Cast care
*For the first 48-72 hours after casting or surgery, your child’s arm or leg should remain elevated with the extremity higher than the heart, to help prevent swelling. In addition, it is important that you check the extremity and the condition of the cast daily and throughout the casting weeks. If you notice anything out of the ordinary, do not hesitate to call our office.
GETTING A CAST
In this video, Dr. Hilton Gottschalk discusses what to expect when getting a cast, including the types of casts we use, how we put it on, and how we take it off.
GENERAL CAST CARE
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Keep the cast as clean and dry as possible. A wet cast may soften and crack. If the cast gets wet, a hairdryer on a cool setting can be used to dry the edges of the cast. If the cast gets soaked it will need to be removed and replaced.
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Do NOT use oil or lotion around the edges of the cast, it will soften the skin, which could lead to irritation or skin breakdown.
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Care should be taken to keep small things (crumbs of food, bobby pins. coins, small toys, pencil erasers, etc.) from falling inside the cast. They can cause irritation or skin breakdown which can lead to infection.
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Do NOT use powder inside the cast as it may cake and irritate the skin.
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Do NOT remove the cast unless your doctor tells you to do so.
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Never permit a child in a cast to ride in a boat.
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Some children complain of itching under the cast. Do NOT put anything inside the cast to scratch. To help with the itching you can rub the skin around the cast edges with your fingertips {no nails) or you can rub the opposite arm/leg. Tapping the cast or sitting the child in front of a fan can help as well. Additionally, you can blow air from a hair dryer on the cool setting down the cast.
ACTIVITY GUIDELINES
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Your child may not participate in organized sports or physical education.
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Your child is limited to ground-level play only, no bikes, rollerblades, skateboards, playscapes, trampolines, wheeled or ball toys, etc.
CALL YOUR DOCTOR IF:
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The arm or leg under the cast is:
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Numb or tingling
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Blue, pale or cold
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Red, puffy or hot
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Has less movement of fingers/toes than before
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Your child begins to complain of increased pain from under the cast.
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The cast becomes too loose and slips/moves up and down easily.
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The cast has slipped and less of the fingers/toes are showing than when the cast was originally placed on the child.
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There are areas of redness that do not improve with position change or there are areas of broken skin.
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You notice any drainage coming from the cast.
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You notice any foul odor coming from under the cast.
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Your child cannot feel you touch his/her fingers or toes which are extending out of the cast.
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The cast is submerged underwater.
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An object is in the cast. (food, toys, coins, etc.)
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Your child has extreme pain when you move his/her fingers or toes. This can be a symptom of compartment syndrome where the swelling can cause damage to the tissue, muscles and/or nerves. This is very rare and the pain is extreme and not relieved with elevation or pain medicine.
DAILY SKIN CARE
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Give a sponge bath, washing all areas of the skin that are not under the cast. Take special care not to get the cast wet. You may bathe your child in a shallow bath with the cast covered with a plastic bag and kept out of the tub. The plastic bag will protect against splashing but will not help if the cast is submerged.
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Check skin condition around the edges of the cast several times a day. Look inside the cast as far as possible using a flashlight.
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Check the odor of the cast daily at the ends. If you notice a new musty or foul odor it could indicate an infection and you would need to notify your doctor.
CHECKING SENSATION + CIRCULATORY STATUS
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Check for MOVEMENT. Your child should be able to move/wiggle their fingers/toes in the cast as they did before the cast was applied. If there are complaints of pain with movement, then it may indicate the cast needs to be loosened or removed. Call your doctor.
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Check for SENSATION. Your child should be able to distinguish which toe or finger is being touched if they could do so previously. Ask your child if they feel any numbness or tingling. A small child will move their toes/fingers spontaneously when touched or lightly pinched.
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Check for CIRCULATION. The color should be pink. Compare
extremity to the opposite side. To check for circulation, gently squeeze the fingernail or toenail. It will become white with pressure and should tum pink again as soon as you release the pressure. A very pale, bluish, or deep red color could indicate a problem with circulation and your doctor should be notified.
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Check the TEMPERATURE of the arm/leg. Compare it to the opposite side. If the extremity is unusually warm, it may be due to being covered for a long time. Uncover it and recheck it in an hour. If the extremity is cool, cover and recheck it in an hour.
Notify your doctor if the temperature is not similar to the opposite arm/leg.
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Check for SWELLING. If swelling is present, elevate the hand/foot higher than the heart for several hours.
