Bone & Joint | Children | Infants & Toddlers
June 8, 2018

How to take care of a child in a spica cast

by Baby crawls through grass in a field

A spica cast extends from the torso down one or both legs. Here’s how you and your child can manage life with a spica cast.

 

A spica cast is used when the upper part of the thigh needs to be immobilized for problems around the hip joint or the thigh bone (femur). While this helps an injury or incision heal, it creates some challenges in keeping young children clean, comfortable and safe.

The two most common reasons for a spica cast are fractures (broken bones) and hip dysplasia (when the hip joint isn’t formed correctly). Spica casts are used to heal femur fractures in children under the age of 5, depending on the location and type of fracture. This may mean the child does not need surgery for metal implants. Sometimes spica casts are used after a surgery, to provide stability while the break or wound heals.

Spica casts are usually put on in the operating room while a child is sedated. That’s because the cast takes time to put on, and the child must stay very still so the hip and leg can be held in exactly the right position.

Here, Megan Johnson, M.D., a pediatric orthopedic surgeon at Monroe Carell Jr. Children’s Hospital at Vanderbilt, answers questions parents often have when a child has to wear this kind of cast.

 

Why is a spica cast so big?

A spica cast starts below the chest and goes around the torso. There will be space between the cast and the child’s chest and abdomen so there is room to breathe, and to allow the belly to expand when he eats and drinks.

When the cast is being placed for hip dysplasia, the cast will reach to the ankle of the leg that was operated on, and to the knee on the other leg. This allows the child to move the ankle freely on the side that had the operation, and the knee and ankle joint on the other side. If the spica cast is being placed for a fracture, many times the cast will only include the fractured side and leave the non-injured side free.  This will depend on the preference of the doctor treating the child and also the type and location of the fracture.

 

How do you keep a spica cast clean and comfortable?

Spica casts are built for cleanliness and comfort. Many spica casts use a waterproof lining, which protects the cast from soiling that may occur from bathroom accidents. An opening is left between the child’s legs to allow toileting and clean-up. The cast has cotton padding so there are no sharp edges to bother the child. In some cases an additional layer of felt tape will be placed around the edges to provide additional comfort.

 

How long do you wear a spica cast?

For most fractures, a child wears the cast for six weeks. It could be needed for more or less time, depending on the age of the child and how well the fracture is healing.  The doctor will take X-rays while the child is in the cast to decide when it can be removed.

Spica casts for hip dysplasia are often left in place for 12 weeks or more, depending on how the hip heals after surgery.  In many of these cases, the cast is changed every 6 weeks.

 

How does a spica cast work with car seats?

After the child is out of the operating room and the cast is in place, a physical therapist will evaluate the child and help the family figure out how to safely transport the child in the car. If need be, they may help you find and select a car seat suitable for a spica cast.

 

How do you keep a child in a spica cast comfortable?

The child may sit in whatever position is comfortable. Try using pillows, throw cushions or a bean bag chair to help prop her up. Small children can be pulled around in a wagon or stroller. Older children may require a reclining wheelchair, which will be provided to the family at the time the cast is placed.

For children with hip dysplasia, the cast will immobilize the legs in a position that makes it difficult for the child to walk.  Many children will try to crawl while in the cast once they start to feel better after surgery.  This is generally safe for the child, although the cast may get worn down on the knee and need to be reinforced. If a single-leg spica cast is placed for a fracture, the child will often start to try to walk on the non-injured leg and sometimes even the fractured side once the bone starts to heal. While the child should not be encouraged to do so, some weightbearing in the cast should not affect the healing process.

 

How do I take care of a spica cast and my child while they wear it?

General

  • Keep an eye out for sharp edges or areas of skin irritation from the cast rubbing. Ask the doctor for some felt tape or moleskin so that any sharp edges can be padded. Duct tape also works!
  • Avoid putting anything down the cast. Small toys, paper clips, coins, etc., can easily make their way in to the cast and get stuck. This can lead to pressure sores and skin problems.

Clothing

  • Larger-sized tops should fit over the portion of the cast on the torso.
  • Break-away pants with side snaps/zippers often fit over the legs.
  • Pants can be altered — try splitting the side seam and adding Velcro or snaps along that seam so you can fasten pants around the legs of the cast.
  • Socks protect the feet and toes.
  • Loose-fitting dresses also work well.

Diet

  • Resume a regular diet once the cast is in place.
  • Avoid foods that cause diarrhea or constipation.

Toileting and diapering

  • If the child wears diapers, place a smaller-sized diaper under the cast in the front and the back. Use a larger diaper over the cast to hold the smaller diaper in place, to contain messes.
  • Try keeping the child positioned at a slight incline (with the head up) so that gravity will keep the flow of urine and stool in the diaper.
  • Change diapers frequently to prevent the cast from getting soiled and to prevent skin irritation.
  • Check the child’s skin every time the diaper is changed.
  • For children who are out of diapers, use a bed pan or hand-held urinal. Tucking a washcloth between the cast and the skin helps prevent urine from getting into the cast.
  • If urine or stool gets into the cast, use a damp — not wet — washcloth to clean the skin and the inside of the cast, when there is a waterproof liner in place. A hair dryer on the cool setting can help dry any dampness in the cast.

Bathing

  • Avoid getting the cast wet. The child will need to have a sponge bath instead of a regular bath. If the cast gets a little damp, a hair dryer on the cool setting can be used to help dry the cast.  If the cast gets soaking wet, call the child’s doctor to decide whether the cast will need to be replaced.
  • Avoid putting anything onto the skin while the child is in the cast – lotion, powders, oils, etc. These can irritate the skin inside and around the cast.

Activity and transportation

  • Prop up your child with pillows, cushions or bean bags.
  • Change the child’s position frequently to avoid pressure sores in the cast.
  • Avoid any pressure on the heels.
  • Give the child activities such as books, crafts, puzzles, board games, etc.
  • Place pillows at the bottom of a stroller or wagon to transport smaller children.
  • Use a reclining wheelchair for larger children.
  • Assess needs for travel. Many small children will still fit in their car seat or a special car seat provided by the hospital, but sometimes a harness or other restraint system is used when the child will not fit in a car seat with the cast in place.

Infants, Early Childhood

2 thoughts on “How to take care of a child in a spica cast”

  1. Judith Wolf Mandell says:

    “Sammy’s Broken Leg (Oh, No!) and the Amazing Cast That Fixed It” is my whimsical book for children in a spica cast. A troop of secret kisses whoosh into Sammy’s cast, inspiring patience and cheer. Endorsed by professionals, adored by readers. The Flying Pig Library at Monroe Carell Jr. Children’s Hospital has copies, as does the Orthopedic Child Life Specialist.

    1. Maura Ammenheuser says:

      Judith, thank you for the reminder that our patients and their families can find helpful books on our medical campus.

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