About The Cast

A hip spica cast is needed after a fracture for a congenitally dislocated hip or after surgery around the hip or upper leg. Your child has been placed in a spica cast to completely immobilize the pelvis and one or both legs. The hips and legs must be kept in a certain position to prevent any movement so the bones or tendons can heal properly.

Handling the cast may be a bit awkward at first, but you will quickly become accustomed to it. Continue to hold/hug your child as much as possible. The closeness and touching will soothe him/her. Keep your child involved with the rest of your family and friends.

Care Of The Cast

The cast is made of plaster of Paris with a soft cotton lining next to the child's skin. It takes 24 hours for the cast to dry. While the cast is drying, it is important to keep the cast uncovered to speed up the drying process.

Keep the cast clean and dry. If the cast becomes wet from liquids or urine, it will absorb the moisture and odor.

A small amount of baking soda or baby powder can be wiped into the soiled portion of the plaster cast to help it look and smell cleaner.

A hair dryer on a cool setting (never hot) and held at least 12 inches from the cast will help the damp portion to dry. Leave the cast open to air until it is dry.

Line the edges of the cast with moleskin "petals" when dry. If you do not overlap the petals, it will be easier to change them when they become soiled. These petals will prevent the cast edges from irritating your child's skin and help keep the cast intact.

Younger Child:

Use of the U-Board for naps and sleeping during the night is recommended.

Safety: When carrying your child, always support the child under the cast. Do not pick up the child under the arms or by the spreader bar (if there is one).

• Secure the child carefully with belts and snaps when in a wheelchair, car seat, U-Board, highchair, stroller, etc.
• Use a car seat for traveling.
• Do not leave your child unattended. It is possible for your child to turn over or "scoot" off in cast. The weight of the cast can cause the child to easily lose his or her balance.

Older Child:

• A seat belt should be worn when in the wheelchair.
• If the child does not understand safety instructions, he or she should not be left unattended.
• The most appropriate method of transportation will be discussed by the Primary Nurse before the child leaves.

Clothing

Casts add extra bulk, so larger clothing will be necessary. Also, to keep your child warm, put clothes such as T-shirts and booties on the uncasted portions of his or her body.

Younger Child:

• Socks or booties help keep feet warm.
• Onsie T-shirts work well to secure the diaper in proper position.
• Long adult tube socks (with toes cut off) can be pulled up over the legs of the cast for crawling. It protects the cast as well as your floors.

Older child:

• Loose clothing, such as sweat pants or oversized shorts, is the best.
• Alter pants by cutting along the seam on the side of the pant legs. Then the child can be easily rolled into the outfit.

Diapering

Line the diaper area of the cast with plastic strips. These may be taped onto the cast when thoroughly dry. The plastic may be washed daily or replaced when soiled.

Tuck the diaper into the diaper area. A sanitary napkin or incontinent pad (such as Serenity) can be placed inside the diaper to absorb the extra urine.

Change the diaper frequently and cleanse skin carefully in the diaper area with baby "wipes" or mild soap. Cloth diapers should be changed more frequently then disposable and should be placed inside a disposable diaper.

Allow the diaper area to be open to air for a few minutes each day. This will decrease the possibility of rashes and skin irritation.

Younger child:

• Breastfed babies tend to have loose stools. For this problem, use unsterile rolled cotton. This cotton can be tucked into the back of the cast and removed when soiled.
• The felt strip in the back portion of the cast should be changed when soiled with urine/stools. This can be machine washed and air dried for reuse.

Skin And Body Care

Keep skin clean and dry. Toes should always be pink and warm. Give your child sponge baths. Do not immerse the child in water while he/she is in the cast. Small amounts of lotion may be used on exposed portions of the body. Do not put lotion on the skin near the cast edges.

Groin areas tend to be damp. Wipe a small amount of baby powder onto this area. Excessive amounts of powder can clump together, causing skin irritation. Sometimes the skin under the cast will feel itchy. Children are often tempted to put forks, food, or other items in the cast. Keep all objects outside of the cast to avoid scratching the skin. Call your physician if an object is stuck in the cast.

Some hints to make the itching more tolerable are:

• Blow cool air from the hair dryer into the cast.
• Gently rub the skin around the cast edges.

Some casts are made of fiberglass. Because those edges tend to be rougher, the stockinette is pulled up and over the edges of the cast.

If an area of the skin is becoming irritated or broken down, the physician should be notified immediately.

Positioning
Change the child's position frequently (every 2-4 hours during the day and at least every 6 hours at night). Children can be on their stomach, back or side. Make sure all extremities are well supported. Always use safety straps on younger children.

Younger Child:
Strollers, bean bag chairs, wagons and highchairs can be adapted so your child can play and eat in different positions throughout the day. Be sure your child is securely restrained in this equipment. Do not leave your child unattended while in any adaptive equipment. The playpen is a safe place for play. Your child can also be placed on a rug or blanket on the floor, in a safe area of the room. Place toys within your child's reach.

Older Child:
If a trapeze or bed with side rails is available, encourage the child to use it during position changes. Keep activities within the child's reach.

Call The Doctor If You See:

• Any breaks or blisters of the skin under the cast or around the cast edges;
• High temperature of at least 100 degrees orally or above 101degrees rectally, which cannot be explained by a cold or ear infection or some other illness;
• Any softening, cracks or breaks in the cast;
• Prolonged, unexplainable fussiness or irritability;
• Toes which are bluish, reddened, swollen, very hot or very cold;
• Any complaints of numbness or tingling;
• Unusual odors coming from the cast;
• If the child is unable to move toes, but was able to do so before the cast was applied.