Spica cast What is a spica cast?

Spica cast
What is a spica cast?
A spica cast is used to keep the lower body
and one or both legs from moving. The cast
starts just below the chest, covering the hips
and part or all of the legs. Made of plaster
or fiberglass, it is used to treat fractures of
the hip or leg or to correct hip problems.
Your child’s skin is protected with a smooth
lining material before the cast is applied.
What can I expect after the cast is
applied?
Fiberglass casts dry within a few hours.
Plaster casts take 1 to 3 days to dry
completely. Drying times vary with cast
size and type. Handle the wet cast with your
palms, not your fingers, to avoid denting it.
A child who has had anesthesia may sleep
more than usual in the next 24 hours.
How do I care for the cast?
If the cast has a bar between the legs, do not
use the bar to lift or turn your child.
Keep the cast as clean and dry as possible.
Because the child must have anesthesia to
have the cast put on, it will not be replaced
if it is dirty or smells bad.
Do not let the cast get wet. A wet cast will
irritate the skin, soften, and fail to hold the
leg and hip in the correct position. If it gets
damp, dry it with a hair dryer on the coolest
setting.
Check the cast daily for cracks, dents,
softening, drainage, or changes in tightness.
Do not apply paint to the cast or keep it
covered with plastic. These materials stop
air from getting through the cast.
If the cast is made of plaster, you may clean
it with a small amount of toothpaste or dry
white cleanser (Ajax® or another brand) on a
slightly dampened cloth. Rub gently to
remove the dirt. Dirt on fiberglass casts can
be washed off with a damp cloth. Dry it
well with a hair dryer set on cool. Never
use a hair dryer on a hot setting because it
can burn the skin.
Any rough edges of the cast can be covered
with pieces of plastic tape, or a fabric tape
called moleskin, cut into petal shapes. Silk
or waterproof tape around the groin opening
can also help keep the cast clean. You can
clean the tape with a damp cloth. Change
the tape as needed. Do not put tape on a
fiberglass cast.
For children who wear diapers:
Keeping urine and stool off the cast can be a
challenge!
•
Position at all times with head and back
higher than hips; otherwise urine will
flow back into the cast. This is
especially important at night.
•
Check the diaper for wetness every 1 to
2 hours and change it as needed. Clean
and dry the skin after each change.
•
Always use disposable diapers. Use
smaller diapers than usual, tucking them
between the child’s skin and the cast.
You can cover the smaller diaper with a
larger diaper to hold it in place.
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Do not place the diaper over the cast
because the urine from the wet diaper
will soak into the cast.
•
Put sanitary napkins or pads inside the
diaper to absorb more urine, especially
at night.
•
If your child gets a diaper rash, turn on
tummy and leave the back of the diaper
open. See the education sheet, “Diaper
rash.”
For children who are toilet trained:
How to use a bedpan
1. Turn your child to the side opposite the
fracture or surgical site and lift the legs.
Tuck a waterproof protector (plastic
sheet or disposable diaper) inside the
back edge of the cast and fold it over the
back of the cast to protect it.
How can I care for my child?
Pain
Children may have discomfort if they had an
incision or from the new position of their
legs. Give medicine to relieve pain as
prescribed.
Eating
Constipation may become a problem for
your child because of the decrease in
activity. Encourage drinking more fluids
especially during hot weather. Your child
should eat more fruits and vegetables.
Offer smaller, more frequent meals to avoid
the discomfort of a full stomach in a rigid
cast.
2. Place the bedpan under your child’s
bottom.
Keep the cast covered with a towel or
blanket when your child eats, to prevent
crumbs from getting into the cast.
3. Position your child’s head and back
higher than the hips; otherwise the urine
will flow back into the cast. (Try using a
pillow under the head and shoulders.)
Place your child in as upright a position as
possible to avoid problems with swallowing.
4. For girls, a “wick” can be made using 4
or 5 pieces of toilet paper to catch the
stream of urine and direct it into the
bedpan.
5. Clean the skin and wipe dry when
finished.
6. Turn or lift your child (he or she may be
able to do this) enough to allow removal
of the bedpan. Be careful not to spill.
7. Remove the waterproof protector.
Children who were recently toilet trained
may regress (temporarily go back to earlier
stage of development). They may need a
diaper at night to prevent soiling the cast.
Skin care
Give your child a daily sponge bath with a
damp cloth, or you can use diaper wipes. Be
careful to keep the cast dry. If possible,
separate the toes after the bath to better
allow air-drying. If the skin between the
toes remains damp, apply rubbing alcohol or
witch hazel with cotton swabs (such as
Q-Tips®).
Check circulation twice a day. Toes should
be warm and normal in color. Your child
should be able to wiggle them easily.
Check the skin twice a day. Press on the
skin around all the cast edges to look and
feel for reddened areas, sores, or objects
inside.
