by Jeremy Rutherfurd

Created on: October 11, 2008   Last Updated: May 09, 2009

If your child has broken a leg and is wearing a hip spica cast, it can be a challenge to keep it clean and dry. Our son Akira, who fractured his femur in a fall, wore a hip spica cast for seven and a half weeks. (See, "Akira Breaks His Leg Here are some tips on how to prevent it from getting soiled:

1. Tuck the diaper inside the cast.
When the hip spica cast was first put on at the hospital, the nurses had the diaper fastened around the outside of the cast. We found this impractical and simply tucked the ends up under the cast.

2. Cut the peel-off adhesives
from the diaper. These stuck to Akira's hip spica cast and the petaling and caused no end of problems. If your child doesn't move much, the diaper should stay tucked up into the cast. If he does move around - as Akira did - his caretaker should check frequently to make sure the diaper is in place.

3. Check the diaper every hour.
We forgot to check him once and his diaper became full of urine, which leaked and soaked the inner lining of the hip spica cast. He smelled like a public urinal for the next two days (despite the liberal application of Febreze).

4. Use moleskin "petaling" to keep the edges clean.
Cast petaling - covering the edges of a cast with waterproof tape to protect the child's skin - can also help prevent the hip spica cast from getting soiled. We used moleskin, a tape with a soft, almost velvety texture. It is gentle on the skin and somewhat absorbent. Once it becomes soaked with sweat or urine (or worse) - and this will happen, no matter what you do, believe me - simply replace it.

It's true that moleskin doesn't stick very well to fiberglass casts. It didn't with Akira's. We solved this problem by taping down the edges of the moleskin on the outside of the hip spica cast with duct tape. (Moleskin adhered with no problem to the inner lining of the cast.)

5. Feed your child high-fiber foods.
I can't overstress the importance of this. Soft or liquid feces is much more likely to leak out of the diaper and soil the inside of the hip spica cast. This is disastrous, as it can't be cleaned and will irritate your child's skin. (Urine, by contrast, is sterile.) This could lead to a skin infection, or worse, so the only recourse is to remove the stained cast and put on a new one, which, with a 2 or 3 year old, means putting him under.

I made sure Akira ate high-fiber foods at every meal: strawberries or high-fiber cereal for breakfast, whole grain bread or carrots for lunch and dinner, other fruits and vegetables whenever possible. His stool was almost always solid. (But beware of grapes: too many of these and his stool will become very loose.)

6. Keep your child away from sick kids, especially those with diarrhea. If he gets diarrhea and it leaks out of the diaper and down his legs, the hip spica cast will have to be removed and a new one put one.

7. Take special care when bathing your child.
We were advised to bathe Akira every day. This is necessary because children sweat a lot wearing a hip spica cast. To keep his cast dry during the bath, we laid Akira on a plastic sheet placed on a bed and wiped him down with a damp washcloth.

To wash his hair - which we also did every day - we had him lie on his back and hang his head over the side of the bed (the plastic sheet hung over the side of the bed too, under him). We then shampooed and rinsed his hair over a plastic storage container - one of those for clothes which you can find at Wal-Mart or Target.

Further reading:
Hip Spica Cast Patient Information (Vanderbilt Children's Hospital)
Hip Spica Cast: A Guide for Patients (Univ. of Iowa Children's Hospital)

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