Spica Cast

When BB broke his leg and was placed in a spica cast, I had never heard of that type of cast before. The nurses at our hospital had limited experience dealing with this type of cast, although they did have a hand-out that they gave me. I imagine that every spica cast case is different, but here's what worked for me:

• If your child isn't potty trained, buy diapers 1-2 sizes smaller than he normally wears. Tuck the diaper inside the cast as best you can. At first this will be difficult, but after a week or so of wearing the cast, you should be able to easily slip the diaper in place. Since I have a son, I found it helpful to place the diaper in the cast at his waist (where his cast began), and then slide the diaper down until it was in place. This insured that nothing got tucked into an awkward position. I then flipped him over onto his stomach and tucked the rest of the diaper around his bottom.
  
• If your child is on his stomach, you will need more diaper coverage in the front. If your child is on his back, you will need more diaper coverage in the back.
  
• You will have to change the bedding often due to diaper leaks and food. I bought some chux (a disposable underpad) to layer between BB and his bedding. This cut down on how often I had to change the bed sheets each day. You can check WalMart for this item in the incontinence section. To be honest, this is the same thing as a housetraining pad for a dog, so check the pet supply section and compare prices. I found that ebay was the cheapest place to buy a large supply of chux.
  
• The cast will get dirty, especially from solid waste. Do the best you can to keep it clean, but keep in mind that you can't really scrub the cast. If the outside of the cast gets wet, try rubbing the area with a small amount of baking soda.
  
• If you know ahead of time that your child will have a cast, check to see if your child can have a colored cast. This will help make the cast seem less intimidating and also help to diguise some of the stains that will occur.
  
• Rotate your child's position frequently, using pillows and rolled towels as needed to support and elevate the body.
  
• Keep a close eye on all visible skin around and under the cast and watch for any signs of skin breakdown. Apply diaper cream or Neosporin to any skin that seems irritated. Of course, call your child's doctor and use common sense when treating the skin.
  
• Make sure you check frequently around all cast openings for bits of food, waste, and toys. As the cast starts itching, your child may try to place things down in the cast as a misguided attempt to relieve the itching.
  
• Buy 1-2 cans of Cast Comfort or Cast Blast spray. This spray helps with the odor as well as the itching. Check Walgreens, medical supply stores, or a compounding pharmacy for the spray. It is also available on-line, but you might not want to wait that long.
• You will not believe how dirty little hands and fingernails will get without bathtime! Make sure you have a child/toddler nail brush on hand and scrub frequently.
• Your child will have his neck bent at an angle most of the time due to being bedridden and trying to see what's going on around him. Wash his neck thoroughly and dry it often. He may develop heat rash on his neck.
  
• If you child is a stomach sleeper, a regular pillow might be too thick for him to comfortably sleep in his cast. A folded towel worked well for us.
• Buy a child-sized lap tray for your child to use for books, coloring and small toys. Hobby Lobby and Michaels both cary plastic trays for around $7 each.
• The first few days of the cast, your child will probably be scared to move much with the cast. Once you can move your child easily without alarm, you can place a mattress on the floor and allow your child to lay on his stomach, slightly hanging off the mattress to play with toys.
• When your child becomes comfortable moving with his cast, you might want to consider placing his mattress on the floor for him to sleep on during the night. You wouldn't want him to try to get out of bed only to fall and break an arm!
• Some children will crawl, pull to a standing position, and even walk while wearing the cast. None of this is recommended by the doctors, but if your child is capable of doing this, there's not much you can do to prevent him from moving. Be aware that your child's sense of balance will be horribly off due to the cast, so watch your child carefully.
  
• I found the easiest way to bathe my son was to give him a sponge bath right on the floor. I placed several towels under him and several towels under the pan of water. I used two pans of water, one for clean water and one for soapy water. You might also try laying your child down in a dry bathtub.
• A hairdryer set on cool air will help some with cast discomfort. I also used a cool hairdryer to dry around the cast after a sponge bath, in case some water got under the cast.
• You may notice some loose padding or rough edges around the cast. You can use cloth tape or duct tape to cover these areas.
  
• If your child likes Play-Dough, you might try substituting Silly Putty instead. Silly Putty won't dry out or flake into small parts, which is a big plus for the bed-ridden!
• You might find that your child doesn't do enough to get tired for a nap during this time. Try to keep the same morning and evening rise and sleep times, however, to keep some type of routine.
• Check your local library or ask friends for videos for your child to watch. I'm not a big fan of TV and children, but videos really helped to pass the time.
• Talk to your child about getting his cast off before it happens. YouTube has several videos of different casts being removed. You child can hear the noise that the saw/vacuum makes, as well as see that the saw doesn't hurt the person.
• Expect seriously dry skin when the cast is removed. I added some unscented baby oil to the bathwater the first few baths and allowed BB to soak as long as he wanted to. A lot of the dead skin cells will simply float off the skin and into the water, so you will need to drain the tub and refill it to rinse off your child. The skin will be too sensitive for you to really scrub the first few days.
• Have a scent-free, dye-free lotion on hand, preferably for extreme dry skin. Apply the lotion liberally several times a day. This is also a good time to massage your child's legs, which will be stiff and sore from being immobilized for weeks.
• Don't allow the skin that was in the cast to get any sunshine (even through a car window) until the skin is completely healed, which will be several weeks. The skin is very fragile after being in a cast. The sun's rays can cause your child's skin to become permanently darker where the skin was drawn in from being so dry inside the cast.
• Expect some hesitation and limited mobility the first few days or even weeks when the cast is removed.

If you have any more tips or hints, feel free to add them in the comments!
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