HOW CAN I TAKE CARE OF MY

CHILD’S SPICA CAST?

WHAT IS A SPICA CAST?

A spica cast extends from torso down to one or both legs.
Here are some useful tips and tricks on how you and your child can manage
life in a better way while being on a spica cast.

WHY IS MY CHILD HAVING A SPICA CAST APPLIED?

A spica cast is applied when the upper part of the thigh needs to be
immobilized for problems around the hip joint or the thigh bone also called femur.
While the cast may help the fracture or incision heal, parents are subjected to a
huge challenge of keeping it clean, comfortable and safe.
The 2 most common reasons for a spica cast are fractures meaning that the
child 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 APPEARS 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 longer time and since they
can not be readily changed in 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 casts edges to provide
additional comfort.
CAN MY CHILD SIT IN A SPICA CAST?
The child may be allowed to sit in any position that is comfortable.
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 wheel chair 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 especially , 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 takes around 4-6weeks 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 xrays 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 may
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
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.

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

Larger sized tops that can be comfortably fitted over the top portion
of the cast.
Break away pants/zippers often fit well over the legs.

Pants can be split sideways and velcro or straps can be used instead

to fasten them around the legs of the cast.

Socks protect the foot and ankle

Try to make the child loosely fitted clothes

HOW TO ENSURE TOILETING AND PROPER DIAPERING
FOR CHILD WITH SPICA

If the child wears a diaper, then 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.
The child should be positioned at a slight incline with heads up so that the urine and stool under
the effect of gravity flows downwards.
Make sure that the diapers are changed frequently to avoid soiling of the cast and irritation of
the skin along the private areas.
Check the child’s skin every time the diapers are changed.
For children who are out of diapers, a bed pan or a hand held 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 wash cloth is used
to clean the inside of the skin and the cast when there is a waterproof liner in place.
A hair dryer on 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 seeked 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:
The child needs to be propped up with cushions, pillows or bean bags.

Changing the position of the child frequently to avoid pressure sores in the cast.

Avoidance of pressure over the heels by keeping them free.

In order to transport smaller children, place pillows at the

bottom of the stroller.
Larger children require a recliner wheelchair for transport.

Keep the cast dry and clean at all times.

Avoid foods that cause diarrhea or constipation.

More information can be found on drowaisrafiq.com

References:
Tachdijan pediatric orthopedics,John A Herring,6th edition.
Lovell and Winters pediatric orthopedics,7th edition.
Fundamentals of pediatric orthopedics,Lynn Satheli,7th edition