Clinical Reference Systems: Pediatric Advisor 10.0

Description

A cast is a hard splint that completely encloses part of an injured arm or leg in the best position for healing. The purpose of a cast is to prevent all movement and protect a fracture, possible fracture, or torn ligament until it heals. The innermost layer of a cast is cotton padding to protect the skin. The cast itself can be made out of plaster or fiberglass.

Home Care

1. Pain Relief. Give acetaminophen or ibuprofen in the appropriate dosage for pain. Continue this for at least the first 48 hours.

2. Elevation. If the leg is injured, elevate the leg on pillows for at least the first 24 hours. This will limit the amount of swelling that occurs. If the arm is injured, your child should wear the sling provided by your physician to keep the injured part elevated and limit swelling. Occasional wiggling of the fingers or toes will also prevent some swelling.

3. Dryness. Don't get the cast wet. Wet plaster can become soft and crumble. Wet padding can cause skin rashes. If the cast becomes wet, dry it with a hair dryer. To avoid getting the cast wet, use a washcloth and wash basin to bathe. Enclosing the cast in a plastic bag for a bath or shower usually doesn't work.

4. Skin care. Don't stick anything down into the cast, such as a coat hanger or other device, to scratch an itch. It might injure the skin and cause an infection.

5. Walking. If the cast is on a leg, don't let your child walk on it unless you have your physician's approval. Never walk on it the first 48 hours because it takes that long to completely dry and become strong. If your child was given crutches or a walker, that means your child should not put any body weight on the cast when walking.

6. Activities. Children with casts can go to school and play. However, they need to avoid riding a bike or playing any hard sports. The reason for this is that if the cast should break, the original injury may sustain more severe damage. Avoid swimming.

7. Signs of a Tight Cast. If the cast is too tight, it can decrease circulation in the fingers and toes. The most common symptoms of a cast that is too tight are the following:
   • Your child feels numbness, tingling, or increased pain.
   • The fingers or toes turn to a different color (pale or bluish) than the color of the fingers or toes of the noninjured arm or leg.
   • The fingers and toes become swollen.

8. Follow-up Appointment. Most children who have a cast need close follow-up.

   Your next appointment is ____________________________.

9. Call Your Child's Physician Immediately If:
   • Your child feels numbness, tingling, or increased pain.
   • The fingers or toes turn to a different color (pale or bluish) than the color of the fingers or toes of the noninjured arm or leg.
   • The fingers and toes become swollen.
   • Pain under the cast becomes severe and pain medicines do not help.
   • Any drainage comes through or out of the end of the cast.
   • The cast feels too loose or too tight.
   • The cast becomes soft or breaks.