Spica cast

What is a spica cast?

A spica cast is used to keep the lower body and one or both legs from moving. The cast starts just below the chest, covering the hips and part or all of the legs. Made of plaster or fiberglass, it is used to treat fractures of the hip or leg or to correct hip problems. Your child's skin is protected with a smooth lining material before the cast is applied.

What can I expect after the cast is applied?

Fiberglass casts dry within a few hours. Plaster casts take 1 to 3 days to dry completely. Drying times vary with cast size and type. Handle the wet cast with your palms, not your fingers, to avoid denting it.

A child who has had anesthesia may sleep more than usual in the next 24 hours.

How do I care for the cast?

If the cast has a bar between the legs, do not use the bar to lift or turn your child.

Keep the cast as clean and dry as possible. Because the child must have anesthesia to have the cast put on, it will not be replaced
if it is dirty or smells bad.

Do not let the cast get wet. A wet cast will irritate the skin, soften, and fail to hold the leg and hip in the correct position. If it gets damp, dry it with a hair dryer on the coolest setting.

Check the cast daily for cracks, dents, softening, drainage, or changes in tightness.

Do not apply paint to the cast or keep it covered with plastic. These materials stop air from getting through the cast.

If the cast is made of plaster, you may clean it with a small amount of toothpaste or dry white cleanser (Ajax® or another brand) on a slightly dampened cloth. Rub gently to remove the dirt. Dirt on fiberglass casts can be washed off with a damp cloth. Dry it well with a hair dryer set on cool. Never use a hair dryer on a hot setting because it can burn the skin.

Any rough edges of the cast can be covered with pieces of plastic tape, or a fabric tape called moleskin, cut into petal shapes. Silk or waterproof tape around the groin opening can also help keep the cast clean. You can clean the tape with a damp cloth. Change the tape as needed. Do not put tape on a fiberglass cast.

For children who wear diapers:

Keeping urine and stool off the cast can be a challenge!

Position at all times with head and back higher than hips; otherwise urine will flow back into the cast. This is especially important at night.
Check the diaper for wetness every 1 to 2 hours and change it as needed. Clean and dry the skin after each change.
Always use disposable diapers. Use smaller diapers than usual, tucking them between the child's skin and the cast. You can cover the smaller diaper with a larger diaper to hold it in place.
Do not place the diaper over the cast because the urine from the wet diaper will soak into the cast.
Put sanitary napkins or pads inside the diaper to absorb more urine, especially at night.
If your child gets a diaper rash, turn on tummy and leave the back of the diaper open. See the education sheet, "Diaper rash."

For children who are toilet trained: How to use a bedpan

Turn your child to the side opposite the fracture or surgical site and lift the legs. Tuck a waterproof protector (plastic sheet or disposable diaper) inside the back edge of the cast and fold it over the back of the cast to protect it.
Place the bedpan under your child's bottom.
Position your child's head and back higher than the hips; otherwise the urine will flow back into the cast. (Try using a pillow under the head and shoulders.)
For girls, a "wick" can be made using 4 or 5 pieces of toilet paper to catch the stream of urine and direct it into the bedpan.
Clean the skin and wipe dry when finished.
Turn or lift your child (he or she may be able to do this) enough to allow removal of the bedpan. Be careful not to spill.
Remove the waterproof protector.

Children who were recently toilet trained may regress (temporarily go back to earlier stage of development). They may need a diaper at night to prevent soiling the cast.

How can I care for my child?

Pain

Children may have discomfort if they had an incision or from the new position of their legs. Give medicine to relieve pain as prescribed.

Eating

Constipation may become a problem for your child because of the decrease in activity. Encourage drinking more fluids especially during hot weather. Your child should eat more fruits and vegetables.

Offer smaller, more frequent meals to avoid the discomfort of a full stomach in a rigid cast.

Keep the cast covered with a towel or blanket when your child eats, to prevent crumbs from getting into the cast.

Place your child in as upright a position as possible to avoid problems with swallowing.

Skin care

Give your child a daily sponge bath with a damp cloth, or you can use diaper wipes. Be careful to keep the cast dry. If possible, separate the toes after the bath to better allow air-drying. If the skin between the toes remains damp, apply rubbing alcohol or witch hazel with cotton swabs (such as Q-Tips®).

Check circulation twice a day. Toes should be warm and normal in color. Your child should be able to wiggle them easily.

