Surgery, Johnson City Medical Center, TN; Department of Surgery St-Alexius Medical Center, Bismarck, ND; Department of Neurosurgery Fort Sanders Medical Center, Knoxville, TN, Department of Neurosurgery UPMC Williamsport PA, Department of Maxillofacial Surgery at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Health Content Provider

06/01/2025

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