Body (Spica) Cast Care

About the spica cast

A spica cast is a body cast that reaches from the chest, over the hips, and down one or both legs, with an opening at the groin for toileting. A bar may connect the legs to keep the cast stable. It holds the hips and thighbone (femur) still so a fracture or a hip problem can heal. Children usually wear a spica cast for about 4–12 weeks.

Positioning & swelling

• For the first 1–2 days, have your child lie on their back, side, or stomach with the head slightly raised and the cast supported on pillows.
• Raise the cast and place ice bags along the sides of the cast (never on top, in case of leaks) during the first 24 hours.
• Reposition your child every 2–4 hours during the day and at least once overnight, supporting the joints with pillows.

Protect the skin

• Check the skin at all cast edges every day for redness, sores, breaks, or a bad odor.
• If a red area stays red for more than about 30 minutes after you reposition, or you notice odor or broken skin, call our office.
• Do not put anything inside the cast or use powder/lotion at the edges. For itching, use cool air from a hair dryer.
• Tape (“petal”) the edges around the groin opening with moleskin or waterproof tape to keep the cast clean and dry.

Diapering & toileting

• Keep the cast clean and dry around the groin opening.
• For a child in diapers: tuck a smaller diaper inside the cast opening and place a larger diaper over the outside. A sanitary pad inside adds absorbency. Change often to prevent skin breakdown and soiling.
• For a toilet-trained child: keep the head and upper body raised so urine flows down and away from the cast; a fracture bedpan or urinal may be used.

Eating, clothing & getting around

• Offer small, frequent meals (a big meal can make the cast feel tight on the belly), plenty of fluids, and fiber to prevent constipation.
• Use loose, larger clothing over the cast; larger diapers or one-piece outfits work well for babies.
• Always use safety straps and pillow support in beds, chairs, wagons, strollers, and the car seat — the cast's weight changes your child's balance. Ask about a special car seat before discharge.

Call our office right away if you notice

• Fingers/toes that are cold, pale, gray, or blue, or that your child cannot move or wiggle
• Numbness, tingling, or burning that does not get better after raising the limb
• Pain that keeps getting worse and is not controlled by the prescribed medicine and elevation
• Fever of 101°F (38.3°C) or higher, or shaking chills
• Swelling that does not go down with rest and elevation
• Severe pain, burning, or loss of feeling under or below the cast that does not improve with medicine, rest, or raising the legs
• Toes that are cold, pale, gray, or blue, swollen, or that your child cannot move
• A foul odor, drainage, or broken/blistered skin at the cast edges
• The cast becomes wet and soft, cracked, broken, or loose, or something is stuck inside it

Call 911 right away if your child has

• Trouble breathing or shortness of breath
• Chest pain
• A pale, gray, or bluish color to the lips or face that does not improve

Follow-up

Keep all follow-up appointments. Your surgeon will tell you when the cast is changed or removed and when your child may begin to bear weight. Do not let your child stand or walk in the cast unless the surgeon says it is okay.

Learn more

For pictures and a family-friendly overview, see the OrthoKids resource linked on this page (OrthoKids: Spica casts). It is provided by pediatric orthopaedic surgeons.