by Jeremy Rutherfurd

Created on: October 11, 2008   Last Updated: June 14, 2009

If your child is 2 to 3 years old and in a hip spica cast, be prepared for a lot of extra work.

Our 3-year-old son Akira broke his left femur this summer and was in a fiberglass hip spica cast - that encircled his waist and both legs - for seven and a half weeks. I personally took care of him and hired a babysitter to look after his triplet brothers. This was a burdensome expense, but there was no way to avoid it. Here are some care-giving tips based on our experience:

1. Watch the child at all times. Someone should be assigned to care for him, and him only, the entire time he's in the cast. There are several reasons for this:

a) He may stick toys, utensils or other objects down the cast. He might do this to scratch an itch - hip spica casts can get hot, and your child will sweat - or just for fun. If things get lodged in the cast, this could cause extreme irritation, break the skin and ultimately result in an infection. The only way to remedy this is to remove the cast, which means a new one will have to be put on.

Besides being a huge hassle for you and your family, this could also be putting your child at risk. As patients, 2 and 3 year olds tend not to be cooperative and are usually put to sleep for the application of a hip spica cast. Whenever general anesthesia is administered there is always the possibility - however remote - that the patient could die.

b) He might accidentally re-injure himself. After Akira had healed for a few weeks and built up some upper-body strength, he kept trying to drag himself across the floor. We once caught him trying to pull himself up the stairs. Another time Akira attempted to stand up. In both cases he could have suffered a fall, damaged the cast and hurt himself.

c) He may drop food or pour liquid into the hip spica cast. Because you can't clean the interior of the cast, this could necessitate the removal and reapplication of the cast. Your child may also eat something that gives him diarrhea, which may run down into the cast.

d) His diaper needs to be checked often.
If he is not toilet trained, as my son wasn't, he'll have to wear a diaper. If the diaper gets full and leaks it will overflow and soak into the lining of the hip spica cast. We checked Akira's diaper every hour. I once went two hours without checking him and his diaper leaked. His cast smelled like a public urinal for days afterward.

You should also check frequently to make sure the diaper is on properly. We found the best way for Akira to wear

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