ARM CAST CARE
For the first 48 to 72 hours after surgery/casting, your child's arm should be elevated with the elbow higher than the heart and the hand higher than the elbow. This will help prevent swelling.
A Carter Pillow or Texas Sling may be used to elevate your child's arm. The sling is slipped over the cast like a sock and then attached to a nail on the wall, upper bunk bed, or the headboard of the bed so that the elbow is level with the shoulder and the hand is pointed up in the air.
As always, monitor for extreme pain when you move the fingers. If this is the case, you may need to call your doctor for possible loosening or cast removal. After 48-72 hours, your child may use a sling for support. If you notice that your child's hand or fingers begin to swell after the arm has been down in the sling, have them sit down and elevate the arm to reduce swelling.
LEG CAST CARE
For the first 48 to 72 hours after surgery/casting, your child's leg should be elevated with the foot higher than the heart to help prevent and alleviate swelling.
A Texas Sling may be provided to help keep the leg elevated. The sling is slipped over the cast like a sock and then attached to a nail on the wall or headboard of the bed to keep the leg elevated above the level of the heart.
As always, check your child's toes for extreme pain when you move the toes. If this is the case, you may need to call your doctor for possible loosening or cast removal. You will want to keep pressure off the heels when the child is lying down to prevent sores from forming under the cast.
When your child is lying down, keep the leg elevated on a small pillow or rolled towel with the heel slightly over the edge of the pillow/towel. For side-lying, a thin pillow may be placed between the legs for comfort. To protect the leg cast from soiling and wear, you may cover it with a tube sock.
Remember: if your child has a walking cast, always make sure they wear the cast shoe provided to avoid slipping on floors and avoid cast breakdown.
WATERPROOF CAST CARE
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Use a shower gel or liquid body wash that rinses easily. (Examples: liquid Dial, Neutrogena, Johnson & Johnson Bath Wash or any clear liquid soap)
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Do not use any type of oil, lotion, or powder in or near your cast.
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If the cast is damp, you may dry with a hairdryer on the cool setting. Do not insert a towel into the cast or use heat to dry it.
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Care should be taken to keep small things (crumbs of food, bobby pins, coins, small toys, etc.) from falling inside the cast. They can cause irritation or skin breakdown which can lead to an infection.
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Some children complain of itching under the cast. Do NOT put ANYTHING inside the cast to scratch the area. Do NOT put any lotions or powders inside the cast. This can lead to skin breakdown and infection. To help with the itching you can run cool water through the cast, rub the skin around the cast edges with your fingertips (not nails) or you can rub the opposite arm/ leg. You can also try blowing air from a handheld hair dryer on the cool setting down the cast.
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The waterproof padding is tighter when the cast is first applied so the fingers or toes may appear discolored (red, purplish). This is normal as long as the patient can move the fingers or toes without pain. This will resolve within the first day. It is important to keep the arm or leg elevated for the first 48 hours.
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Limited swimming is permitted
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One hour per day in chlorinated pools - it takes 1 to 2 hours for the cast to completely dry. If you don't allow enough time for the cast to completely dry the skin will remain moist for extended periods of time which can cause skin breakdown. After swimming in a chlorinated pool, rinse the cast with tap water to remove as much of the chlorine as possible.
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Do NOT remove the cast unless your doctor tells you to do so.
COMMON CAST QUESTIONS
MY CHILD HAS A CAST - WHAT ACTIVITIES CAN HE/SHE PARTICIPATE IN?
Your child may not participate in organized sports or physical education. In addition, he or she is limited to ground level play only, and no bikes, rollerblades, skateboards, playscapes, trampolines, wheeled or ball toys, etc.
MY CHILD IS VERY UNCOMFORTABLE IN THE CAST; SHOULD I BRING HIM/HER IN?
Casts are never fun and your child may have some mild discomfort. If, however, your child experiences numbness or tingling, increased pain (that is not relieved with
elevation of the extremity or pain medicine), you should call your doctor.
Additionally, if you notice that the extremity is turning blue, pale or cold, or red, puffy or hot, or if you notice any drainage or a foul odor, then you should call our office.
THE CAST FEELS LOOSE/TIGHT - SHOULD WE COME IN?
If the cast slips or moves loosely up and down the extremity, or if the cast feels too tight to have normal feeling or sensation in the extremity, please call our office.
THE CAST GOT WET - DO WE NEED TO GET A NEW ONE?
