North
N
Jersey Ortho
opaedic Institute
Rutgers,
R
The State
e University of Ne
ew Jersey
140 Bergen Streett, D1610
Newark,
N
NJ 07101
973-972-2150
S
South Orange Ambulatory Center
H
Hackensack Mediccal Plaza
O
Overlook Medical Arts Center
S
Saint Barnabas Medical Center
Divvision of Pediatric
P
O
Orthopaediics
Sanjee
ev Sabharwa
al, MD
Flo Ed
dobor-Osula
a, MD
Emily
y McClemens, PA-C Miche
ele Gilliland, PA-C
Phone
e: (973) 972-0246
PEDSORTHO
[email protected]
TGERS.EDU
SPICA
A CAST
T CARE
Thi
is inform
mation te
eaches you
yo about
t cast ca
are, bath
hing and
d skin ca
are,
dia
apering, positio
oning yo
our chil
ld, safe
ety and comfort
t measur
res,
hel
lpful hin
nts, and when to call the
e doctor.
.
What iss a spica cast?
c
A spica cast is a cast that covers the
e body. It starts at the chest from the nipples,
goes aro
ound the waist
w
and hips,
h
and co
ontinues doown the leg
gs. It has a
an opening cut out
for diap
pering or to
oilet use. The
T type of
f cast depe
ends on the
e problem being trea
ated.
c
used for?
What iss a spica cast
A hip sp
pica cast may
m be app
plied after differentt types of hip or leg surgeries,, tendon
releasess, or a broken bone. It serves a very spe
ecific purpo
ose: to imm
mobilize th
he hip(s)
and legss, and to maintain
m
the
e correct position
p
for healing. T
The cast m
may seen la
arge and
awkward
d, but you will learn how
h
to take
e care of yyour child in the spica
a.
How do I take ca
are of my child in th
he spica ca
ast?
 It iss extremely
y importan
nt to keep the cast cclean and d
dry. Skin so
ore or diap
per rash
can occur beneath
h the edge
es of the cast
c
from a wet or ssoiled diape
er, or if urrine and
bowel movements
m
are allowe
ed to remain in conttact with your child’s skin. It is very
importa
ant that alll precautio
ons be take
en to prevvent skin irrritation. I
In addition
n, if the
cast getts wet, it may
m soften
n or crack and
a lose itss proper po
osition.
Keeping
g the cast clean:
c
 The edges of the cast should be covered w
with waterrproof pla
astic tape. This is
especiallly importa
ant around the genita
al area to h
help preven
nt soiling.
 A ch
hild who iss toilet tra
ained may use a urinnal. This w
work well for boys an
nd girls.
Place th
he urinal snuggly against the girl, and lett her void into the u
urinal. A be
edpan is
used for bowel movements. It may be
e helpful too place a w
washcloth between c
cast and
skin to prevent
p
urine from le
eaking into the cast.
 If a child who is not toilet-trained
d do not ap
pply the diaper as yo
ou normally
y would.
Check for
f a wet or
o soiled diiaper at lea
ast every 2 hours duuring the d
day, and evvery 4-8
hours during
d
the night. The
e diaper sh
hould be cchanged as soon as itt becomess wet to
preventt the cast from
f
gettiing wet. If
f the cast becomes ssoiled, you may use a slightly
dampened (not wet)
w
cloth to clean the
t
area. Afterward
d, keep th
he area uncovered
until it is complete
ely dried. A blow dry
yer on the ccool or air setting ma
ay be used
d to help
e cast. If the child is propped
d up with the head and chestt higher than the
dry the
bottom,, this will le
et the urin
ne run into the diaperr and not in
nto the casst.
 To prevent
p
irrritating the
e skin from
m rough e
edges on th
he cast, th
he cast sh
hould be
“petaled
d”. Some of the petaling will be
b done at tthe hospital, but you
u may want to have
extra materials
m
at home in case they
y loosen or additional areas nee
ed to be c
covered.
You can
n obtain th
he adhesive
e, which iss called moole skin, frrom a surg
gical supply
y store.
The pettaling techn
nique is sho
own below..
Skin and
d cast insp
pection:
 Chec
ck carefully
y beneath the cast edges
e
mornning and eve
ening, and in the diap
per area
with ea
ach cast ch
hange. Loo
ok for skin
n redness, irritation, blisters, open or d
drainage
areas, or
o pressure spots. Check
C
the elbow
e
for chafing. A flashligh
ht may be helpful.
Observe
e the cast for crackss, softenin
ng, increasing tightne
ess, draina
age from th
he cast,
or foul odors.
o
Conttact your doctor
d
if there is a p
problem.
