Taking care of a child in a spica cast can be a difficult experience for both you and your child. This section will help you care for the spica cast, avoid common mistakes and problems, and decrease overall stress and anxiety. It is important to realize that, while it may seem counterintuitive, your child is quite stable while in the cast.
Most spica casts today are made of fiberglass. A fiberglass cast usually dries quickly after it is applied. They are usually completely dry about one hour after application, and fiberglass casts weigh much less than plaster casts. To avoid skin problems, it is extremely important that the cast be kept as dry and clean as possible. Keeping the cast clean and dry is challenging for all caregivers. To help prevent skin breakdown, the spica cast is lined with a special liner. This helps protect the cast and padding from becoming soiled from moisture. You may want to put something over the cast (such as an older t-shirt) as the fiberglass can be rough and may damage clothing or other materials.
Keeping the cast clean and dry
This is usually the most difficult aspect of caring for a child in a spica body cast. For infants and toddlers, diaper and skin care can often be a challenge. The general rule of thumb is to keep the cast as dry as possible. If urine or bowel movements are allowed to remain in contact with the skin (such as under a wet or soiled diaper or beneath the edges of the cast), diaper rash and subsequent skin breakdown are likely. For infants and toddlers, diapers will need to be changed very frequently (about every two hours during the day and every three to four hours at night). A smaller diaper or incontinence pad is usually placed under a larger diaper which then goes over the spica cast. You should experiment with various pads, newborn diapers, and incontinence pads until you find the right one for your child. Every child’s urinary and bowel routines are different. It is generally a good idea to allow the diaper area to be open to air for a few minutes each day. This will decrease the possibility of diaper dermatitis (rashes) and skin irritation.
What do I do if my child’s skin becomes reddened or irritated?
This is a very common problem with hip spica casts. The diaper area tends to be the most common area of skin irritation and breakdown. This is usually caused by moisture from urine or stools that irritate the skin. You should definitely check the skin at least two to three times a day for any redness or areas of irritation. Positioning and frequent diaper changes are the key to avoiding skin irritation. It is always much easier to prevent skin irritation or sores than to heal them. If skin redness or irritation develops, the general rule of thumb is to expose the affected skin to the air. It is not a good idea to put lotions, creams, or powders down the cast, as this will often make the skin condition worse. A hair dryer on a cool setting (never hot or warm) held at least ten inches from the cast might help the damp portion to dry.
If itching is a problem, first try the hair dryer on cool setting. If that does not help, try repositioning. In general, the itching will decrease as your child becomes accustomed to the cast. Never stick anything down the cast to scratch the skin. This will often lead to skin irritation and could also cause a secondary skin infection. If you find that your child has put something down the cast, you should contact Dr. Paley’s office as soon as possible.
Should there be any changes in my child’s diet?
As always, nutrition is very important. Feeding your child fresh fruits, vegetables, and whole grain breads (increasing fiber) will often help prevent constipation. It is also important to drink plenty of water and juices to prevent dehydration. The first few weeks in a spica cast are generally not a good time to introduce new foods in your child’s diet. New foods have a higher likelihood of causing loose stools or diarrhea. If this occurs, diaper changes will need to be made more frequently and skin care becomes even more important. If the cast gets soiled, or your child has diarrhea that is in the cast, please contact Dr. Paley’s office immediately.
If your child complains of a tight feeling in the cast, you may want to try giving smaller, more frequent meals. To prevent food from falling down into the cast while eating, a large shirt or towel should be used to cover the front of the cast.
What should my child wear with the spica cast?
The spica cast will add extra bulk, so larger clothing will often be necessary. Your child will be most comfortable if kept cool. Sweating under the cast can cause itching. Your child may not need much clothing over the spica cast, especially in the summer months. For the majority of patients, a t-shirt, nightshirt, or loose dress may be the only necessary clothes. In addition, a larger sized one-piece outfit may be useful for infants and young toddlers. Young children may want to wear clothes that cover more of the cast. Large t-shirts, elastic pants, pants that button up the side, and loose dresses can usually be worn over the spica cast. Clothes can also be adapted by cutting the seams as necessary and sewing in Velcro. Again, it is a good idea to experiment with several different types of clothes and see which one works best for you and your child.
How do I clean my child in the spica cast?
You should give your child a sponge bath daily while they are in the spica cast. Be very careful not to get the cast wet. The skin around the spica cast should be washed with gentle soap and water. Do not put anything under the cast, including lotions, powders, or oils. Lotions can often macerate and soften the skin, causing skin breakdown. Powders have a tendency to cake under the cast and again lead to further skin irritation. While cleaning the skin daily, it is a good idea to check carefully beneath the case edges for areas of skin irritation, redness, blistering, open areas, or pressure spots. It is often helpful to use a flashlight to look down cast edges for any area of skin irritation.
