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Uses

• Fractures: Spica casts are often used to treat femur fractures in young children as an alternative to surgery or metal implants, depending on the type and location of the fracture. They may also be used post-surgery for femur and hip fractures to provide additional stability and comfort during the healing process.

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• Hip Dysplasia: For children with hip dysplasia (a condition involving instability or poor formation of the hip joint), spica casts can be employed either as a primary treatment or after surgical intervention. The cast helps maintain the correct position of the hip joint.

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Cast Placement

Spica casts are usually applied in a controlled setting, such as an operating room, while the child is sedated or under anesthesia. Proper placement is crucial to ensure the cast serves its intended purpose.

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The cast covers the lower abdomen and waist and includes one or both legs. It is left open between the legs to allow for toileting and cleaning.

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Duration

The duration of cast use depends on the condition being treated. For hip dysplasia, children may need to wear the cast for 12 to 18 weeks, with possible cast changes every 6 weeks.

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Managing the Cast

Cast Care Tips

• Monitor for Issues: Check the edges of the cast for skin problems such as redness, abrasions, or sores. Sharp edges can be smoothed with a nail file, and padded edges can be protected with tape (duct tape is effective).

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• Cleaning: Discuss with your doctor how to clean your child based on the cast materials. Avoid inserting objects into the cast to prevent sores or scratches.

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Clothing

• Fit: Larger clothing, such as oversized t-shirts, long night shirts, or loose dresses, typically fits over the cast. For older children, breakaway pants can be useful. Clothing can be adapted by splitting seams and using Velcro strips to fasten around the cast.

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• Footwear: Keep toes and feet warm with a sock if needed.

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Diet

• Avoid foods and drinks that may cause diarrhea. Smaller, frequent meals can help prevent bloating and tightness.

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Toileting and Diapering

• Diapering: For diapered children, tuck a smaller diaper into the front and back of the cast, then cover with a larger diaper to contain messes. Positioning the child on a slight incline can help gravity move urine and stool into the diaper. Check and change the diaper frequently to prevent soiling and diaper rash.

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• Older Children: Use a bedpan and handheld urinal as needed, with a washcloth between the cast and skin to prevent urine leakage.

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Bathing

• Give sponge baths daily, ensuring the cast remains dry. Avoid using lotions, powders, or oils near the cast, as they can cause skin irritation or soften the skin, leading to pressure sores.

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Comfort, Positioning, and Activity

• Entertainment: Provide activities like books, crafts, and board games. Place items within reach to keep your child entertained.

• Relief: Use a hair dryer on a cool setting to alleviate itching or dampness. Avoid using powders or creams inside the cast.

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• Positioning: Use pillows or cushions to help your child sit comfortably and change positions every 2 hours to prevent pressure sores. Protect the heels from pressure, even if they are included in the cast.

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Transportation

• Car Seats: Special car seats or harnesses may be necessary to accommodate the cast. The hospital may assist with fitting these seats.

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• Strollers and Wheelchairs: For smaller children, a stroller or wagon with pillows can be useful. For older children, a reclining wheelchair may be more appropriate.

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