 If yo
our child complains
c
of
o tightnesss, pain, tinngling, num
mbness, inability to m
move the
toes, orr there is swelling,
s
trry elevating
g the feett for an ho
our or more
e. If the p
problem
persistss, contact the
t office..
How do I change my child’ss diapers?
Your ch
hild’s diape
er should be
b changed
d as soon aas it becomes wet. It is bestt to use
disposab
ble diaperss. They sh
hould be tu
ucked deep
p inside the edges of
f the cast. Follow
the step
ps below:
m child?
How do I bathe my
Give your child a sponge ba
ath daily. Be
B careful not to ge
et the castt wet. Do not use
lotions, powders, or
o oils unde
er the cast or around
d the edge
es. This can irritate tthe skin
under the
t
cast. If
I your chiild sweats a lot, a d
dry soft clloth can help absorb
b sweat.
Change it as neede
ed.
Circulation Checks Check circulation at least 4 times a day. To do this, check the toes. They should stay
pink and feel warm. Call the office if your child’s toes become more swollen,
discolored, or if she/he is unable to move the toes easily.
Positioning  The position of a child in a spica cast must be changed every 2 hours during the
day, and every 6-8 hours during the night to prevent skin problems. Turn your child on
his/her back, sides, or stomach. Keep the cast in alignment with the chest and
shoulder blades to keep the cast from pressing on them.
 Protect the toes from touching the mattress when your child is on his/her stomach
by placing a pillow, rolled towel, or washcloth beneath the ankle.
 Keep heels free from pressure by placing a rolled ankle or small pillow under the
calf of the leg.
 The child may sit propped up with cushion or pillow. This will also help in keeping
the cast clean and dry. It is also easier for the older child to use the bathroom.
 Your child may figure how to stand or walk in the hip spica cast. Do not allow your
child to stand or walk unless instructed by your doctor.
Clothing tips:
 The cast covers most of your child’s body. Your child may not need many clothes.
Big t-shirts, long nightshirts, or loose dresses work well.
 For older children, hand towels can be used to cover the bottom. Boxer shorts can
be pulled up over the cast. Break away parts work great.
 Dresses are usually most comfortable for girls. Large sweatpants or shorts are
best for boys.
 Pants, underwear and shorts can be modified to fit. Take the crotch seam out. Pace
snaps or Velcro no the seam. The clothing can be pulled over the head.
Helpful hints:
 Since the norm
mal activity
y level of your
y
child w
will be alte
ered due to
o the cast, it is
very imp
portant tha
at he/she be allowed
d to do as m
many activiities as posssible within the
specifie
ed limitatio
ons. If you
ur child must be on be
edrest, pro
oviding spe
ecial activitties or
sources of stimula
ation for him/her willl make thiss adjustme
ent easier. Here are some
suggesttions:






ur child outt for fresh
h air in a sttroller or rreclining wheelchair.
Take you
While inside keep your
y
child in a room tthat is the
e center of activity.
Have toy
ys and othe
er items ea
asily withinn the child’’s reach.
Keep you
ur child invvolved with
h the familyy and frien
nds.
Small ch
hildren shou
uld be held
d as often aas possible
e, as the clloseness wiill
soothe them
t
Try to keep the da
aily activities as close
e to normal as possible.
on:
Nutritio
While your child iss in the casst, it is imp
portant to maintain g
good nutrittion. Drin
nking
plenty of
o water an
nd juices will
w help pre
event consttipation or urinary trract infections.
Eating small,
s
frequ
uent mealss will prevent a tight feeling in tthe cast frrom a large
e, full
stomach
h.
Safety and comfort measures  Do not let your child place small toys, or other objects, or food inside the cast.
This may cause pressure areas and skin breakdown. It will make it more difficult to
put things inside the cast if your child wears a one-piece type outfit or a long t-shirt.
 Your child may complain of itching, especially if he/she is hot and sweaty. Do not
poke objects such as coat hangers into the cast. To help itching, use a blow dryer on a
cool or air setting, and direct the air inside the cast. If itching still continues,
appropriate dose of liquid Benadryl may be given by mouth.
 The child will be most comfortable if kept cool.
 Always have you child strapped in to chairs, beds, car seats and strollers.
 Put a large smock or shirt on your child that extends down over the cast before
he/she eats. This will prevent food and crumbs from falling down into the cast.
WHEN TO CALL THE DOCTOR’S OFFICE








Severe pain, numbness or burning inside or below the cast that is not relieved with
elevation.
Unexplained fever over 101 degrees.
A new stain on the cast coming from the inside.
A crack in the cast.
A very foul odor coming from inside the cast.
An object lost or lodged in the cast.
Very cold or discolored toes on the leg with the cast.
Broken or blistered skin around the cast edges.