hip spica cast chair

Tips & Tricks

Here is an informational list that will help with hip Spica cast care of a toddler. Our son suffered from a spiral femur fracture. Included are multiple photos of my son in a hip Spica cast and links to products we used.

1. Sleeping in a Spica Cast

The first thing we had to figure out upon coming home from the hospital, was how to make our sons bed (crib) suitable for sleeping. Since his cast had a curve at the waste, he could not lay in bed with the mattress flat. We had to put a mattress wedge under the mattress to incline it. We then put a pillow and folded up blanket under the fitted sheet. This way, the bed inclined to the angle of his cast, and the pillow and blanket contoured to his body. We readjusted the pillow and blanket until he looked as “comfortable” as  possible. His first night at home was rough and he woke up a lot, but after that first night, we had very few sleepless nights.

Sleeping in a hip Spica cast
Sleeping in a hip Spica cast
mattress wedge
Mattress Wedge used in the crib

2. Diaper Changing Station

So, changing the diaper of a toddler in a hip Spica cast is a task. We couldn’t change the little guy’s diaper on the changing table, so we used the end of the chaise as the diaper changing station. We laid down a beach towel and had the box of supplies handy. We just used a large, empty diaper  box. You will want everything that you may possibly need within reach.  We used two sizes of diapers, our son was in a size 4, so we used size 3 and size 5. Here was our diaper station checklist:

diaper changing in hip Spica cast
Diaper changing station for hip Spica cast

3. Diapering a toddler in a Spica Cast

Okay, so here it is. The dreaded diaper change of a toddler in a hip Spica cast. Hope for solid poop!!! We did have a few blow-outs and it’s bound to happen to you, too! It’s just a matter of time, so be ready for it! Have your diaper changing box ready to go. Here is the process we used. First, we prepped the cast surrounding the opening. We bought a lot of moleskin and taped it on the outside of the Spica cast surrounding the diaper area, then folded it down under the cast. This way, if there is a blowout, you remove the moleskin without getting much poop under the cast. Then, wipe under the cast with antibacterial wipes and replace the moleskin. Next, take the smaller size diaper and cut the velcro tabs off. Tuck the diaper in as far as you can all the way around the opening. Since this diaper is tucked in, I felt that it would be a little more comfortable with the velcro cut off. Next, take the larger size diaper and tuck it in around the diaper area. pull the tabs around to the front and velcro in place. If your child won’t be wearing clothes that can cover the velcro, secure it with the masking tape. So, the small diaper is tucked in all the way around the opening, and the larger one is just tucked in as much as possible, while leaving the tabs out to velcro in place.

diaper in hip Spica cast
Diaper in a hip Spica cast

4. Pacifier

When the fall happened and our son ended up with a spiral femur fracture , our twins were only taking a pacifier at nap. Well, this all changed. Our son pretty much got the paci whenever he wanted it. He did have a broken leg! If something as simple as a paci would comfort him, we gave it to him! And, since brother got the paci, of course, twin sister had to have hers, as well!! We are now about a month out of the cast and they are both back to just taking the paci at nap.

5. Bathing in a Spica Cast

As with diapering, we set up a bathing station in the bathroom. We placed a padded play mat down first, then put our yoga mats on top of that. This gave a semi water-resistant surface. For the actual sponge bath, we filled a water bottle up with water and mixed a small amount of his regular soap in with it. We would also have a bowl of clear, warm water nearby (out of reach of him!). We placed a folded up towel under his head to soak up the water after washing his hair. Commence to sponge him down. We just used a washcloth and the diluted soap all over exposed skin and his head. Then, we used the clear water on the washcloth to rinse the soap off. Since the soap was diluted, it was very easy to rinse off his body. We did bath time at the same time as his previous schedule. Since he and sister always got their bath together, we decided that placing his sponge bath station in the same bathroom that sister was in helped. They could still have bath at the same time, just in different ways! One parent would bathe sister in the tub and one would bathe brother on the floor.

6. Spica Cast Clothes

We found the BEST thing for our little guy to while in a Spica cast was snap up rompers. We found them at Carter’s. They would snap around the bar of the cast and cover his diaper. We bought five and rotated through them, washing them constantly.

hip Spica cast clothing
Romper for hip Spica cast
hip Spica cast clothing
Romper for hip Spica cast

7. Sitting and Positioning in a Spica Cast

We found quite a few ways for our son to sit upright and play and eat in his Spica cast.