Check the skin twice a day. Press on the skin around all the cast edges to look and feel for reddened areas, sores, or objects inside.

Do not use lotion or powder inside the cast or on the skin at the cast edges. Powder can cake, and lotion will soften the skin, making sores more likely.

Heels and elbows may get sore from changing position or moving around in bed. Have your child wear long sleeves and socks to protect these areas.

Do not let your child put anything into the cast. Even a small object inside the cast can cause sores.

Itching is very common. It often comes and goes. To lessen itching, keep the area inside the cast as dry and cool as possible. Sometimes distraction or blowing cool air under the cast may help.

Do not insert anything into the cast to scratch the itch. Sometimes rubbing inside with finger tips (not finger nails) will help. For severe itching, check with your doctor about a medicine to relieve it.

Positioning

Change positions (back, front, sides) every 1 to 2 hours while awake, for comfort and to prevent pressure sores. Changes can be small, such as tilting less or more, to shift the pressure to another area.

A physical therapist may help you learn how to correctly lift and move your child. Practice lifting and moving your child while in the hospital. To protect your back, remember to keep your back straight, bend your knees and carry the child close to you.

If the cast has a bar between the legs, do not use the bar to lift or turn your child.

Support your child's upper and lower body when turning. Use pillows for propping and cushioning when your child is on his or her back, stomach, or side.

When child lies on the back, especially if the heel is covered by the cast, keep pressure off the heels by placing a pillow or rolled towels under the lower legs. When on the stomach, put the cushioning under the ankles to keep pressure off the toes.

Activity

Your child will become more active each day and may learn to move around without help. Place a mattress or blanket on the floor as a play area. Keep toys within the child's reach. Use a tray for meals or play. For more ideas to help your child, see the education sheet, "Mobility changes: Helping children cope."

Encourage your child to wiggle the parts of the legs that are not in the cast (toes, foot, ankle, and the leg that is not casted), to keep blood moving and help keep swelling down.

To increase your child's mobility, a small child may use a wagon. Older children can use a dolly, like those used by mechanics under cars. The child can lie on his or her stomach on the dolly and move around using the arms and hands.

You may want to rent a hospital bed, reclining wheelchair, or other special equipment from a hospital supply vendor. Please talk with the doctor or nurse. When using the wheelchair, make sure your child is properly secured.

Children in a spica cast require special car seats or restraints for proper transportation. The restraint must fit correctly and meet the federal standard for child safety devices. Your nurse will help you obtain a restraint.

Carefully read the instructions that come with the restraint to assure you are using it properly. Information is also available at:

Children's Family Resource Center
Minneapolis: 612-813-6816
St. Paul: 651-220-6368
www.seatcheck.org or 1-866-SEAT-CHECK
www.carseatsmadesimple.org

For a child who weighs more than 40 pounds, transporting the child creates a special challenge. You must find a vehicle large enough to transport your child safely.

Clothing

Use long dresses, gowns, or long T-shirts. Pants or gym shorts can be slit at the inside or outside seam. Apply Velcro®, ties, or snaps to close it over the cast. You may want to use extra-large clothes.

A sock or knit cap can be worn over the toes to keep them warm, and to keep dirt and gravel from getting into the cast.

Dress your child lightly in hot weather to prevent overheating.

What can I expect when the cast is removed?

A cast cutter will be used to remove the cast. Instead of spinning around, the blades vibrate side to side and make a loud buzzing noise. Your child will feel the vibration and a warm sensation. The cutter will not cut your child, but it will feel like the skin is being touched.

After the cast is off, the skin looks scaly. Your child's arm or leg will look thinner than usual because of the lack of movement.

The skin will be tender. If it itches, rub gently with fingertips. Avoid scratching.

Talk with the doctor about how soon your child can stand and walk, and if any pain should be expected.

When should I call the clinic?

Call the clinic if:

the cast looks tight and the skin is swollen at the cast edges
toes are reddish, bluish, cold, or swollen
numbness or tingling in the feet or legs
something has dropped in the cast and you cannot get it out
the cast has cracks or is getting soft
temperature higher than 101° F
unusual drainage on the cast or an unexplained smell
skin around the cast edges has redness that does not go away within 30 minutes after changing positions
you notice new signs of skin irritation such as rashes, sores, blisters, or bruises
pain does not go away
unexplained fussiness