Spica Resources
The Doctors & Staff at Sinai Hospital Rubin Institute for Advanced Orthopedics
Dr. Shaun Standard
  Types Of Spica Cast
What to Expect?
1. What is the shape of the cast?
Her legs are bent slightly at the knees and apart. The cast goes up under both arms and around her chest. If she is lying on her back her legs are off the ground by several inches.
2. Diapering?
The whole around the diaper area is about the size of your hand.
We found that if we used a mini pad as a liner (Kotex Ultra Thins without wings), and either a newborn diaper or a size one over top of the pad we had very few leaks. We trimmed the tabs from each diaper both back and front, and tore just a small amount of the paper backing off of the top and bottom of the pad leaving the sticky part covered.
These pieces removed would either poke the child or make the diaper harder to fit and slide. Place the child on her tummy over a pillow or bolster, lay the pad in and tuck edges in front and back of the cast then put the diaper over the pad and push it up inside the back (about ¾’s of the diaper will go up the back side and tuck the remaining part of the diaper in the front of the cast. (Insert picture mollycast4a & mollycast4b) Make sure that the entire underside of the diaper is against the skin and not touching the cast. It will wick up and wet the cast.
Overtop the cast we put a large size Pull Up with easy open sides on just incase of leaks and it helps hold the diaper in place like underwear. You can reuse the outside Pull Up’s several times if it doesn’t get wet.
Note: we precut the diapers and opened the pad liners. We kept a “Boppy” Pillow in our mini van for diaper changes on the go!
Hint: If diapering a girl the urine will run to the back so send more of the diaper to the back. If diapering a boy send more of the diaper to the front. If the cast gets wet use a cool hair dryer to dry. A warm dryer will really heat up the cast. Be diligent about changes, at least every 2 hours, and before sleeping. We even modified our feeding to give her last bottle of the day earlier than usually and feed her cereal for last meal so we could change the last wet diaper before bed. Otherwise, plan on getting up at least one time during the night. If the diaper does leak in the cast the urine can burn the child’s skin.
2. Travel:
The cast is formed with the child’s legs are bent at the knees and out to the sides, therefore a traditional car seat might not fit, and will probably not fit. We have a 18 pd daughter and we purchased a very large Evenflow brand child seat and padded it with a blanket and it fits very snugly. I think that if she was any larger we would have had to purchase a special car seat specifically for children (see below). Keep in mind that if your child is rear facing and is close to the 20lb. weight to be front facing take into consideration the weight of the cast which is a few pounds and they might need to be forward facing. Also the leg position might not allow rear facing any longer.
Below is a list of resources for the EZ-On Modified Vest for Patients in Spica Casts:
Contact: Jill Bello in New York (914) 907-5580, Rental Price $10.00/week for vest.
Some insurances are accepted DME code: E1399 Purchase
HC Armstrong in Pennsylvania 1-866-396-6776. $130.00 plus Shipping
EZ Way in Ohio 1-800-543-0575, $140.00 plus shipping
Children 18-25 inch waist order model #M203
Children up to 32-inch waist order model #101M2
Insurances are not accepted with HC Armstrong or EZ way, but you can check with your healthcare or car insurance to seek reimbursement.
Note: you will need to have this transportation in place to transport your child home. The delivery of these seats could take 1- 2 days and your medical insurance will not cover the extra time at the hospital if you are waiting for the car seat.
3. Clothing?
Since most of the body is covered by cast you only need to worry about covering the upper torso and feet. If it is summer time a t-shirt with snaps at the crotch will work just fine. I suggest the snaps because the shirt will tend to ride up, and even if it is warm the underside of the arm will chafe after rubbing against the top of the cast. If is cold out then use a long sleeve shirt that snaps with or without and undershirt, or a sweat shirt, nightgowns, or any type of shirt that doesn’t have snaps or buttons in the back.
The t-shirts and shirts will need to be 1 or 2 sizes larger than what they usually wear or use clothing from an older sibling. For her feet we used ladies colorful knee socks of ladies footies with cute decorations. They looked like tights over the cast. Regular socks, tube socks, or Soccer type will fit well also for boys. We found that even soft sided shoes bunch up at the heal.
Keep in mind when heating your house in the winter that the child in the cast is warmer than everyone else so be aware of the temperature in the house not being too warm.
4. Sleeping?
The child’s feet will be a few inches off the ground so position a pillow under the feet. Also place a few toys well in reach. Our child woke up several times in the middle of the night in the beginning so be prepared for that. Our child also figured out how to wiggle up to the top of the crib and pull herself by the crib rails, so check often to make sure they are not smashed up against the railing. If your side drops down on the side of the crib you could keep it in the lower position for easy reaching and taking out. The child can not get out of the bed from that position. We found that one of the reasons our child was waking was due to gas. Being so immobile didn’t allow for her to burp or dispel it so make sure they are well burped and danced around before bed to help out. We also use Mylicon drops to aid in gas reduction.
5. Daily Seating:
We purchased a bean bag with structure made for Video Game playing (found at Target).. It is very light weight and has a handle. It can even travel with you.
The child can also be propped up on the sofa. We put a bunch of her toys in a wide, low basket and propped it up on a pillow beside her for hours of enjoyment. If you put a pillow in front of the between the legs that can also stabilize a favorite toy. She also enjoyed being on her back on the ground to wiggle around a bit.
6. Feeding:
We used the video chair at the table for snacks or to self feed. Or I sit on the floor to feed her, or drag the chair into the kitchen for meals at the table. If they are at an age where they like to hold their own sippy cup or bottle watch for when they are finished so they don’t drop the bottle or cup because it might leak on the cast. We found our daughter shaking the bottle of milk out on her cast because she was bored. If they are self feeding check around the neck to make sure no food goes down inside the cast. We also bought a small snack tray with legs, it fits in front of her so she can snack and eat. Our favorite item is a small cup with handles and a lid with slits in it it’s called a “Snack Trap” www.snacktrap.com it holds crackers, cheerios ect… and it’s great for all kids to reduce spills.
7. Bathing:
Use a wash cloth and a bowl of water daily to clean all exposed skin. We washed hair once a week on the kitchen counter top with the baby on a soft pad. We used the sink sprayer with the child’s head hanging over the sink. After her bath her favorite thing was to play with a few small toys in the big bowl of bath water. We would wrap her cast in a towel and sit and hold the bowl for safety sake for about fifteen minutes. I think she likes it so much because she sensed that water is forbidden right now.
8. Stroller:
Our child fit easily into our Century stroller. This is a larger stroller heavy duty that was a few years old. She will not fit in any of our double strollers or umbrella strollers, or smaller compact strollers.
9. Carrying:
Their legs are shaped perfectly in the cast to fit around your hips just like if they weren’t casted. They are just a few pounds heavier.
We are currently half way through our experience and I have to say that the unknown prior to having the cast on was worse than that actuality of it. If you are prepared things should go smoothly and your routine will take over. Our daughter seems quite happy and doesn’t seem to mind the cast. After you figure out your own logistics it might be not as bad as you picture it. We hope that our web site was informative and helpful to you if you are in our situation, and the best of luck to your family !
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