When should I call the doctor? Call your child’s doctor right away if he has any of the following: – Numbness or tingling in the extremity with the cast – Pain that is different from what he has had before – Pain that does not get better with medicine – Swelling that does not get better with elevation – Decreased or loss of movement in the fingers or toes – Change in skin color below the cast – Bad smell from inside the cast – Bright red drainage on the cast – Fever more than 100.5°F for longer than 24 hours with no other symptoms – A crack in the cast – A wet cast that does not dry completely – Something stuck inside the cast Visit www.choa.org/fracture or call 404-785-4913 for more information. Caring for your child’s cast Fracture Care Program Your child’s cast holds his injured or broken bone in place while it heals. Keeping the injured part still is important to help the bone heal the right way. This brochure will teach you how to care for your child’s cast. Some physicians and affiliated professionals who perform services at Children’s Healthcare of Atlanta are independent providers and are not our employees. ©2011 Children’s Healthcare of Atlanta, Inc. All rights reserved. ORT 941271.cb.2/11 How do I care for my child’s cast? What about itching? Arm casts – After the cast is put on, let it dry completely. A fiberglass cast will take 30 to 45 minutes to dry completely. A plaster cast takes 24 to 48 hours to dry completely. – Do not let your child put anything inside the cast. This could hurt the skin and lead to skin breakdown and infection. – If your child is using a sling to support an arm, raise the wrist higher than the elbow when your child walks or sits. – Gently pat the cast (do not dent it) above the area that itches. – Use a sling only as directed by his doctor. – The cast can be deformed or dented if it rests on a hard surface, such as a floor or table, before it is completely dry. Rest the cast on soft surfaces, such as a pillow or couch. – The inside of all casts (except those with a Gore-Tex liner) needs to be kept dry. A fiberglass cast can be wiped clean with a damp cloth. A plaster cast can be wiped with a cloth but should be kept dry. How do I care for my child’s skin? – Skin inside of the cast should be kept dry. A Gore-Tex liner can allow the skin to get wet, but it should not stay wet. All water should be drained from the cast. Not all casts can properly drain. Casts that cannot drain should not have Gore-Tex liners. – Your child can bathe or shower only if the cast can be kept dry. – Cast protectors (Seal-Tight) are available at most drug stores. – Give your child a daily sponge bath. • Cover the cast with a plastic bag. • Use a damp—not wet—cloth and mild soap to clean skin you can reach with your hand. • Dry it completely with a towel. – Keep any rough edges of the cast covered with moleskin or pink tape. – Check the skin around and under the edges of the cast each day for dry, red or irritated areas. – Do not use lotions, oils or powder around the edges or under the cast. – Be sure the top end of the cast does not indent the skin when sitting or resting. This may cause discoloration and swelling of the extremity. – While your child is awake, change the position of the limb about every two hours. This keeps the cast from putting too much pressure on the skin. – Keep your child as cool as possible to prevent sweating. – Change your child’s position to shift the weight of the cast. – Use a hairdryer to blow cool air inside the cast. Never use heat. Sensation and circulation Be sure the cast is not too tight and that blood can flow well to all body parts around the cast. Every eight hours, or more often if needed, be sure to check: – Sensation (feeling): Touch the area above and below the cast several times a day. Call your child’s doctor right away if he complains of numbness, tingling or pain. – Blood flow (circulation): Press briefly on your child’s fingernail or large toenail several times a day. When it turns white, let go. Call your child’s doctor right away if pink color does not return in three seconds. – Severe swelling: Look for swelling above and below the cast several times each day. Some swelling is normal, but a lot of swelling, especially with increasing pain, is not. Raise the cast higher than the level of the heart to try and decrease the swelling. Check for drainage When a cast covers a surgical wound, you should expect to see some red or reddish-brown drainage during the first two days after surgery. After this, drainage may be a sign of a problem. Call your child’s doctor right away if there is more drainage. How can my child be comfortable with a cast? – Have your child rest the first 24 to 48 hours. Do not let him do anything too active, such as running, jumping or climbing. – To prevent swelling, have your child keep the casted limb propped on pillows above the level of the heart for one to two days after the cast is applied. – Have your child wiggle his fingers and toes often to increase blood flow and decrease swelling. Leg casts – Keep pressure off the heels when your child is lying down to prevent sores on the heels. – Lying on the back: Put your child’s legs on a small pillow or rolled towel, with the heel over the edge. – Lying face down: Let your child’s feet hang over the end of the mattress. – Lying sideways: Put a thin pillow between your child’s legs. Is it OK to sign the cast? Family and friends may want to sign their names or draw pictures on the cast. That is OK, but do not let them paint over large areas. This could seal the cast so air cannot get in and could hurt the skin under the cast.