Hip dysplasia: Caring for your child in a body (spica) cast
How do I care for my child's spica cast?
Properly caring for your child's cast includes allowing it to dry properly, keeping it clean, preventing infections and other problems, and knowing when to call your doctor. You should also be able to position your child properly in the cast.
Drying the cast
If your child's cast is made of plaster, will likely need time to dry after you are home. Turn your child at least every 2 hours for the first 24 to 48 hours to prevent uneven drying of the cast. If you place a fan in your child's room, the cast may dry faster. Don't use heat to dry the cast, because the outside will dry before the inside and may burn your child. When you tap the cast and hear a hollow sound, it is dry.
Keeping the cast clean and dry
Spot clean the cast and do your best to keep it dry. But realize that the cast may get dirty and wet on occasion.
Focus on taking preventive measures and cleaning the cast whenever necessary.
- If your child wears diapers, use a smaller size than you normally would and use only disposable diapers. Cut the adhesive tabs off the diaper so that they won't irritate your child's skin, and tuck the diaper under the cast beginning at the child's rear and moving toward the front. The plastic side of the diaper should face the cast; the absorbent side should be next to your child's skin. Change the diaper as soon as possible after your child urinates or has a bowel movement. At night, add an extra smaller diaper, sanitary napkin, or adult incontinence pad inside the diaper.
- If you can lift your potty-trained child, help him or her to use the toilet. Try tucking a sheet of plastic food wrap under the back edges of the cast to help guide your child's waste into the toilet. Remove the plastic and throw it away each time after your child has finished using the toilet. (Do not flush plastic wrap down the toilet.) Be sure the skin is clean and dry after your child uses the toilet.
- Use a bedpan for a bigger child. Put your child in a semi-sitting position, in which the torso and head are up higher than the lower body. Gently turn your child onto one side and slip the bedpan beneath his or her bottom. After you return him or her to the semi-sitting position, adjust the bedpan as needed by locating it between your child's thighs. Make a "wick" from toilet paper for girls when they urinate. Roll some sheets of toilet paper and place them between the genital area and bedpan. This helps the urine flow into the bedpan in a controlled stream. Be sure the skin is clean and dry after your child uses the bedpan.
- Clean off heavily soiled areas of the cast and reduce odors. You can use a damp cloth, with or without cleanser, to wipe dirty areas on a fiberglass cast. Scrubbing toothpaste onto soiled areas can also help to get rid of odors. Use a cloth with as little water as possible to clean a plaster cast. Odor strips, such as those used in the shoes, can be taped onto the outside of the cast.
- Dry the cast if it gets wet by using a hair dryer on a low, cool setting. Keep the hair dryer about 18 in. (45.7 cm) away from your child's skin.
- Give your child a daily sponge bath. Take care not to get the cast wet. Use a damp cloth and clean your child's exposed skin as well as under the edges of the cast. Remove small crumbs or other particles from beneath the cast if you can do so easily. Do not poke underneath the cast with any objects to try to get anything out of the cast.
- Place your child's clothing over the cast to prevent food or small toys from getting inside it.
Positioning, movement, and comfort
Keep your child safe and comfortable by using basic care techniques.
- You can apply moleskin padding to the edges of the cut-out open area around your child's genitals and bottom if these hard edges irritate or hurt your child's skin. Cut 4-inch pieces of moleskin. Place one end of a piece under the inside edge of the cast. Wrap the other end up onto the cast and tape it in place. No tape should be touching your child's skin. Partially overlap the pieces until you have made a soft, padded edge all around the openings of the cast. See a photo of a spica cast with padded edges
.
- Check for swelling. Your child's toes should be pink and warm (not hot). He or she should be able to wiggle them and feel them being touched.
- Change your child's position every 2 to 4 hours. Regular movement helps to relieve pressure areas under the cast to help prevent irritation and sores from developing. Occasionally, put your child in a semi-sitting position by propping his or her head on pillows or with a beanbag chair.
- Never move or lift your child using the crossbar of the cast. This type of movement can harm the cast or disturb your child's hip placement.
- Prevent pressure sores by keeping your child's feet off flat surfaces, such as the floor or bed mattress, for long periods. Place a pillow, rolled up towel, or other soft object:
- Under the top front of the ankles while your child is lying on his or her stomach.
- Beneath the ankles and under the calf of the leg while your child is lying on his or her back.
- Move your child with care. Bend your knees and keep your back straight when lifting your child. As you lift, support the weight of the cast with one arm cradled around your child's shoulders and the other around his or her buttocks. When two people move your child, one person lifts under the shoulders, the other lifts under the legs. Lift together on the count of three.
- Provide comfortable clothing. Your child can wear oversized shirts, skirts, and dresses over the cast after it is dry. You can adapt clothing that goes over the legs and torso, such as shorts or pants, by cutting the side seams. You can then apply snaps or stick-on strips, such as Velcro, to the seams. The sides can be attached to each other or to the sides of the cast.
Your child needs physical contact with you, especially while he or she is in a cast. As long as you make sure to take basic safety measures, you can and should continue to hold, interact with, and provide stimulating activities for your child.
Encourage your child's involvement with your family.
- Move your child around to different areas of the house throughout the day. Try padding a wagon or stroller with pillows and blankets to move your child around the house. Older children can use a wheelchair with an adjustable back, which you can rent from a medical supply house or hospital. You may want to try using an outdoor reclining lawn chair to move your child around in your home or yard.
- Go for walks with your child. Many strollers are made with adjustable backs to recline as needed. Make sure your child is secured with safety belts or straps.
- Go for car rides. Your young child should always stay in the back seat and in a car seat. Depending on your child's leg positions, he or she may need a specially designed car seat. Ask your doctor about where to buy or rent one. Usually they are available through hospitals or medical supply houses. Older children may need to be positioned and safely secured lying down in the back seat.
Knowing when to call the doctor
Keep a constant watch on your child and the condition of the cast. Although you should call your doctor any time you have questions, talk to him or her right away whenever your child:
- Shows signs of pain or discomfort, such as crying or fussing for unknown reasons. An older child may complain of pain or burning in a certain area under the cast.
- Is vomiting or has a fever higher than 101.5°F (38.6°C).
- Itches continuously or develops other signs of irritation, such as redness, itching, blistering, or sores. Look at your child's skin around the edges of the cast every day. Use a flashlight to look beneath the cast's edges.
- Has oozing from underneath the cast.
- Develops swelling.
Also call you doctor any time the cast:
- Has anything fall into it that becomes stuck.
- Develops a bad smell.
- Has worn, cracked, soft, or loose spots.
Test Your Knowledge
The spica cast can be washed regularly in a bath.
I need to let my child rest and should only interact with him or her when absolutely necessary.
I should call my doctor whenever the cast becomes wet or soiled.
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| Author: | Shannon Erstad, MBA/MPH | Last Updated: May 15, 2007 |
| Medical Review: | Michael J. Sexton, MD - Pediatrics Thomas S. Renshaw, MD - Orthopedics | |
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