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Do not use lotion or powder inside the cast
or on the skin at the cast edges. Powder can
cake, and lotion will soften the skin, making
sores more likely.
Heels and elbows may get sore from
changing position or moving around in bed.
Have your child wear long sleeves and socks
to protect these areas.
Do not let your child put anything into the
cast. Even a small object inside the cast can
cause sores.
Itching is very common. It often comes and
goes. To lessen itching, keep the area inside
the cast as dry and cool as possible.
Sometimes distraction or blowing cool air
under the cast may help.
Do not insert anything into the cast to
scratch the itch. Sometimes rubbing inside
with finger tips (not finger nails) will help.
For severe itching, check with your doctor
about a medicine to relieve it.
Positioning
Change positions (back, front, sides) every 1
to 2 hours while awake, for comfort and to
prevent pressure sores. Changes can be
small, such as tilting less or more, to shift
the pressure to another area.
A physical therapist may help you learn how
to correctly lift and move your child.
Practice lifting and moving your child while
in the hospital. To protect your back,
remember to keep your back straight, bend
your knees and carry the child close to you.
If the cast has a bar between the legs, do not
use the bar to lift or turn your child.
Support your child’s upper and lower body
when turning. Use pillows for propping and
cushioning when your child is on his or her
back, stomach, or side.
When child lies on the back, especially if the
heel is covered by the cast, keep pressure off
the heels by placing a pillow or rolled towels
under the lower legs. When on the
stomach, put the cushioning under the
ankles to keep pressure off the toes.
Activity
Your child will become more active each
day and may learn to move around without
help. Place a mattress or blanket on the
floor as a play area. Keep toys within the
child’s reach. Use a tray for meals or play.
For more ideas to help your child, see the
education sheet, Mobility changes: Helping
children cope.
Encourage your child to wiggle the parts of
the legs that are not in the cast (toes, foot,
ankle, and the leg that is not casted), to keep
blood moving and help keep swelling down.
To increase your child’s mobility, a small
child may use a wagon. Older children can
use a dolly, like those used by mechanics
under cars. The child can lie on his or her
stomach on the dolly and move around using
the arms and hands.
You may want to rent a hospital bed,
reclining wheelchair, or other special
equipment from a hospital supply vendor.
Please talk with the doctor or nurse. When
using the wheelchair, make sure your child
is properly secured.
Children in a spica cast require special car
seats or restraints for proper transportation.
The restraint must fit correctly and meet the
federal standard for child safety devices.
Your nurse will help you obtain a restraint.
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Carefully read the instructions that come
with the restraint to assure you are using it
properly. Information is also available at:
The skin will be tender. If it itches, rub
gently with fingertips. Avoid scratching.
•
Children’s Family Resource Center
Minneapolis
(612) 813-6816
St. Paul
(651) 220-6368
Talk with the doctor about how soon your
child can stand and walk, and if any pain
should be expected.
•
www.seatcheck.org or 1-866-SEATCHECK
When should I call the clinic?
•
www.carseatsmadesimple.org
Call the clinic if:
For a child who weighs more than 40
pounds, transporting the child creates a
special challenge. You must find a vehicle
large enough to transport your child safely.
Clothing
Use long dresses, gowns, or long T-shirts.
Pants or gym shorts can be slit at the inside
or outside seam. Apply Velcro®, ties, or
snaps to close it over the cast. You may
want to use extra-large clothes.
•
the cast looks tight and the skin is
swollen at the cast edges
•
toes are reddish, bluish, cold, or swollen
•
numbness or tingling in the feet or legs
•
something has dropped in the cast and
you cannot get it out
•
the cast has cracks or is getting soft
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temperature higher than 101° F
•
unusual drainage on the cast or an
unexplained smell
•
A sock or knit cap can be worn over the toes
to keep them warm, and to keep dirt and
gravel from getting into the cast.
skin around the cast edges has redness
that does not go away within 30 minutes
after changing positions.
•
Dress your child lightly in hot weather to
prevent overheating.
you notice new signs of skin irritation
such as rashes, sores, blisters, or bruises.
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pain does not go away
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unexplained fussiness
What can I expect when the cast is
removed?
A cast cutter will be used to remove the cast.
Instead of spinning around, the blades
vibrate side to side and make a loud buzzing
noise. Your child will feel the vibration and
a warm sensation. The cutter will not cut
your child, but it will feel like the skin is
being touched.
After the cast is off, the skin looks scaly.
Your child’s arm or leg will look thinner
than usual because of the lack of movement.
Questions?
This sheet is not specific to your child, but
provides general information. If you have
any questions, please call clinic.
For more reading material about this and
other health topics, please call or visit the
Family Resource Center library, or visit our
Web site: www.childrensmn.org.
Children’s Hospitals and Clinics of Minnesota
Patient/Family Education
2525 Chicago Avenue South
Minneapolis, MN 55404
5/08 Copyright
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