The best innovation of all was the patio chair turned Spica cast seat!!! We took a plastic patio chair and cut out the front of the armrests. Next, we measured where his leg would reach and cut out a hole in the seat of the chair. His leg was able to fit right in the hole! We strapped a belt around his waist (just in case!) and pushed him up to his craft table. He was able to play with toys, eat, paint, color. You name it! It was a lifesaver!! We also put a bean bag behind his chair, just in case he decided to push himself backwards. We didn’t need a head injury on top of everything else!!

hip Spica cast chair
Patio chair turned hip Spica cast chair – where to cut
hip Spica cast chair
Hip Spica cast chair

hip Spica cast chair

He also fit quite nicely in his strollers. They were not special Spica cast strollers, but they worked well.. We took a LOT of walks!

hip Spica cast stroller
Strolling in a hip Spica cast
hip Spica cast stroller
Strolling in a hip Spica cast

He fit perfectly in a highchair that we borrowed from Gramma. As with the stroller, it was not a special Spica cast highchair, but it did work. The stroller needs to accommodate the width of the cast and the bar that runs between the legs. Underneath the high chair also made a good little hideout for twin sister!

hip Spica cast high chair
High chair for a hip Spica cast

We had previously received Pottery Barn Anywhere Chairs, secondhand, from my sister-in-law. It was great! He could push right up under the coffee table and play with his toys. We moved that chair all over the house and even outside! Whatever room we went in, it went with us. It got to the point where his sister would drag BOTH chairs around the house (and outside) to make sure they had somewhere to sit!

hip Spica cast chair
Chair for a hip Spica cast

We also bought a hammock Hanging Rope Swing from Amazon. He loved to sit in it and spin in circles.

hip Spica cast hammock
Hammock for a hip Spica cast

He also fit in his cozy coupe car. And twin sister loved to push him around! It was actually better if she pushed him backwards. That way, if his body were to scoot down in the car, his cast leg would not hit the ground!

hip Spica cast cozy coupe
In a cozy coupe in a hip Spica cast

I think a bean bag chair would have worked better if we had a larger one that we could get him more upright in, but it did work.

hip Spica cast bean bag  chair
In a bean bag in a hip Spica cast
hip spica cast hammock

Don’t Worry, Be Happy!!!

A toddler CAN be happy in a Spica cast!! Hopefully, these videos and pictures of our little boy in a Spica cast will put a smile on  your face, too!

Bubble Fun!

Serenade!

Read to me!

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hip Spica cast art
Art! Keeping a toddler in a Spica cast busy!
hip Spica cast smile
Poppy can always put a smile of his face!
hip Spica cast hammock
Hammock swinging in a hip Spica cast
hip Spica cast high chair
Artwork in a high chair that accommodates a hip Spica cast

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One more night

Once we were sent to the floor if the pediatrics unit, we were told that he would most likely be sent home in the morning. We had one more night to spend in the hospital. I had spent the first two nights, and so my husband and I decided that he would spend that last night at the hospital with our son.

While in the new room, we  learned some wonderful tricks from a very seasoned nurse. She had obvious experience with toddlers in Spica casts. Find out all we learned in the Tricks and Tips post.

Late the next morning, we were being discharged. With his new hip Spica cast  car seat and prescription pain medicine in hand, we were sent on our way.

We were thinking, “And now what!”

hip spica cast picu

The PICU

From the recovery room, we were then moved to a room in the PICU. Our little guy was a pitiful site. He had an IV, oxygen being delivered through nasal cannulas, heart monitor leads stuck to his chest, oxygen level meter taped around his toe, and a blood pressure cuff. Since he was just 21 months old and did not understand everything that was going on, he, naturally, tried to pull everything out. Therefore, they put cuffs around his arms so he could not get to the wires. So, he couldn’t move his left leg, he had all these wires coming out everywhere, and now he couldn’t move his arms. He could, however, kick the hell out of that right leg. And he did! To say the least, he was pissed.

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Once he was settled into the PICU, the doctor came in and did a chest x-Ray. His lungs were full of gunk. Therefore, she ordered breathing treatments every four hours. He hated it. He cried more during the treatments than he had through the whole ordeal. The treatments forced large amounts of oxygen and medicine into his lungs to try to break up the funk and increase his oxygen saturation. It got to the point where he would cry when the respiratory nurse walked in the door. He learned who she was very quickly.

IMG_4262It was now education time for everyone. None of the nurses had ever cared for a patient in a Spica cast. We all learned how to change diapers. As you can imagine, it was not a pleasant task in some cases! Learn what we did in the Tips and Tricks post. After that first diaper, I realized that this cast was going to require me to stay home with my son for the next 6 weeks. Daycare could not be expected to give our son the care and attention he needed, while also giving the remaining children the care and attention they needed. It would be too much to ask and would not be fair for anyone. I would have to take six weeks leave from work.

