When my daughter broke her leg, we brought home a scared and hurting little girl in the biggest, pinkest cement block you have ever seen. The doctors called it a spica cast, and then they told us that it is "a real bear", "notoriously difficult to deal with", and "unsanitary" to boot.
Over time, we became experts in our daughter's spica cast care, and you will, too. No matter how insufficient you feel right now, you are going to get so familiar with this process that when your child has this cast cut off, it will indeed feel strange to hold a little person who is so bendable!
DIAPERING
The biggest hurdle is the diapering, and I am going to share with you every practical tip I know and will add any that anyone else would like to contribute.
- ASK FOR HELP! If there is no help available to you, don't panic, it can be done alone, however, diapering can seem very overwhelming at first, and a second pair of hands to hold supplies, turn or lift your child, or grab something you forgot is a big help. In the hospital, get the nurses to help you. At home, take any pair of hands you can get. Hubby, friend, neighbor or sibling will do. As your child's pain level decreases this job will become easier and less delicate of an operation.
- PANTY LINERS! Get the very thinest ones you can find. These are going to keep your child's cast from getting extra stinky. With your child on their tummy, you are going to cover the back interior edge of the cast with panty liners. I used two. Remove the paper backing over the adhesive and slide them between the back of the cast and your child's back with the soft absorbant side against your child's skin. If you center it up you should have some of the liner poking out the top, and some out of the bottom. Wrap these edges over the cast and secure with medical tape. I used packing tape once in a pinch! I changed these every morning, and only when wet during the day. Repeat this process for other problem areas, like the where the leg joins the groin and the front of the cast if you need to. Don't be afraid to cut the pantiliners and place them wherever you have difficulty keeping the cast clean and dry. Our first 3 weeks were difficult, but once we started using this extra step, our daughter's cast remained dry the rest of the time she was in it!
- LAYERS! Some people like to line the inner diaper with a super absorbant maxi, it worked great for my daughter. I would tear the tabs off one of her regular diapers that I already had at home and line it with a super maxi pad (we really liked the kotex maxis that were the shorter lenth- experiment!). Then you stuff the edges of this diaper up into the cast. If you have a helper, get them to stand by your child's head and lift the cast slightly so you can get both hands under your child to stuff the back part of the opening first. If you are going it alone you can stuff the back one side at a time by turning your child slightly onto their side. Stuffing the front is easier, once you get the diaper under the edge of the cast, slide your fingers in by the waistline and pull the diaper up until it fits nicely.
- TOP IT OFF! Over all of this I suggest a pull-up. Open the side seams and put it on like a diaper over the top of the cast. This will keep the diaper you have worked so hard to get on in place, and will discourage your child from pulling it out! You only have to change this if it gets wet, which it sometimes might, or when it gets kind of worn out. The layers can get expensive, but I only had to change the pull up about twice a day.
- WATCH FOR SORES! Change diapers often if you suspect they are wet, and keep an eye out for any sores or rash. Use diaper creme if you think it will help!
- KEEP YOUR STUFF TOGETHER! I used a basket to keep diapers, pull ups, maxis, pantiliners, wipes, tape, scissors, medications, small pad of paper and pen (to keep track of when to give the next dose and write down things I thought of to ask someone to pick up at the store). I also kept a few small toys in it, and whenever I did not have help available, at least everything I needed was in one place.
- IN CASE OF ACCIDENT... When your child's cast gets dirty clean it as best as you can and blow dry on a cool setting. I used a toothbrush to scrub it with just a tiny bit of toothpaste - I mean tiny. Then I wiped it off with a damp cloth and blowdryed. Disney movies are your friend at this time! Accidents will happen, but remember this is a temporary thing! Some people tape odor eaters to the outside of the cast to help with odor, but for us, once we could keep her DRY, the odor problem was not an issue unless you pressed your nose against the cast. The pantiliners really helped.
- KEEP A SENSE OF HUMOR! When all else fails, sometimes laughing is all you can do. I spent 6 hours one day blowdrying, scrubbing, and blowdrying some more. When my husband came home my daughter was propped up on our bed watching cinderella on her tummy while I was blowdrying her behind, AGAIN. I told my husband to go get the camera, because, well it was just funny.
POSITIONING
This might sound simple, but the very thought of keeping my daughter clean with sponge baths terrified me. I just couldn't conceive of how I could wash waist length hair on a two and half year old girl and not get that cast wet. Thankfully, my brother had just begun his clinicals in the hospital and had spent several weeks giving sponge baths to quadriplegics and elderly patients on his rounds. He came and gave my daughter her first sponge bath and showed me how we could do this and still keep her cast dry.
