They should be warm and pink. When you press on the toenail, it will turn white. When you let go, it should turn pink in seconds. If it takes longer, you child's cast may be too tight and you should elevate that leg for 15 minutes. Your child should be able to move his toes. The toes should not be swollen. Traveling Your child must wear a seat belt in a stroller, wheelchair or car.
If your child needs a wheelchair, the Orthopedic Nurse Clinician will order one for you. It is your responsibility to return the wheelchair when you are done using it. Do not allow walking in a spica cast. This may disrupt the healing process. Some children do not fit safely in their car seat after they are in a spica cast. There are options to rent a car seat from the Trauma Department discussed in more detail later.
Cast care Keep the cast dry. If the cast becomes wet, it can hurt your child's skin. Do not try to dry cast with something warm i. Do not put anything down inside the cast. This can cause a sore or an infection. Protect the cast with a towel or large bib from small toys, dirt or pieces of food.
If something does get into the cast and you can see it, try to remove it with your hand. If you cannot see the object or can't reach it, call your doctor. If your child complains of itching, use a blow dryer set on cool to blow air down the cast or try scratching another part of the body.
Your cast has a Gortex lining that helps to protect and "waterproof" the inside of the cast, especially around the groin area. There are special ways to "double diaper" to help protect from accidents. Your nurse can show you how to do this. Do not allow the child to pull the padding out of the cast.
The padding protects the skin from rubbing or sores. Skin care Do not use lotions, oils or powder on the skin under the cast. Check the skin daily for sore areas. Use a flashlight to look inside the cast. Change your child's position at least every 2 hours. Lying in one position in the heavy cast can cause skin sores under the cast. Use pillows, blanket rolls or chair cushions for support. Put a pillow or blanket roll under the lower leg not under the heel to keep the heel off of the bed.
Don't forget that you can put your child on their belly as well to give their butt a rest! Place a folded blanket, sheet or pillow lengthwise under the chest and abdomen when your child is lying on their stomach. Move the child to the foot of the bed so that the toes hang over the edge of the mattress.
If you notice a rash on your child's skin, try to cleanse the skin with some mild soap and water on a washcloth and allow to air dry. Call the Orthopedic Nurse Clinician if you think it is getting worse or if you see bleeding.
Diet Your child may want to eat small, frequent meals instead of three meals a day. To prevent constipation, your child needs to drink a lot of fluids and eat foods with roughage. Some foods with roughage are raw carrots, fruits and cereals like oatmeal and graham crackers.
Be careful with small pieces of food. Your child may choke because they cannot sit up straight in the cast. Going to the bathroom If your child wears diapers It is best to use a method called "double diapering.
Check the diaper often and at least once overnight. Safe sleep guidelines still apply to babies in hip spicas. Nappies need to be checked often at least every two hours during the day and every four hours during the night. Nappies must be changed as soon as they are wet or soiled. Use baby wipes to clean inside the plaster cast.
For extra protection, tuck sanitary or incontinence pads into the front and back of the toileting area. Cover with a disposable nappy to keep the cast dry.
Older children can use a urine bottle or pan for toileting. They can be lifted onto the toilet, making sure they are sitting as upright as possible This will be demonstrated prior to discharge. An over-toilet aid with arm supports and adjustable height legs may assist with toilet transfers please seek advice from your occupational therapist.
Leaving the toileting area open will assist in airing the cast. Positioning of your child with their head elevated above the level of his hips can also prevent urine or faeces from soiling the cast.
Car transport and moving around In Queensland children aged seven years and under must be secured in an approved child restraint when travelling in a car. Things to remember Do not get the hip spica wet Avoid using powders, oils and lotions in the casts Check skin around the edges of the plaster daily for redness, blisters, pressure areas or skin irritations Your child will continue to grow while in a hip spica.
Toys should be placed within easy reach. Frequent changes of scenery will help with boredom. Regular interaction with family and friends is important. Feeding and diet Breastfeeding infants can and should continue to breastfeed. If your child is eating solids, feed them smaller meals more often to reduce bloating of the stomach.
Sit your child as upright as possible when feeding probably in their pram or wheelchair , ensuring the child and chair are well secured.
Discourage large amounts of fluid and food intake prior to bedtime or sleep to avoid increase in excretions faeces and urine. Encourage and maintain well balanced healthy intake from all food groups to help prevent constipation and to promote healing.
The total time spent in the cast depends of the appearance of the hip on x-ray with the arthrogram. After the final cast has been removed, the child is normally placed into a hip abduction brace for several more weeks. The brace allows for more hip movement than a cast. This weaning time helps to reintroduce more range of motion to the hips while the hip is growing and becoming more stable. Morning of surgery You should report to the anesthesia pre-op area at the designated time.
After surgery The hip spica cast will be applied in the operating room after surgery is completed and while your child is still asleep. Things you can expect: Your child will be lying on pillows in the hip spica cast. Smaller children will be propped sitting upright, which allows for optimal positioning of the hips down into the cast.
Your child will have an IV intravenous line that was started in the operating room. The IV will be continued until the child is able to take an adequate amount of fluids and is eating solids. Please ask your nurse before giving your child anything to eat or drink. The nurses will be measuring how much your child drinks and the amount of urinary output. Your child may experience pain or muscle spasms. The nurse will give pain medication via the lV or by mouth.
Pain medication will be started as soon as possible and given as often as needed. It is important that you, and if possible your child, take an active role in assessing and reporting pain to the nurse so that effective measures can be taken. Your child may be nauseated or may vomit. Medications will be available to control this if the problem persists. The nurse will be monitoring your child's vital signs frequently and checking the child's toes for color, movement, sensation, and warmth.
Toes should remain warm and pink with good blood return. Your child may have some drainage coming through the cast. This is normal and the nurses will be monitoring increases.
This is normal due to the close proximity of some surgical incisions to the genital area. Ice and elevation may reduce the swelling and discomfort that may accompany it. X-rays may be taken while your child is in Post Anesthesia Care Unit or after returning to the hospital room.
Care of the hip spica cast Keep the cast clean and dry Cast care and skin care are closely linked. Remember: A cast that feels dry on the outside is not necessarily dry on the inside. Cleaning the cast If the cast becomes soiled from stool, it may be cleaned by using a damp cloth and a small amount of cleanser. Drying the cast If the cast becomes damp, it can be dried by exposing it to air during the child's nap time. Bathing Give your child a sponge bath daily.
Skin and cast inspection Check carefully beneath the cast edges morning and evening for skin irritation, redness, blistering, open or draining areas, or pressure spots. Diet Avoid introducing new fruit juices or foods which could cause loose stools.
Clothing Velcro can be used on legs of clothing to ease in dressing. Pain medication at home Appropriate pain medication with instructions will be sent home with you. Positioning and turning The child in a hip spica cast must be positioned properly and turned regularly to prevent skin problems and to provide maximum comfort. Telephone numbers How to reach the orthopedic doctor or nurse For nursing questions about your child's care call the Orthopedic Clinic at If you would like to talk with your doctor, call the Orthopedic Clinic, a.
After 5 p. Feel free to call any time—day or night—if you have questions or problems. Helpful suggestions The following are suggestions from parents of children in hip spica casts: Diapers: Use adult incontinence pads in the genital area.
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