Cast Care Instructions

Purpose

A cast is a hard splint that helps position an arm or leg for healing. The purpose of a cast is to prevent movement and protect a fracture, possible fracture, or soft tissue injury until it heals. The inside layer of the cast is cotton padding used to protect the skin, and the outside of the cast is made of plaster or fiberglass.

Diet

You may follow your child’s usual home diet. Encourage fluids and foods high in fiber, vitamin D and calcium. No carbonated drinks or exposure to second hand smoke.

Pain management

Your child may have pain at the fracture or surgical incision site. Depending on your child’s diagnosis, the doctor may order a prescription for pain medication or may recommend acetaminophen or ibuprofen. Follow the directions given to you by your doctor or nurse for pain management.  If the recommended medications do not adequately control the child’s pain please call the Orthopedic Division.

Position the casted arm or leg above the level of the heart to prevent pain and swelling for at least the first 24 hours after cast placement. Pillows may be used to elevate a leg or sling to elevate the arm. Wiggling of the fingers or toes will also help with swelling.

Basic cast care

• Check the cast daily for cracks and changes.
• Keep the cast dry and clean.
• Be sure the cast edges are not cutting into or pinching the skin.
• We may have you ‘petal’ the rough edges of the cast to protect the skin with ‘moleskin’ tape. Moleskin can be purchased at any drug store. Remove any ‘petals’ that become wet or soiled and replace with new ‘petals’. Simply tape ½ of the tape to the outside of the cast and the other ½ can go directly onto the cast padding. The cotton inside the cast can also be removed if it is soiled or wet.

Checking the skin

• Check the skin around all cast edges daily for redness, swelling, or sores. Most swelling will go away with repositioning, turning or massaging the area.
• Check for color changes by comparing the casted arm or leg with the non-casted arm or leg. If the digits appear discolored (pale, blue, purple, red)  and/or do not match the other side please call the Orthopedic Division immediately.
• Check skin temperature by comparing the casted arm or leg with the non-casted arm or leg. If the skin is cool or clammy and/or does not match the other side please call the Orthopedic Division immediately.

Checking movement and sensation

• Make sure your child can wiggle his or her toes/fingers just like before the cast.
• Check to make sure your child can tell which toe or finger is being touched.
• To check arm or leg sensations on a small child squeeze the child’s fingers or toes. Your child should react by pulling away.
• Check for complaints of numbness, tingling or increased pain.
• Please call the Orthopedic Division with any concerns.

Hygiene

• Sponge baths may be given as needed. NO showers or baths.
• Keep the cast DRY. Wash all areas NOT covered by the cast.
• DO NOT use plastic bags to cover the cast, they will leak.
• DO NOT use powder, oils, or greasy creams near the cast edges.
• The cast may have an odor – especially if it is wet or soiled.
• Care should be taken to keep all small items (crumbs of food, coins, small toys, etc.) from being placed inside the cast.

Clothing

Use loose fitting clothing for comfort. If needed, place snaps or Velcro along the arm or leg of clothing to make changing easier.

Itching

Skin under the cast may itch. Do not to insert anything into the cast to itch the skin; this may cause a sore or an infection. A hair dryer on cool setting only may be used to blow cool air into the cast to relieve itching. Also, placing something that ‘vibrates’ on the cast may relieve itching.

Decorating the cast

Permanent markers may be used to decorate the cast. No paint. Do not use rhinestones or other metallic objects on the cast. Do not use any type of tape on the cast that will prevent the cast from breathing properly.

Safety

A seatbelt must always be worn when using a wheelchair or in the car.

Cast Care Questions?

Hospital Cast Room: 858-576-1700, ext. 224570

Escondido Cast Room: 858-576-1700, ext. 258371

Orthopedic Division: 858-966-6789

Orthopedic Division After-Hours Triage (4:30 p.m. to 8 a.m.): 858-576-1700

When to call the Orthopedic Division

1. Numbness, tingling, increasing pain, decreased sensation, or color changes in fingers and toes (pale, blue, purple, red) when compared to the non-casted arm or leg.
2. Pain under the cast worsens, becomes severe and pain medications do not help.
3. Any redness, swelling or sores around the cast edges that is not resolved with repositioning or massage.
4. Drainage through the cast or out of the end of the cast.
5. Cast feels too loose or too tight.
6. Cast becomes soft or breaks.
7. Extremely foul smelling cast.

When to call your Pediatrician

1. Constipation which is defined as increased effort with stooling and/or change in daily pattern.
2. Any other medically related problems.