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.
- 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
- 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.
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
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.
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.
- 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
- Severe pain or swelling not relieved by medication or elevating
- 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
- 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.
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