We spent the next three days in the PICU. Every time the nurse would take his oxygen off, his level would dip again. His temperature spiked a couple more times. We did get a  bit of good news from the anesthesiologist, though. She said after checking on him and reviewing his charts, she was convinced that he did not have a fat embolism. In all her years, she had never seen a fat embolism in a patient so young. She and the PICU doctor both believed that the cold he already had decided to get worse at a bad time. At least we were out of the woods on that one!

The staff on the PICU were fantastic. They were very attentive and knowledgeable. Our son received fantastic care!

On the last day of our hospital stay, the Physical Therapy team came in to make sure that he could fit in his car seat. Well, he didn’t really fit. We were then given a Spica cast loaner car seat to take with us.

Finally, after three days in the PICU, and after his temperature quit spiking and his oxygen saturation stabilized, we were sent out to the floor and told we would be released within the next few hours.

We were thinking, “And now what?!?”

The Recovery Room

After hearing the news that our son did not need surgery and he was now in a Spica cast, we had to wait a little while longer before seeing him in recovery. When we finally could go see him, they would only let one person in the recovery room. I went. Seeing such a tiny little person in that cast and waking up from anesthesiology was heart wrenching. I cried some more. I had pretty much been a complete mess for the last 24 hours.

Upon waking up, our son’s oxygen saturation had plummeted. Without the aid of oxygen, it was around 89. He also woke up with a temperature of 101, major coughing, and super congested. He had a slight head and chest cold before the break, but nothing major. He had not been having trouble breathing or been suffering from a bad cough. Just slight congestion and a runny nose. The nurses were not sure what was wrong. They called the doctor back. The doctor and anesthesiologist returned to his bedside in the recovery room. They were not sure what was causing the temp and low oxygen saturation. They called it “broken bone syndrome” which can cause other symptoms to occur after a fracture. That was not very comforting.

Then, the anesthesiologist said it could be a fat embolism. A fat embolism is usually caused by physical trauma such as fracture of long bones, soft tissue trauma, and burns. They most frequently occur in closed fractures of the long bones. In the case of a fracture, it occurs when fat from the disrupted bone marrow or tissue is forced into torn venules in areas of trauma. Symptoms usually present within 24-72 hours…it had been almost exactly 24 hours since the break. The respiratory symptoms of a fat embolism are dyspnea, difficult or labored breathing and shortness of breath; tachypnea, abnormally rapid breathing; and hypoxemia, abnormally low level of oxygen in the blood. He presented with dyspnea and hypoxemia. We were being sent to the Pediatrics Intensive Care Unit so his breathing could be monitored more closely than it would be out on the floor. I texted my husband this information and he panicked. He asked if he could come to the recovery room.  The nurse was very gracious and said that he could come.

The “Surgery”

We were then told that our son was going to need surgery on his left femur. Plates and pins. That meant another surgery six months later to remove the plates and pins. I cried.

The surgery was set for 10:00 a.m. the next morning. I stayed at the hospital that night and “slept” on the terrible, hard, fold down couch. In reality, I didn’t sleep a minute. Our son had a fitful night, but got a little sleep. At about 4:30 in the morning, he woke up crying out for milk and water. He was so thirsty. What an easy thing for me to fix, but I couldn’t. Since he was schedule for surgery the next morning, he could not have any food or drink after midnight. I just stood by his bed stroking his hair and crying.

Monday, March 30, 2015

10:00 a.m. came and went. We were not taken to surgery. We saw the orthopedics doctor walk by in the hall. Time kept passing and we still were not taken to surgery. Hours passed before we were finally told it was time. Apparently there had been a mix up with the anesthesiologist. Our son was finally wheeled away and we were sent to the waiting room. We sat and watched the monitor and saw his name remain in the OR. In the meantime, my husband was researching femur fractures in toddlers. He started showing me these crazy casts that some children had to get. The only upside to surgery is that he would most likely not be in a cast, but just a splint. We waited longer.

A few hours later, my husband got up to walk around the waiting room. He disappeared behind a column for a few seconds and then came walking back to me with an x-Ray in his hand. He had just so happened to run into the orthopedics doctor who was coming out of the OR at that exact moment.

The doctor had given us good and bad news. The good news was….NO surgery!!! They got the bone lined up so perfectly that they said they could not cut him open. The bad news was….he got put in a hip Spica cast. Yep, those crazy casts my husband had been showing me pictures of. The cast starts right below the nipples, goes down the entire torso, down the entire left leg, and down the right leg to the knee. There is a bar that connects the legs together. And, yes, there is a cut out for a diaper. Because, no, he is not potty trained. This was about to be an experience like no other. Find out how we cared for our toddler in a hip Spica cast in the Tips and Tricks post and how we kept him busy and happy in the Keeping Busy post.

