When should I call the doctor?

When should I call the doctor?
Call your child’s doctor right away if he has any of
the following:
– Numbness or tingling in the extremity with the cast
– Pain that is different from what he has had before
– Pain that does not get better with medicine
– Swelling that does not get better with elevation
– Decreased or loss of movement in the fingers or toes
– Change in skin color below the cast
– Bad smell from inside the cast
– Bright red drainage on the cast
– Fever more than 100.5°F for longer than 24 hours with
no other symptoms
– A crack in the cast
– A wet cast that does not dry completely
– Something stuck inside the cast
Visit www.choa.org/fracture or call 404-785-4913
for more information.
Caring for your
child’s cast
Fracture Care Program
Your child’s cast holds his injured or broken bone
in place while it heals. Keeping the injured part
still is important to help the bone heal the right
way. This brochure will teach you how to care for
your child’s cast.
Some physicians and affiliated professionals who perform services at
Children’s Healthcare of Atlanta are independent providers and are not our employees.
©2011 Children’s Healthcare of Atlanta, Inc. All rights reserved. ORT 941271.cb.2/11
How do I care for my child’s cast?
What about itching?
Arm casts
– After the cast is put on, let it dry completely. A fiberglass cast
will take 30 to 45 minutes to dry completely. A plaster cast
takes 24 to 48 hours to dry completely.
– Do not let your child put anything inside the cast. This could
hurt the skin and lead to skin breakdown and infection.
– If your child is using a sling to support an arm, raise the wrist
higher than the elbow when your child walks or sits.
– Gently pat the cast (do not dent it) above the area
that itches.
– Use a sling only as directed by his doctor.
– The cast can be deformed or dented if it rests on a hard
surface, such as a floor or table, before it is completely dry.
Rest the cast on soft surfaces, such as a pillow or couch.
– The inside of all casts (except those with a Gore-Tex liner)
needs to be kept dry. A fiberglass cast can be wiped clean
with a damp cloth. A plaster cast can be wiped with a cloth
but should be kept dry.
How do I care for my child’s skin?
– Skin inside of the cast should be kept dry. A Gore-Tex liner
can allow the skin to get wet, but it should not stay wet. All
water should be drained from the cast. Not all casts can
properly drain. Casts that cannot drain should not have
Gore-Tex liners.
– Your child can bathe or shower only if the cast can be
kept dry.
– Cast protectors (Seal-Tight) are available at most drug stores.
– Give your child a daily sponge bath.
• Cover the cast with a plastic bag.
• Use a damp—not wet—cloth and mild soap to clean
skin you can reach with your hand.
• Dry it completely with a towel.
– Keep any rough edges of the cast covered with moleskin or
pink tape.
– Check the skin around and under the edges of the cast each
day for dry, red or irritated areas.
– Do not use lotions, oils or powder around the edges or
under the cast.
– Be sure the top end of the cast does not indent the skin when
sitting or resting. This may cause discoloration and swelling
of the extremity.
– While your child is awake, change the position of the limb
about every two hours. This keeps the cast from putting too
much pressure on the skin.
– Keep your child as cool as possible to prevent sweating.
– Change your child’s position to shift the weight of the cast.
– Use a hairdryer to blow cool air inside the cast.
Never use heat.
Sensation and circulation
Be sure the cast is not too tight and that blood can flow well
to all body parts around the cast. Every eight hours, or more
often if needed, be sure to check:
– Sensation (feeling): Touch the area above and below the cast
several times a day. Call your child’s doctor right away if he
complains of numbness, tingling or pain.
– Blood flow (circulation): Press briefly on your child’s fingernail
or large toenail several times a day. When it turns white, let
go. Call your child’s doctor right away if pink color does not
return in three seconds.
– Severe swelling: Look for swelling above and below the cast
several times each day. Some swelling is normal, but a lot of
swelling, especially with increasing pain, is not. Raise the cast
higher than the level of the heart to try and decrease
the swelling.
Check for drainage
When a cast covers a surgical wound, you should expect to
see some red or reddish-brown drainage during the first two
days after surgery. After this, drainage may be a sign of
a problem.
Call your child’s doctor right away if there is more drainage.
How can my child be comfortable with a cast?
– Have your child rest the first 24 to 48 hours. Do not let him
do anything too active, such as running, jumping or climbing.
– To prevent swelling, have your child keep the casted limb
propped on pillows above the level of the heart for one to
two days after the cast is applied.
– Have your child wiggle his fingers and toes often to increase
blood flow and decrease swelling.
Leg casts
– Keep pressure off the heels when your child is lying down to
prevent sores on the heels.
– Lying on the back: Put your child’s legs on a small pillow
or rolled towel, with the heel over the edge.
– Lying face down: Let your child’s feet hang over the end
of the mattress.
– Lying sideways: Put a thin pillow between your child’s legs.
Is it OK to sign the cast?
Family and friends may want to sign their names or draw
pictures on the cast. That is OK, but do not let them paint
over large areas. This could seal the cast so air cannot
get in and could hurt the skin under the cast.