Keep the cast clean and dry
Cast care and skin care are closely linked. If urine or bowel movements stays on skin, such as under a wet diaper or under the cast edges, diaper rash and skin breakdown are likely. This is painful for your child. It can slow healing if the cast must be removed due to skin problems. So, all precautions must be taken to prevent skin irritations.
Nurses will show you how to care for the cast. They will encourage you to help care for your child while in the hospital.
Use incontinence pads to protect the cast and skin if your child wears diapers. Place a pad across the diaper area. Tuck it under the front and back edges of the cast. Then, put on their diaper.
Every child's urinary and bowel routines are different. Children come in all sizes. No cast opening is the same. It changes based on the type of surgery done. So, you may need to try pads, newborn preemie diapers, folded cloth diapers, and incontinence pads until you find the right one.
Also, check the site at least every 2 hours during the day. Make sure the pad and diaper is changed as soon as it is wet or dirty. During the night, the pad and diaper should be checked and changed with each position change if needed. This should be done about every 3 hours. You may need to set an alarm clock to make sure this is not missed.
Remember: A cast can feel dry outside but is not always dry inside.
Position your child on pillows so their head and shoulders are higher than the buttocks. This also helps keep the cast dry. Protect the pillow with plastic wrap or a disposable diaper on the inside of a pillowcase.
Care of the Hip Spica Cast
Elevate your child's head and shoulders with pillows when they use a bedpan. This will help prevent urine from running inside the cast. Place a gauze or cloth pad or a small, folded towel on the back rim of the bedpan. This will absorb moisture and help keep the cast dry. Remove the pad with the bedpan. A plastic bedpan can be sent home with your child if needed.
Clean the cast with a damp cloth and small amount of soap if it gets poop on it.
If the cast is damp, expose it to air during the child's nap. Do this by taking off your child's diaper but leave the incontinence pad in place. Use a hair dryer on a warm or cool setting for l0 to 15 minutes. Do not use a hot setting. The hair dryer should be l0 to 12 inches from the site. It should not touch skin.
Give your child a sponge bath each day. Do not get the cast wet. Use a damp cloth to reach under the cast edges to remove plaster and food pieces.
Do not use lotions, powders, or oils under the cast or around the edges. Powders can cake, and lotions and oils soften the skin. Both make skin break down easier.
Check under the cast edges in the morning and evening. Look for:
- Skin irritation
- Open or draining sites
- Pressure spots
A flashlight may be helpful.
Look at the cast for:
Do not let your child poke crayons, small toys, or other objects under the cast edges. They may cause pressure areas and skin breakdown.
Do not give new fruit juices or foods. These can cause loose bowel movements. Have your child drink plenty of fluids. They should eat fruits and vegetables to prevent constipation and help healing.
Use Velcro® on the legs of clothing to ease dressing.
You will get a pain medicine prescription when you go home.
Your child must be positioned well and turned often to prevent skin problems. This will also help their comfort. Their head and upper body should always be elevated. This helps with better positioning of the hips down in the cast. It also lets gravity pull urine and poop away from the cast.
Reposition your child on pillows at least every 2 to 4 hours, even at night. Turn your child from side to side, on their back, or on their stomach. Make sure the cast is not too tight at the waist or chest. Place a pillow or rolled towel under the ankle when your child:
- Is on their back so there is no pressure on their heels
- Is on their stomach so the toes do not touch the mattress
Sometimes, a wooden crossbar is placed between the legs. It is built into the cast with plaster when the cast is put on. The crossbar stabilizes the legs. Do not use the crossbar to turn your child. It may break off. When turning your child, have them keep their arms above their head.
If you see red sites near the base or top of the spine or on the heels, your child must stay on their stomach longer.
Your child may be out of bed in a stroller or wagon if the cast size allows. Larger children may need a reclining wheelchair with elevated leg rests. Always use proper positioning and safety measures, such as side rails, seat belts, and safety straps. Your child’s nurse will provide a car seat or vest restraint to use in your car. This will be loaned to you. You will need to return it to the clinic when your child is no longer in the cast.