How to Care for a Child in Hip Spica Cast?

WHAT IS A SPICA CAST?

A spica cast extends from the torso down to one or both legs.

While the cast may help the fracture or incision heal, parents are subjected to the huge challenge of keeping it clean, comfortable, and safe.

The 2 most common reasons for a Spica cast are fractures meaning that the child’s bone has been broken and hip dysplasia meaning that the child’s hip has not been properly formed. Spica casts are used to heal femur fractures in children under the age of 5 years without the requirement for any surgical procedures or in other words putting metal implants depending upon the location and type of the fracture.

Sometimes, the Spica casts are used after surgery to provide stability while the wound heals. These casts are usually done in the operating room while a child is under sedation because the cast takes time to put on and the child must stay very still so that the hips and legs can be held exactly in the required position.

WHY DOES MY CHILD’S SPICA CAST APPEAR SO BIG?

A Spica cast usually starts below the chest and goes around the child’s abdomen but there may be enough space between the child’s chest and the cast to allow for comfortable breathing and eating. Another opening is usually present to allow for comfortable urination and passage of stools around the child’s private areas.

DIFFERENT TYPES OF SPICA CAST:

If the cast is being placed for a fracture, many times a cast will only include the fractured site leaving the uninjured site free but this mainly depends upon the physician and the type and location of the fracture.

HOW TO MAKE SURE THAT THE CHILD IS COMFORTABLE IN A SPICA CAST:

Spica casts are usually kept for a longer time and since they cannot be readily changed in an outpatient clinical setting it is very important that they are kept as clean as possible. This would not only provide comfort to the child but also allow a proper healing environment.

Many Spica casts use waterproof and light material for casting which protects the cast from soiling that may occur from bathroom mishaps. In some cases, an additional layer of felt tape is placed around the Spica cast edges to provide additional comfort.

CAN MY CHILD SIT IN A SPICA CAST?

The child comfortable in Pavlik harness may be allowed to sit in any position that is comfortable. The use of pillows, bean bags, and small cushions to prop up the child may provide additional.

HOW CAN MY CHILD MOVE WHILE BEING ON SPICA CAST?

Small children can be pulled around in a stroller, older children may require a reclining wheelchair.

For children with hip dysplasia, the cast may be kept in a way that would make it difficult for them to walk but nevertheless sitting on a chair or being carried on wheelchair is feasible.

Many children will try to crawl in the cast once they start to feel better after surgery, this is generally safe for the child, although the cast may be worn down on the knees and may need to be reinforced.

If a single leg cast is applied for a fracture, the child may start to walk on the uninjured leg and this usually does not affect the healing, occasionally the child may start bearing weight on the fractured leg once there is some healing and the pain has subsided, though this should not be encouraged but some weight bearing after a period of time usually does not hinder the union of the fracture site.

HOW LONG WOULD MY CHILD BE ON A SPICA CAST?

Fractures usually take around 4-6 weeks to heal therefore if the Spica cast is applied for a fracture, the child usually wears it for a month or a month and a half though this is variable and mainly depends upon the age and type of the fracture, also how well the fracture is healing as determined by the follow-up x-rays would determine the duration of the casts Radiographs can be taken while the child is on Spica to decide when it may be removed.

Spica casts for hip dysplasia are usually left for longer time durations sometimes for up to 3 months depending upon the treatment provided and how the hip heals after surgery. In many cases, the cast may require changing every 6 weeks.

HOW CAN I TAKE CARE OF MY CHILD WHILE HE IS ON SPICA CAST:

GENERAL INSTRUCTIONS:

1. Be vigilant of sharp edges or areas of irritation of skin due to rubbing of the cast. Ask for extra felt tape to be kept in case of any sharp edges, a duct tape may also work.
2. Putting anything down the cast is a big NO. Small children tend to slip in all sorts of small objects ranging from small toys, paper clips, coins, and food particles that can easily make their way through the cast and cause pressure sores and skin problems later on.

WHAT TYPES OF CLOTHES:

1. Larger-sized tops that can be comfortably fitted over the top portion of the cast.
2. Breakaway pants/zippers often fit well over the legs.
3. Pants can be split sideways and Velcro or straps can be used instead to fasten them around the legs of the cast.
4. Socks protect the foot and ankle
5. Try to make the child loosely fitted clothes

HOW TO ENSURE TOILETING AND PROPER DIAPERING FOR A CHILD WITH SPICA

1. If the child wears a diaper, then the double diapering technique is usually used. First, a smaller-sized diaper is placed under the cast and tucked in firmly from the front and back. A larger diaper is then used to hold this smaller diaper over the cast to contain the mess.
2. The child should be positioned at a slight incline with heads up so that the urine and stool under the effect of gravity flow downwards.
3. Make sure that the diapers are changed frequently to avoid soiling of the cast and irritation of the skin along the private areas.
4. Check the child’s skin every time the diapers are changed.
5. For children who are out of diapers, a bedpan or a handheld urinal is used for urination, it is helpful to tuck a wet washcloth in between the cast and skin to avoid any accidental spilling of urine onto the skin.

WHAT TO DO IF MY CHILD’S SPICA CAST IS ACCIDENTALLY SOILED WITH URINE OR STOOL?

In case of accidental spillage of urine or stool into the cast, a damp non-wet washcloth is used to clean the inside of the skin and the cast when there is a waterproof liner in place.

A hairdryer in a cooler setting is another way to dry any dampening occurring in the cast.

HOW CAN MY CHILD SHOWER WHILE BEING ON A SPICA CAST?

Avoid getting the cast wet at all costs, try giving your child a sponge bath instead of a regular bath. If the cast accidentally gets wet then a hair dryer on cool settings can be used to dry the cast however if the cast gets soaking wet then proper medical attention should be sought so as to ensure if the case might require replacement.

Avoid putting creams, lotions, oil, or powders while the child is on the cast, they may irritate the skin inside and outside the cast.

IMPORTANT POINTS TO REMEMBER WHILE THE CHILD IS ON SPICA CAST:

1. Changing the position of the child frequently to avoid pressure sores in the cast.
2. Avoidance of pressure over the heels by keeping them free.
3. In order to transport smaller children, place pillows at the bottom of the stroller.
4. Larger children require a recliner wheelchair for transport.
5. Keep the cast dry and clean at all times
6. Avoid foods that cause diarrhea or constipation.