What is a spica cast?

A spica cast (also called a hip spica cast or body cast) immobilizes the hips and thighs so that bones or tendons can heal properly. It's usually put on in surgery while the child is sleeping.

There are several types of spica casts. They begin at the chest and may extend down to cover one leg, both legs, or the leg on one side and down to the hip or knee of the other side. The doctor will decide what type of spica cast your child needs.

Cast care

• Keep the cast as clean and dry as possible. Positioning your child with his head slightly elevated will help keep the cast dry. If the cast gets wet, it may soften or crack and possibly lose its proper position. While moisture won't damage fiberglass casts, the padding may get moist and will cause skin problems if it stays wet. Check the padding and the cast to make sure they're dry.
  
• If the cast gets dirty, you can clean it with a damp (not wet) cloth. Then, keep the area uncovered until it's completely dry. To help dry the cast, you may use a hand-held dryer on a cool setting (never use the hot settings because it might burn your child).
  
• If the cast starts to smell bad, rub a small amount of dry baking soda into the soiled areas.
  
• Check daily to be sure the cast is not too tight or too loose. If your child feels tightness, pain, tingling, numbness, or she can't move her toes, or if there's swelling, elevate her leg(s) on a pillow for one hour. If that doesn't help, call your doctor. A cast that is too tight could cut off the blood supply or damage nerves.
• The skin and toes on the casted leg should stay pink and feel warm, like the skin and toes on the other side. Call your doctor if the toes become swollen, cold, pale, or blue, or if your child can't move them.

Skin care

Closely check your child's skin frequently to make sure there is no redness. Inspect the skin at the edges of the cast at least four times a day. If there are any reddened areas, change your child's position so that the pressure is removed. If an area continues to look reddened despite a change in position, a pressure sore may be developing. Keep your child positioned so that there is no pressure at all on this area.

Some children complain of itching under the cast. Don't put anything inside the cast to scratch the skin. If your child complains of itching, rub the skin around the cast edges with your fingers or rub the opposite leg for a few minutes. If itching continues, blow cool air (not hot) from a hand-held hair dryer into the cast. You may also rub the skin at the edges of the cast with rubbing alcohol to relieve itching and provide a cooling effect.

Positioning and activity

While your child is in a spica cast, it's important to change her position every two to four hours during the day, and at least once at night. He may lie on his back, side or stomach as long as the cast is supported. You may use pillows and blankets for support. Always use special care to protect your child from falling.

Never use the bar between the casted legs to turn your child.

Follow your doctor's instructions about physical activity carefully. Your child should not stand or walk in the cast unless your doctor says it's OK.

Diapering and using a bedpan

Proper positioning will help keep the cast clean and dry during toileting. Keeping your child's head slightly higher than his feet will help drain urine and stool away from the cast. This can be done by using pillows or blankets under the mattress of your child's bed or crib.

Plastic wrap (such as Saran Wrap) may be placed around the edges of the cast to protect it from soiling. Cut several pieces of plastic wrap and place half underneath the cast and bring the other half to the outside of the cast; tape the plastic securely to the cast. Remove the plastic immediately after the child wets or stools.

Diapering infants/toddlers — Use disposable diapers only. Tuck the edges of the diaper inside the edges of the cast (plastic side towards the cast and absorbent side next to skin). Use a sanitary napkin inside the diaper for extra absorbency. Both diaper and sanitary napkin should be changed immediately after wetting. One-piece infant sleepers help hold the diaper in place inside the cast.

Older children — Because it's difficult for children to use the bathroom while in a spica cast, use a bedpan or urinal. To use a bedpan, turn your child to the side and place the bedpan under her buttocks and then turn her back onto the bedpan. Check between her thighs to be sure the bedpan is properly positioned. Always elevate your child's head, so urine flows down and away from the cast.

Bathing

Children in spica casts should have sponge baths only. Wash all skin not covered by the cast with soap and water every day. Make sure you keep the cast as dry as possible. If the cast gets wet, it may soften or crack and lose its proper position. If it does get wet, dry it thoroughly with a hand-held dryer on the cool setting (never use the hot settings).

Don't use lotion or powders at the cast edges because they may cake up, irritate the skin, and lead to infection.

Safety

• The cast is heavy and might make your child lose his balance and fall. Always protect your child from rolling or falling by keeping him strapped into chairs, beds, car seats and sofas. In addition, use a safety side rail for beds and couches.
• Never put anything or allow your child to put anything into the cast. Objects such as coat hangers and pencils can break the skin and cause infection. Don't give your child small objects such as coins and toys that could fall down into the cast. If this happens and you can't remove the item with your fingers, call your doctor immediately.
• Be extra careful using plastic wrap — it can make small children choke or suffocate. Always tape the plastic securely to the cast so your child can't pull it off.
• Children in spica casts must be safely restrained while riding in cars. Some approved car seats can be modified to be used with young children. For older children your can buy a special spica cast seat belt (ask your nurse for more information).
• When using hand-held hair dryers, always use the cool setting. Hot settings can quickly burn your child.

When to call your doctor

If your child has any of the following symptoms, call your doctor immediately:

• Severe pain or swelling not relieved by medication or elevating the leg.
• Numbness or "pins and needles" sensation under the cast that does not go away after position is changed.
• An exposed body area below the cast (such as toes) becomes cold, numb or bluish in color.
• Inability to move toes on the casted side, compared to the other side.
• A new blood stain on the cast or foul odor coming from inside.
• Severe skin irritation or rash around cast edges.
• Cast becomes broken, cracked, loose or soft.
• Unexplained fever above 101°F.
• If any kind of object gets stuck inside the cast.

Cast removal

When the injury is healed, the cast will be removed. The doctor will use a tool called a "cast cutter." The cast cutter will only cut the hard cast.

After the cast is removed, the skin will appear dry, pale, and scaly. To soften and remove the dead skin, wash the skin in warm water and use skin moisturizers.

After the cast has been taken off, follow your doctor's instructions about your child's physical activity.

From the Parent/Patient Education Series,
Holmes Regional Medical Center Pediatric Services

Peds: Pt Ed 12. Reviewed 4/98, 6/00.