Non-waterproof casts should be kept as clean and dry as possible. A wet cast may soften and crack. If the cast does get wet, a hair dryer on a cool setting can be used to dry the edges of the cast. If the cast gets soaked or submerged under water then it will need to be removed and replaced as soon as possible.
You may bathe your child in a shallow bath with the cast covered with a plastic bag and kept out of the tub. The plastic bag will protect against splashing, but will not help if the cast is submerged.
MY CHILD HAS A WATERPROOF CAST - HOW DO WE CARE FOR IT?
Your child may bathe or shower using a shower gel or liquid body wash that rinses easily (such as liquid Dial, Neutrogena, Johnson & Johnson Bath Wash, or any clear liquid soap). If the cast is damp, you may dry with a hairdryer on the cool setting. Do not insert a towel into the cast or use heat to dry it.
MY CHILD IS COMPLAINING OF ITCHINESS UNDER THE CAST - IS THIS NORMAL?
Many children complain of itching under the cast. To help with this, you can rub the skin around the cast edges with your fingertips (no nails) or you can rub the opposite arm/leg. Tapping the cast or sitting the child in front of a fan can help as well. (For waterproof casts you can run cool water through the cast).
DO NOT put anything inside the cast to scratch the area and do not put lotions, oils, and powders in or near your cast. This can lead to skin breakdown and infection.
MY CHILD HAS JUST HAD A CAST REMOVED - WHEN CAN HE/SHE BATHE?
Your child may bathe right away, but his/her skin may be sensitive, so take your time. It will take some time for the skin to appear and feel “normal” again.
HOW LONG WILL MY CHILD EXPERIENCE PAIN/DISCOMFORT AFTER THE CAST IS REMOVED?
Pain or discomfort may occur for a few days after the cast is removed. Some over-the-counter Ibuprofen taken with food may help this. Pain is usually a result of stiffness from being immobilized. Many children also experience discomfort in the form of itchiness. It is important NOT to scratch once the cast has been removed, your fingernails can break or irritate the skin. If the pain or discomfort continues beyond this, please call our office.
HOW LONG AFTER THE CAST IS REMOVED CAN MY CHILD RETURN TO ACTIVITIES?
Most children may resume their normal activities two weeks after the cast is removed.
DOES MY CHILD NEED PHYSICAL THERAPY?
Most children do not require physical therapy after a routine fracture; however, some may need PT if they are going to be resuming aggressive sports quickly. Additionally, some children may need PT briefly to work out stiffness and regain strength after being in a cast.
HAVE A QUESTION WE DIDN'T COVER?
FEEL FREE TO CALL OUR OFFICE AT (512)478-8116!
REMOVING THE CAST
WHAT TO EXPECT WHEN YOU TAKE OFF A CAST
HOW TO REMOVE A LONG ARM SOFT CAST
AFTER THE CAST IS REMOVED
Keep in mind, the bone is mended but not completely healed. Your child may experience some discomfort or pain after the cast is removed. This is a normal part of the process. The muscles have not been used for several weeks and it will take time for your child to regain his/her normal strength and flexibility.
We realize this is an important day for your child and family and you may have some questions when you get home. Here are general answers to some questions that have been commonly asked...
WHEN CAN MY CHILD BATHE?
Your child may bathe immediately but his/her skin may be sensitive so take your time. It will take a few days to a week for the skin to appear "normal". The hair may get darker under the cast and the skin may appear scaly, this is all normal and will resolve.
Please do NOT scratch - if your skin is itching you can rub it with your fingertips or knuckles, but your fingernails can break/irritate the skin.
HOW LONG WILL MY CHILD EXPERIENCE DISCOMFORT OR PAIN?
Your child may experience discomfort or pain for a few days after the cast is removed. Some over-the-counter Ibuprofen taken with food may help. (If your child experiences any stomach upset from the medication, stop taking the Ibuprofen.) The pain is usually a result of stiffness from being immobilized.
WHEN CAN MY CHILD RESUME NORMAL ACTIVITIES?
For the first two weeks after the cast is removed activity should be limited as it was while the child was in the cast. Most children may resume their normal activities 2 weeks after the cast is removed.
WILL MY CHILD NEED PHYSICAL THERAPY AFTER CAST REMOVAL?
Most children do not require physical therapy after a routine fracture; however, some may need physical therapy if they are going to be resuming aggressive sports quickly. Also, some children need physical therapy briefly to work out stiffness and regain strength after being in a cast at the doctor's discretion.
If you have any questions or concerns, please feel free to call our office at 512-478-8116.