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broken femur spiral fracture emergency room

The ER & Interrogation

We left our daughter at home with my mom, grabbed the diaper bag, some food for our son, his water cup, and headed to the car. Loading him up in the car seat was horrible. He cried. A lot. It was not easy, but as soon as he was situated in his car seat, he didn’t cry for the 10 minute car ride. By the time we reached the hospital, it was about 3:30. Only around a half an hour had passed since the fall. When we arrived at the ER, I gingerly lifted our son out of his car seat. He cried. I held him very still as we walked into the ER. We got a lot of sympathetic looks as we received our paperwork. Probably due to his young age, we got called back pretty quickly. The nurse asked me to lay him down on the scale so she could get his weight. I carefully placed him on the scale. He cried more at that time than he had throughout. He tried to cling to me and repeated “Mommy, Mommy” over and over again as he reached out to me. The nurse got his weight and I got him back in my arms and still. He calmed right down.

With one look at his leg, the nurse knew. She said, “It’s not good, it’s his femur.” This is when the panic hit full force. Our stomachs dropped, blood drained from our faces, and tears sprang to our eyes.

Let the interrogation begin.

The nurse asked, “So, what happened?” We told her the story. I cried.

A bed was then brought in for him, but I wasn’t about to put him down. I climbed right up in that children’s sized bed with my son in my arms. Once he received his bracelets, we were pretty quickly taken to a room in the ER. They wheeled the two of us down the hall. He remained quiet and calm. The nurses kept commenting on how “good’ he was being. I don’t think that would have been the case had I put him in that bed alone.

Next, it was time for an x-Ray to be done. An x-Ray tech wheeled a portable machine into our room. I was told I had to get out of the bed and lay my son down under the machine. He cried. They needed two angles, one with his leg out straight to get a straight on shot, and one with him rolled up on his right side. He cried.

While the nurse and tech were getting the x-Rays, they asked, “So, what happened?” We told them the story. I cried.

He was then given an IV. The first nurse attempted to get the IV in, but she blew the vein. Realizing this, she did not give it another attempt, and, thankfully, called in another nurse. This time, the IV was done successfully.

This nurse asked, “So, what happened?” We told her the story. I cried

Once we were situated in the ER room, the x-Ray taken and IV in, the doctor finally came in.  He pulled the x-Ray up on the monitor for about 20 seconds and showed us the image. He said, “It’s a spiral fracture to his left femur.” He pointed to the diagonal line that cut across his bone. In a spiral fracture, the fracture line encircles the shaft like the stripes on a candy cane. A twisting force to the thigh causes this type of fracture. I cried.

We did not get a copy of the x-Ray, but the following picture is pretty close to what his fracture looked like.

spiral femur fracture
Not our sons x-Ray, but a likeness to his spiral femur fracture

He asked, “So, what happened?” We told him the story, my husband acting out the fall, showing how our son’s right leg caught and he twisted on his left leg as he fell. The doctor started nodding his head. He told us as soon as he heard us say twist and saw the motion my husband was doing, he knew why it had fractured the way it did. He then proceeded to put a temporary splint on his leg and wrap it in an Ace bandage. He cried and I continued to hold him. They gave him morphine in his IV. The doctor told us that we were going to feel scrutinized. We were going to be asked a lot of questions and to tell the truth. Just tell the truth. He then left. The nurse said, “So, what he meant by that is that a social worker is going to come in and ask you questions.”

Spiral femur fracture leg splint; ER
Spiral femur fracture leg splint; in the ER
Spiral femur fracture leg splint; ER
Spiral femur fracture leg splint; in the ER

Sure enough, about 10 minutes later, here comes the social worker. As soon as she walked in I start to cry (again) and she asks, “What’s the matter, Mom?” I kind of motioned to my pitiful boy and said, “This.” She proceeded to ask what happened and we told the story, yet again.

She told us that the story matched with the injury. She was required to ask questions. She said that she had reviewed our son’s medical records and didn’t see anything else there. She also told us that with this injury, she was required to call the Department of Human Resources (DHR). She didn’t want to call, but she had to. We felt like she truly believed our story. We told her that it was okay, that it’s good that they follow up. This is when we completely realized that we were being questioned due to possible child abuse. Apparently, one of the leading causes of a spiral femur fracture in children is child abuse. The social worker told us that DHR might send a social worker out to talk to us, but she didn’t think they would. She said that, since it was Sunday, if they did come, it would most likely be on Monday. She also said that they might want to do a full body scan to check for past fractures. I said, “That’s fine, they won’t find any.” DHR never came. A full body scan was never done.

Though the questioning was very stressful, especially since it was done IN THE ER, and I cried throughout, it is a great thing that the hospital staff is so thorough. We are grateful that there are dedicated nurses, doctors, and social workers who are looking out for our children.

In the ER
in the ER
In the ER
In the ER

From there, our son was admitted and we were moved to a room.