Materials to gather before you start (you may not need all of these for a child with short hair):
Take your two large bowls and baby wash to the sink, filling one with clean warm water, and the other with warm water and a VERY SMALL AMOUNT of baby wash. The more you use, the more difficult it is to get it off, and you don't want to leave any soap residue on your child's skin.
If you have a squirt bottle, go ahead and fill it with warm water, too. Take these supplies to your makeshift spongebath station, and put on the floor.
Check now and make sure you have all your supplies in this spot, and arrange your pillows before bringing your child over. Put the large pillow (we used a square gusseted floor pillow for this) on the floor and drape a towel over it. Have the other two pillows nearby, and one of the cake pans right next to the large pillow.
When you bring your child over you are going to lay their body and cast on the pillow, tummy side up, and their head is going to be a little lower than their body, with the back of their head in the cake pan. Make certain that the big pillow is thick enough so that your child's neck is not resting on the edge of the cake pan, that would be really uncomfortable! Check to see that you have your towels and pillows nearby, in case you need to roll one up and put one behind their neck, and you will probably need to prop up the cast on one of the pillows. You will put the other one under their head in just a moment when you have washed their hair.
Now once you have brought your child over and gotten them situated on the pillows, the waterworks begin! Put a clean wash rag in each of your bowls, one with soapy water and one with clean water. When you use the soapy rag, make sure it is wrung out until it is almost dry. Start with your child's face and neck, wiping them with the soapy rag, and following immediately with the clean rag, also wrung out most of the way. Feel your child's skin as you go, making sure it is clean and that there is no soap left behind! If it is cool in the room, go ahead and dry each area after washing.
Next go to the hair. I'm going to tell you what I did to wash long hair, if your child's hair is short some of these steps may not be necessary.
Bring your large bowls close to your child's hair, but out of their reach if they are young. Wet the hair by slowly wringing out your wet rag onto their hair, or using the squeeze bottle if you have one. Once it is wet, get a TINY AMOUNT of shampoo, and lather it in your hands. Spread the lather onto your child's hair, using more if needed, but only just as much as you need. Now you are going to rinse. Don't forget to lift your child's head and get the back of their head clean, too. Once the scalp is pretty well rinsed out, lift your child's head and slide out the cake pan, replacing it with your second cake pan immediately and continue rinsing. If you need to refill your squeeze bottle, just refill it from your clean water bowl so you don't have to get up. My daughter liked this when I told her she was getting her hair washed like Cinderella got her hair washed by the bluebirds. Once the hair is completely free of shampoo, remove the cake pan, wrap a towel around their hair and slide the other pillow under their head.
Next, the arms. Don't forget to make sure your rags are wrung out almost all the way before you bring them near your child! Keep checking the skin as you go, making sure you leave no soap behind.
At this point you might want to wrap a towel around your child's cast, and tuck it into the waist. I only did this the first few times until I got comfortable with sponge bathing. Wash your child's tummy, roll them to one side and wash the back, and repeat for the other side of the back if you couldn't reach it all the first time. Use this time to get a good look under the edges of the cast to monitor your child's skin for any sores or breakdown.
Wash the free leg if your child's cast leaves one out, and dry it as well.
Remove the diaper and wash your child's bottom. If you have a very tiny baby, you may need to modify how you do this in order to keep from having any bathtime surprises. Extra dry washcloths can come in handy for this! I did not always use the soapy water on the diaper area. If I had been able to keep her bottom very clean that day I only used the clean water, so there was no chance of irritating soap residue in the diaper area. KEEP YOUR RAGS JUST BARELY DAMP DURING THIS PROCESS IN ORDER TO HELP YOU KEEP THE CAST DRY. Keep checking the skin under the cast for any sores or breakdown that you would need to call your doctor about.
Keep your baby warm during the bath, and don't be afraid to get someone to help you! They can wash one arm as you wash the other, help hold your child's head while washing hair, turn your child on their side for back and diaper washing, or run get anything you forgot!
You will get good at this with practice!
- BEAN BAGS. Buy a bean bag or borrow one. My mother bought one for about $20 and it was worth every penny. It is easy to slightly alter your child's position frequently, with out disturbing them too much, allowing them to rest and protecting them from pressure sores. As your child heals he or she will do a lot of adjusting on their own!
- LOTS OF PILLOWS. Prop them up on the couch, in a recliner, on the floor, or a bed. Always check each limb and their waist to make sure nothing is pinched or twisted when you position them.
- KEEP THEM COOL. That cast is warm! If you cover them up too much they will get sweaty, and STINKY. In warm climates put a kneesock on the free legif it feels cold, and a nice loose t-shirt that will cover the top of the cast. This will keep small toys and crumbs from making their way down into the cast and causing discomfort. Remember not to use excess blankets at night.
