A cast that is too tight may decrease circulation to the affected limb, damage underlying skin, and/or injure underlying nerves.
What Is a Cast and Why Does My Child Need One?
An orthopedic cast is a hard plaster or fiberglass shell with an inner padded surface that surrounds an injured extremity thereby preventing movement and providing protection
By preventing movement, the cast immobilizes the underlying broken bone or torn ligament in the proper position allowing proper healing to occur
The duration the cast is used depends on the type of injury
How Can I Take Care of My Child with a Cast?
Elevation of the affected limb for the first 24 hours significantly reduces the natural swelling that occurs after an injury. Swelling is normal in the initial phase of the injury, usually lasting one to three days. The limb should be placed above the level of the patient’s heart (“High Five” Position for arm injuries) by using either pillows or supporting the limb. Moving the fingers or toes of the affected limb may also assist in reducing swelling.
Pain relief in the form of Tylenol, Ibuprofen or medication prescribed by your physician should be continued for at least the first 48 hours after injury. Medication should be taken as directed on the medication bottle. Aspirin should not be given to children and adolescents
Checking the skin for redness, swelling, bleeding, sores, or color changes around all the cast edges should be conducted every day. The opposite limb may be used as a reference to determine worsening swelling or color changes.
Bathing the affected extremity with a cast should be avoided in most circumstances. Unless the patient has specifically asked for a waterproof cast, the cast should not get wet. Wet plaster can become soft and crumble. Wet padding under a fiberglass cast can cause skin irritation, rash formation, and underlying damage.
A sponge bath is most desirable to avoid wetting the cast when the child needs bathing, but the cast should still be covered in several layers of towel or plastic bags to ensure it stays dry.
A variety of manufactured “shower/water safe” cast covers are available, but no single one is perfect. In the event a cast becomes wet, dry the cast with a hair dryer on the cool setting.
Waterproof casts are available at an additional cost not covered by insurance. These casts can be completely submerged in fresh water thus the child may bathe, shower, or swim. Salt water should be avoided. Not all fractures are suitable for this type of casts such as those applied immediately after surgery or surrounding the ankle or elbow. To make sure the cast stays clean, run warm soapy water through it as needed.
Placing objects within the cast must be avoided. At no time should the child place rulers, paper, pencils, pens, etc. into the cast. Furthermore, powders or lotions should not be placed in the cast. This does not mean the child or his/her peers cannot draw on the cast.
Itching under the cast can occur and may be bothersome, but under no circumstances should an object be placed under the cast. Scratching the underlying skin may cause injury and/or infection. Itching may be overcome by tapping on the cast, blowing cool air in to the cast with a hair dryer, or giving the child an antihistamine such as Benadryl (diphenhydramine) as directed on the medication bottle may be helpful. If itching becomes severe and/or persistent, please contact the orthopedic office.
Walking on a leg with a cast may damage the cast and underlying bone. Do not let your child walk on a cast unless your doctor has provided approval and if so use of a cast shoe is beneficial to protect the cast
Activities of daily living do not necessarily need to be restricted if your child has a cast. They may go to school and play. However, they must avoid activities that can lead to cast damage, reinjury, or wetting of the extremity. Examples of inappropriate activities include but are not limited to: bicycle riding, swimming, roughhousing, contact sports, skate boarding, etc.
Cast odor is normal and not an indication to change the cast. Odor is common because the affected limb cannot be bathed. Under no circumstances should powder or perfume be applied on or in the cast
Is My Child’s Cast Too Tight? Too Loose?
A cast that is too tight may decrease circulation to the affected limb, damage underlying skin, and/or injure underlying nerves. The most common symptoms of a cast that is too tight are:
A feeling of numbness, tingling, or increased pain
The fingers or toes of the affected limb are a different color than the skin of the non-injured extremities (i.e. pale or blue)
New swelling of fingers or toes
Swelling is to be expected in the first 24‐72 hours after injury or surgery of the affected limb and may lead to the cast feeling tight. This is best treated with elevation of the affected extremity
A cast can become too loose, especially after the initial bout of swelling subsides. A child should not be able to remove the cast or significantly move the affected limb under the cast. Being able to place one or two fingers under a cast is appropriate.
When Should My Child Be Seen Again?
Children who need a cast will also need close follow up. The patient should be seen again usually within one to four weeks. Ask your doctor when to return if they have not specified.
If you do not have an appointment for your child or unsure of when the appointment is please call the Orthopedic clinic or Office.
When Should I Call My Child’s Healthcare Provider?
Call IMMEDIATELY if:
Your child feels numbness, tingling, or increased pain.
The affected fingers and/or toes turn an abnormal color such as white or blue
The fingers and/or toes become severely swollen.
Your child has trouble moving the fingers and/or toes of the affected limb
Pain under the cast becomes severe and pain medicines do not help.
Any drainage comes through or out of the end of the cast.
A bad odor comes from underneath the cast.
You notice a stain or area of warmth on the cast.
Your child develops a fever.
The cast feels too loose or too tight.
The cast becomes soft or breaks.
You have a fiberglass cast that doesn’t feel dry in 4 or 5 hours after getting it wet.