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Cast Care (Spica Cast)

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What is a spica cast?

A spica cast is also called a "Body Cast". It usually fits from the chest to the toes, but may stop above the knees. The length of the cast depends on where the bone is broken or is operated on.

There are three types of spica casts: PLASTER, FIBERGLASS, and GORE-TEX LINED.

PLASTER molds well and dries fast. It can get soft and lose its shape if it gets dirty or wet. Plaster is usually lined with cotton which may smell if it gets wet or soiled. Gore-TEX liners can be used with plaster but this is not done often.

FIBERGLASS is very sturdy and dries fast. It does not get soft or lose its shape very easily. Fiberglass can be lined with cotton or Gore-TEX. If the cotton lining gets wet or soiled, it will not dry since fiberglass does not let air pass through it. This may lead to skin problems under the cast.

GORE-TEX is a special material used to line spica casts. It is waterproof but “breathes” so air can pass through it. Gore-TEX can help protect the skin.

How do I care for a spica cast?

Bathing:

  • If your child has a cotton lined spica cast you must not bathe him/her in the tub. Use a washcloth to bathe him/her. Do not get the cotton lining or plaster cast wet.
  • If your child has a Gore-TEX lined fiberglass spica cast you may bathe your child in water two or three times a week. Make sure the water is not too soapy and that you rinse your child with clean, warm water. After bathing, hold your child upright so all the water can drain out of the cast. The few drops left will dry with body heat.

Toileting:

  • Using a Bradford Frame can help. Place your child on the frame with his/her bottom over the opening so urine or stool falls away from the cast onto a diaper or “chux” under it. For an older child use a bedpan under it.

Diapering:

  • Take a much smaller diaper than you normally use, and tuck it inside the opening at the bottom of the cast. The diaper should not touch the plaster or fiberglass.
  • You may also use a "Serenity Pad" (an adult sanitary pad) and tuck it inside the cast opening. Secure it in place with tape.
  • Dirty diapers should not touch the plaster or cotton lining. Change diapers as soon as they get dirty. Never wrap a diaper around the outside of any spica cast with a cotton lining.

Itching: (Children with Gor-TEX lined spica casts usually do not have problems with itching.)

  • DO NOT let your child scratch or put anything into the cast. This may cause a sore or infection.
  • DO NOT use powder or lotion inside the cast.
  • Keep your child cool. Heat and sweat can make itching worse.
  • Blow cool air into the cast using a blow dryer on the "cool" setting held twelve inches away. Do not use the warm or hot settings, it may cause burns.
  • Give Benadryl to your child for itching. You can find it at pharmacies and some stores. Follow the directions on the label.
  • Gently tap/knock on the cast above the area that itches.

"Petaling" the cast:

  • Cotton lined cast edges may be covered with strips of soft “moleskin” that is available at local grocery stores or pharmacies to protect the skin from being scratched by rough edges.
  • Gor-TEX lined cast edges may only be covered with duct-tape.

Positioning:

  • A Bradford Frame can help. If you do not use the frame, prop up the chest and head if your child lays on his/her stomach. You may also turn your child on his/her side. Use pillows or rolled up blankets behind the back, legs, and head.
  • Change your child’s position every couple of hours. This will help air to reach all of the skin under the cast and keep pressure from causing problems in one area.
  • It is best that your child NOT sleep on his/her stomach unless you are able to watch him/her constantly.

Activity:

  • Let your child move from room to room during the day. This will help keep him/her from getting so bored. A small child can be moved in a wagon. Older children need a wheelchair. At some point your child will be able to stand up in the cast. Your child’s doctor will discuss this with you.
  • For older children, help them do exercises such as tightening up their muscles inside the cast. This can be a playful time you set aside each day just to spend with him/her. A physical therapist may also help set up a special program.

Skin Care:

  • Check your child’s skin every day. Press the skin back around all of the cast edges. Look and feel for red areas or sores. Use a flashlight to help you see inside the cast.
  • There may be swelling for the first week or so after the cast is put on. If the cast gets too tight, your child may have more pain (not helped by pain medicines), tingling or pale skin. Call your child’s doctor if the cast seems too tight.
  • Do not let sand or dirt get inside the cast. This may cause pain or skin problems under the cast.

Clothes:

Clothes may have to be altered to fit around the cast.

  • For older children, adult shirts or boxer shorts are great!
  • Inseams of shorts or pants may be split and Velcro sewn in. They can be put on like a skirt and then “Velcro” together as shorts or pants.

Diet:

  • A high fiber diet with foods like fruit, vegetables, and bran cereals will help prevent constipation. If your child is constipated, you may give Milk of Magnesia. Please call your child’s doctor for advice.
  • Offer fresh fruit for snacks and plenty of fluids.
  • Avoid fatty foods and junk foods. These can lead to weight gain.
  • Foods high in protein and calcium help heal and rebuild bones. Meats, peanut butter and milk products are good sources of protein and calcium.

When to call your child's doctor:

  • You see red areas, sores, or smell a foul odor.
  • The cast seems too tight, pain is worse (not helped by the pain medicine), tingling or pale skin.
  • Your child’s toes do not quickly turn back to pink under the nails after being squeezed.
  • Your child has pain inside the cast that is new and you do not know why.
  • He/she loses feeling in the toes
  • Something is down inside the cast.
  • Cast is badly soiled.
  • Constipation is not better after using Milk of Magnesia.

Call your child’s doctor if you have any questions or concerns.


Disclaimer: This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.

Reviewed: 08/06

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