- WAGON! When our daughter broke her leg, our church bought us a radio flyer wagon, and it was a real life saver. If you don't have one, borrow or buy one. You will have to use creative pillow solutions to keep them comfortable in the wagon. We used some old dining room chair pads (4) and a wedge pillow from the bedroom.
- LAP TABLE. If you can find one that will fit over your child's new cement lap, this is wonderful to have for coloring, snacking, and just feeling normal.
DISTRACTION
- Movies
- toys
- action figures/ baby dolls
- stickers
- colors
- washable markers (fascinating for kids who aren't usually allowed markers)
- books
- sponge bath
- wagon rides
- legos
- colorforms (reusable stickers)
Sponge Bathing
This might sound simple, but the very thought of keeping my daughter clean with sponge baths terrified me. I just couldn't conceive of how I could wash waist length hair on a two and half year old girl and not get that cast wet. Thankfully, my brother had just begun his clinicals in the hospital and had spent several weeks giving sponge baths to quadriplegics and elderly patients on his rounds. He came and gave my daughter her first sponge bath and showed me how we could do this and still keep her cast dry.
Materials to gather before you start (you may not need all of these for a child with short hair):
- Towels (2-3)
- washcloths (3-4)
- 9x13 cake pans(2) or casseroles with short sides (for washing hair)
- Large bowls(2)
- Pillows (3) - 1 large enough to lay most of your child on(make sure it is thick, or use 2) and 2 smaller ones
- small squeeze squirt bottle (optional)
- Baby wash
- baby shampoo
- Clean diaper and diapering supplies
- clean clothes
- Press 'n' seal to help keep cast edges dry (optional tip, I didn't use this but some love it)
- roll of paper towels to mop up any spills
Take your two large bowls and baby wash to the sink, filling one with clean warm water, and the other with warm water and a VERY SMALL AMOUNT of baby wash. The more you use, the more difficult it is to get it off, and you don't want to leave any soap residue on your child's skin.
If you have a squirt bottle, go ahead and fill it with warm water, too. Take these supplies to your makeshift spongebath station, and put on the floor.
Check now and make sure you have all your supplies in this spot, and arrange your pillows before bringing your child over. Put the large pillow (we used a square gusseted floor pillow for this) on the floor and drape a towel over it. Have the other two pillows nearby, and one of the cake pans right next to the large pillow.
When you bring your child over you are going to lay their body and cast on the pillow, tummy side up, and their head is going to be a little lower than their body, with the back of their head in the cake pan. Make certain that the big pillow is thick enough so that your child's neck is not resting on the edge of the cake pan, that would be really uncomfortable! Check to see that you have your towels and pillows nearby, in case you need to roll one up and put one behind their neck, and you will probably need to prop up the cast on one of the pillows. You will put the other one under their head in just a moment when you have washed their hair.
Now once you have brought your child over and gotten them situated on the pillows, the waterworks begin! Put a clean wash rag in each of your bowls, one with soapy water and one with clean water. When you use the soapy rag, make sure it is wrung out until it is almost dry. Start with your child's face and neck, wiping them with the soapy rag, and following immediately with the clean rag, also wrung out most of the way. Feel your child's skin as you go, making sure it is clean and that there is no soap left behind! If it is cool in the room, go ahead and dry each area after washing.
Next go to the hair. I'm going to tell you what I did to wash long hair, if your child's hair is short some of these steps may not be necessary.
Bring your large bowls close to your child's hair, but out of their reach if they are young. Wet the hair by slowly wringing out your wet rag onto their hair, or using the squeeze bottle if you have one. Once it is wet, get a TINY AMOUNT of shampoo, and lather it in your hands. Spread the lather onto your child's hair, using more if needed, but only just as much as you need. Now you are going to rinse. Don't forget to lift your child's head and get the back of their head clean, too. Once the scalp is pretty well rinsed out, lift your child's head and slide out the cake pan, replacing it with your second cake pan immediately and continue rinsing. If you need to refill your squeeze bottle, just refill it from your clean water bowl so you don't have to get up. My daughter liked this when I told her she was getting her hair washed like Cinderella got her hair washed by the bluebirds. Once the hair is completely free of shampoo, remove the cake pan, wrap a towel around their hair and slide the other pillow under their head.
Next, the arms. Don't forget to make sure your rags are wrung out almost all the way before you bring them near your child! Keep checking the skin as you go, making sure you leave no soap behind.
At this point you might want to wrap a towel around your child's cast, and tuck it into the waist. I only did this the first few times until I got comfortable with sponge bathing. Wash your child's tummy, roll them to one side and wash the back, and repeat for the other side of the back if you couldn't reach it all the first time. Use this time to get a good look under the edges of the cast to monitor your child's skin for any sores or breakdown.
