Hopefully none of you will have to experience the joy of a spica cast first hand. If you do, here are a few tips I picked up from my own experience.
Spica casts (pronounced spike-uh) are used for a variety of reasons, but are most commonly used to immobilize the hips and thighs. The babe got a hairline compression fracture in his femur, and this is what he looked like after getting his cast:
His is considered a 1/2 spica cast, because only one leg goes to the ankle. I would argue there is nothing HALF about it. For hip issues that involve legs needing to be turned, sometimes a bar is placed between the legs to encourage twisting.
I've never been in a cast myself, but I always hear about people itching. It doesn't help when you begin with bad eczema. Within a few days, the babe was looking like this:
Overusing steroid skin cream can thin the skin and make things worse. Every 3-4 days we would mix lotion and cortozine in a 3-1 ratio and spread it as far down as we could reach. After each sponge bath he would get a light coating of lotion and a cool blow dryer to make sure all the moisture was out of the cast.
There are certain 'rules' for caring for a spica cast: don't get it wet, don't stick anything down it (powder, things to scratch with, etc.), try your best to catch all of their 'mess' out the bottom end, and love your child when they become stinky!!
Well, that wasn't enough for me. We had weeks left in this thing and my poor baby's skin was literally going to rub off!
So, as they say, necessity was the mother of invention! First thing I did was get duct tape and wrap it as far in the cast as the inside diaper would cover (blue duct tape to blend in). I didn't want his skin rubbing against duct tape, but the smaller inside diaper went up his chest about 5 inches and about 1/2 an inch down his legs. This made a waterproof barrier at the bottom that could be wiped clean during changing.
Then, I took a newly washed dri-fit athletic shirt (one that is made to wick away moisture) and cut it into four large trapezoid shapes (think triangle with the top cut off). I fed the shirt through the cast, pulled it tight, and taped the edges together with duct tape (black/white checker). I was careful to be sure the inside of the shirt was facing his skin so the wicking would work properly. This did two things: 1) keep the itchy gauze off of his skin 2) give a protective layer I could remove and wash if we had any accidents.
I did the same on the front and back and changed the 'inserts' weekly (or in the event of a mess). The shirt made two sets of inserts, so there was a backup on hand at all times. They went into the laundry with our normal load, except for the set that went through a blow-out... those went straight to the trash.
You can see in the pictures above, the spica requires a double-diaper. The inner diaper is 1 or 2 sizes smaller than the normal diaper size the baby would wear. We were only 1 size smaller, because our cast had quite a bit of room between his tummy and the cast. Some casts focused on immobilizing the hips may be tighter and won't allow for a diaper to be tucked in so far.
On the outside, you have a 'catcher' diaper that misses anything the inside doesn't catch. It also loosely holds the inside diaper in, so it doesn't fall out. Ours was 2 sizes larger than regular.
The silver lining is that bowels are less active with less motion, so keeping a good diet is key. The last thing we wanted is a constipated baby!!
One of the other things people don't think about is the fact that you cannot bend in half with a torso cast. That means no high chair, no stroller, no car seat... so, the hospital provided a 'car bed' for us to use. With all of the marketing car seats do to inform you of their safety features, I was honestly scared strapping him in this tiny bucket. It is literally a plastic tub with a liner and two loops to go through the seat belt. He hates not being able to see out the windows, but that's better than not being properly harnessed in his normal seat.
Another life saver was a wagon. It was easy to slip the babe in and wedge a pillow behind him. We went for walks around the neighborhood and even used it inside when I didn't have the energy to tote him around the house while I did chores.
I also created a desk/command center for the babe when he was on the couch. Since he can't bend, he can't reach things in his lap. So, he was restricted to holding one item at a time. I took a medium sized mailing box and cut out holes for his legs. I also cut off one of the corners. Then, I wrapped it in wrapping paper and coated it in packing tape (essentially waterproofing it).
It allows him to keep food and toys within reach, and has given him the independence to choose what he wants to play with whenever he is ready.
Luckily, babies and children are resilient. Within a week the babe was crab-walking around the coffee table, and within 2 weeks he was pushing his toys around the house. I think spica casts are a test in patience, but once you get it figured out you can develop a routine.
If you ever have to deal with a spica cast, know that it is only temporary. It is protecting and healing your baby, and that makes any headache/backache/mess worth it!!!
It is important to note that I am not a medical professional, just a mom who made it work for her baby! If you are unsure about anything, please check with your doctor first.
