When a parent is told their childs treatment will require the use of a spica cast, it can be a little intimidating. No parent wants to see their child in such a cast. The question arises, How do I care for my child in the cast? This question is further complicated when the child is not toilet trained.
A spica cast is a cast which extends from the abdomen down both lower extremities. It is called a double spica cast if it extends below both knees and it is called a one and one-half spica if it extend below one knee on one side and above one knee on the other side. The cast may or may not have a crossbar between the legs. The crossbar is used to add stability to the cast in older children.
Spica casts are used to treat various conditions. The most common conditions in which the spica cast are used is hip dysplasia and trauma, especially femur fractures in young children.
If your child need to have a spica cast, the first thing to do is to stay calm. It will take some work, but you will get through this period. The following information will help. It may not be the only way to do it, but is has worked pretty well for our patients.
This is a major source of concern for parents of young children. The object is to keep the cast as clean as possible. If a cast that is soiled with urine or feces remains against the childs skin, it will ultimately cause a severe rash and possibly skin breakdown. This could negatively impact the childs care by requiring cast removal or changing before an optimal time.
Diapering is done in a specific way. You will need some patience and different size diapers than you already use. Any type of absorbent pad is also helpful.
A small diaper, with an absorbent pad placed within it, is tucked inside the opening of the cast between the childs legs. The diaper should be large enough to be able to completely cover the opening and allow a small margin of diaper to be under the cast, that is, between the cast and the childs skin all the way around. This is generally a diaper that is a size or two smaller than the diapers the child normally uses. Then a diaper that is a size or two larger the the normal diaper used is placed over the first diaper and secured around the hips over the cast.
The parents must check the diapers more frequently, at least every 2-3 hours during the day and hopefully once or twice during the night to see if the diaper is soiled so it can be changed immediately.
If the child is toilet trained, this part of caring for the child should be easier. The child can be placed on the toilet, bedpan, or use a urinal as needed. The child should be asked more frequently if they have to go to the bathroom.
If your child is just beginning to toilet train or is just getting the hang of it, being in a spica cast may set them back. It is better to be safe and sorry and do diapering if at all needed.
For any child, the parents should avoid introducing any new foods into the childs diet during this period, which may lead to loose stools. The parents also want to limit the childs fluid intake before they go to sleep, as best as possible, to prevent excessive nighttime urination.
The cast needs to remain dry. That means a child is cleaned using a sponge bath. The cotton padding used to line a cast holds on to moisture and resists drying. It is this continued exposure to moisture that can cause skin breakdown
A Gortex cast liner can be ordered for the child undergoing an non-urgent procedure. Gortex is a material that does not absorb water. The liner is placed against the childs skin and the cotton padding is placed over it. The liner effectively blocks moisture from reaching the cotton. With a liner a wet cloth or wipe cast be used under the cast to help cleaning. The liner is an extra expense that is not covered by insurance, but is often worth it.
If a Gortex liner is not used than the opening of the cast can be petaled with a waterproof tape. A cast is petaled by placing strips of tape over the edge of the cast. The area of the tape can be cleaned easier with a damp cloth or wipe.
When cleaning your child, you should use mild cleansers, such as a baby wipe to avoid the development of a rash.
It will be necessary for parents to transfer their children everywhere while they are in the cast.
A child in a spica cast is lifted with one arm supporting the cast and legs and the other arm supporting the childs back. If the cast has a crossbar, the crossbar should not be used to lift the child, since it may break.
Transporting a child with a spica cast in a car can be a challenge.
If the child is already in a booster seat, then that seat can be used without difficulty. Some pillows should be used to support the childs legs.
For the child in a regular car seat, there are several options. First, a child may be able to fit in their regular seat, if a small pillow is placed under the child, in order to loft the child in the seat slightly. This may allow the childs legs to pass over the sides of the car seat. The harness is secured as usual. Second, you could purchase a seat which has small sides which would allow the childs legs to pass over the sides of the seat. Costco is a brand which seems to have lower sides. Third, there are several outlets from which a parent could rent a special care seat for a child in a spica cast, if available.
Taking care of your child in a spica cast is not easy, but it can be done with some persistence and determination.