Wash the free leg if your child's cast leaves one out, and dry it as well.
Remove the diaper and wash your child's bottom. If you have a very tiny baby, you may need to modify how you do this in order to keep from having any bathtime surprises. Extra dry washcloths can come in handy for this! I did not always use the soapy water on the diaper area. If I had been able to keep her bottom very clean that day I only used the clean water, so there was no chance of irritating soap residue in the diaper area. KEEP YOUR RAGS JUST BARELY DAMP DURING THIS PROCESS IN ORDER TO HELP YOU KEEP THE CAST DRY. Keep checking the skin under the cast for any sores or breakdown that you would need to call your doctor about.
Keep your baby warm during the bath, and don't be afraid to get someone to help you! They can wash one arm as you wash the other, help hold your child's head while washing hair, turn your child on their side for back and diaper washing, or run get anything you forgot!
You will get good at this with practice!
Pain Management
Follow your doctor's directions for pain management, and ask them for tips if you are having trouble getting your child to take their medicine. Our nurse told us to hide our child's meds in chocolate milk. This worked some of the time. Ask your doctor, nurse, or pharmacist what would best mask your child's type of medicine. Most pharmacies will flavor medicines now, although this may not help with some types of pain meds. Some of them just plain taste yucky no matter what you do!
Be aware, too, that the weather may affect your child's pain level. My daughter had been healing very well, getting by on just occasional ibuprofen when we had a setback. Her pain level INCREASED unexpectedly, and we were back to using Lortab. When I spoke with her nurse, we could correspond the date of the pain worsening with a hurricane remnant that had passed through our area, and as soon as the barometer went back to normal her pain stopped again. The nurse told me that in her experience, this is common - IF YOU HAVE ANY CONCERNS ABOUT YOUR CHILD'S LEVEL OF PAIN, CALL YOUR DOCTOR IMMEDIATELY, but be aware that if you see a big storm coming in the seven day forecast, you might want to get caught up on housework before it gets here so you can be prepared to give your hurting child your attention on those rainy days!
Be aware, too, that the weather may affect your child's pain level. My daughter had been healing very well, getting by on just occasional ibuprofen when we had a setback. Her pain level INCREASED unexpectedly, and we were back to using Lortab. When I spoke with her nurse, we could correspond the date of the pain worsening with a hurricane remnant that had passed through our area, and as soon as the barometer went back to normal her pain stopped again. The nurse told me that in her experience, this is common - IF YOU HAVE ANY CONCERNS ABOUT YOUR CHILD'S LEVEL OF PAIN, CALL YOUR DOCTOR IMMEDIATELY, but be aware that if you see a big storm coming in the seven day forecast, you might want to get caught up on housework before it gets here so you can be prepared to give your hurting child your attention on those rainy days!
Remaining Sane
This is not easy. I had days I thought I would pull my hair out. I didn't know if I could have enough patience to make it through the current diaper change, let alone the rest of the day. My two older boys still needed food, clean clothes, and a mother who was not growling or yelling at them to be careful around their sister. Then there were the hours spent blow drying the cast, and comforting my daughter as best as I could while she cried that it hurt and asked me to rub an injury I could not even reach.
The nights were often full of broken sleep, and the days could be difficult to manage. But I did not do this alone. I had someone who wiped away my tears while I wiped away my daughter's . I had someone whose patience said "What can I do to help you?" when mine wanted to say "What is it this time?"
There are few things in this world that will drive you to your knees like seeing your child in pain, and if this has put you there, there is NO SHAME IN IT. Don't be afraid to tell Him you need Him. If you are overwhelmed and just can't do this on your own, tell Him. He knows exactly what it is like to see a child in pain, and He wants to help you.
This is not easy. I had days I thought I would pull my hair out. I didn't know if I could have enough patience to make it through the current diaper change, let alone the rest of the day. My two older boys still needed food, clean clothes, and a mother who was not growling or yelling at them to be careful around their sister. Then there were the hours spent blow drying the cast, and comforting my daughter as best as I could while she cried that it hurt and asked me to rub an injury I could not even reach.
The nights were often full of broken sleep, and the days could be difficult to manage. But I did not do this alone. I had someone who wiped away my tears while I wiped away my daughter's . I had someone whose patience said "What can I do to help you?" when mine wanted to say "What is it this time?"
There are few things in this world that will drive you to your knees like seeing your child in pain, and if this has put you there, there is NO SHAME IN IT. Don't be afraid to tell Him you need Him. If you are overwhelmed and just can't do this on your own, tell Him. He knows exactly what it is like to see a child in pain, and He wants to help you.
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