Turning and positioning your child in a spica cast
While in the hospital, you will learn how to turn and position your child. Frequent position changes and turning will often help prevent skin irritation and skin breakdown. Your child should be positioned frequently, usually about every two to three hours during the day. Turn your child on their back, sides, and stomach. Keep heels free of pressure by placing a rolled towel or small pillow under the calf of the leg. Your child may sit propped up with cushions or pillows. Make sure that your child is secure and cannot roll or fall. Strollers, beanbag chairs, and wagons can usually be adapted so that your child can play and eat in different positions throughout the day. Small children can be pulled in a wagon, while older children will often find a reclining wheelchair or stroller more comfortable. It is important to provide activities for your child throughout the day. To allow for some independence, place things within easy reach so your child can get them safely. Children are very resourceful and they will soon find their own way of moving about. Bringing your child for walks or into an area with the family will help avoid isolation. To provide comfort, you should be encouraged to hold infants and small children when possible. Do not allow your child to play with very small toys that can get lodged inside the cast. Remember, the internal hardware inside your child is very strong. It may feel that not a lot is holding them together, but they are very stable.
What do I do about a car seat while my child is in a spica cast?
All newborns, infants, toddlers and children should be properly restrained even when in the spica cast. It is often possible for your child to fit into their regular car seat in the cast. It is recommended that you bring the car seat up to the inpatient floor after surgery to determine if it will accommodate your child in the spica cast. Some patients will not fit into their standard car seat while in the cast. If it is not possible for your child to fit into their regular car seat, it may be necessary to purchase a larger car seat for your child. There are specially designed car seats made specifically to accommodate a spica cast. There are also safety harness straps available from the hospital.
Please contact Dr. Paley or one of his physician’s assistants if you notice any of the following in regards to the spica cast:
- Any breaks or blisters of the skin under the cast or around cast edges.
- Toes are pale or blue in color and or feel cold. If your child is unable to wiggle toes but was able to do so before the cast was applied. If your child complains of tingling or numbness of the toes.
- Your child has a persistent fever over 100° Fahrenheit/ 38° Celsius, which cannot be explained by a cold, ear infection, or other viral illness.
- Any softening, breaking, or cracking of the cast.
- Prolonged, unexplainable fussiness or irritability.
- There is drainage you have not seen before or if there is an unpleasant or foul odor coming from the cast.
- The cast gets wet or soiled with urine or stool.
- Your child has new pain that does not get better with pain medication or with the comfort measures explained above (position changes, etc.).
- Something falls into the cast and gets stuck.
- The cast is broken or damaged in any way.
- Your child complains of excessive pain or increased pain.
- The cast feels too tight and feeling does not improve after elevating the limb.
- There is persistent numbness or tingling of the limb.
- Your child experiences pain in one place under the cast, and changing positions does not bring relief.
- The limb continues to swell after elevating it.
- Check the circulation of your child’s foot each day. Gently press the toes and watch the return of blood flow. The toes will turn white and then quickly return to pink if the blood flow is good. This is called blanching. If the toes are dark and cold and do not blanch (white to pink), call Dr. Paley’s office immediately.
The caregiver needs to be extra careful when moving a child who has a cast. You will be provided specific positioning instructions for your child prior to discharge. Use good body mechanics to avoid injury to yourself or your child. Also be aware of any restrictions or limitations your child may have. Children often have difficulty sleeping as they adjust to the cast. Depending on their age, your child may be more comfortable propped up in bed.
What to do with a spica cast
- Encourage your child to move fingers and toes frequently to reduce swelling and prevent stiffness.
- Keep the cast as clean as possible.
- Elevate the casted limb on a pillow and apply ice to reduce swelling.
- Inspect the skin at the cast edges and beneath the cast. Look for any changes in temperature, color or texture.
- If the lining of the cast gets wet it will irritate the skin. Use a blow dryer set on COOL to blow air into the cast until the padding is dry. Never use a blow dryer on a warm or hot setting. Air that hot can burn the skin.
- Apply moleskin around the cast edges to protect the skin.
What NOT to do with a spica cast
- Never get the cast wet.
- Never cut a hole in the cast or split it open.
- Never use objects such as a pencil, ruler, toothbrush, or food items to scratch underneath the cast. Such items can get stuck inside the cast and scratching can cause severe skin damage.
- Do not break off rough edges. They can be lightly sanded down with an emery board until smooth and moleskin applied around the edges.
- Never remove the cast yourself without permission from Dr. Paley.