What is a body cast?
A body cast is a special type of cast that is used to treat progressive scoliosis in very young children. Serial casting may be used to minimize the spinal curve before beginning bracing. It may be used to help delay scoliosis surgery until your child gets older. A body cast may also be used to protect spinal instrumentation after surgery. The body cast will cover the upper body and extend over both shoulders. Legs and arms are free to move. The body cast uses gentle corrective pressure to reshape the spine.
Applying the cast
The body cast is put on your child in the operating room while they are asleep under general anaesthesia and will be applied with the assistance of an Orthopaedic Technologist.
A special t-shirt with moisture wicking and antimicrobial properties will be applied first, followed by soft padding that provides cushioning. The plaster is applied next and carefully molded before it sets.
A specially trained practitioner or an orthopaedic doctor will mold the plaster to control the curvature of the spine. The fiberglass is then wrapped over the plaster to strengthen the cast without further weighing it down.
A large abdominal hole (called a window) is cut into the front and back of the cast to allow for chest and abdominal expansion as your child breathes and eats. Often, a small window is also cut on the back side of the cast. The edges of the cast are padded and secured with tape. The fiberglass is dry before your child leaves the operating room; however, plaster can take 48 hours to dry completely.
The cast may feel warm to your child when they wake up. The entire process takes approximately two hours.
Taking care of the cast
Keeping the cast dry
While the cast is on, your child will need to sponge bath. Be careful not to get the cast wet.
To keep the padding dry, you may need to line the edges of the area above the groin with “petals” of water-proof tape. This means that each piece of tape should overlap the other just like the petals of a flower. Make sure that each piece of the tape covers at least 2 to 3 inches of the padding inside the cast. A nurse or orthopaedic technologist can show you how to do this before your child leaves the hospital.
If the cast does get wet, you may clean the soiled area of the cast with a damp cloth and leave the area open to air until it is dry. You can also use a hairdryer on a cool or cold setting to dry the cast. Do NOT use a heat setting.
Protecting your child’s skin
Most children will be able to move about and roll themselves at night, minimizing the risk of developing a pressure sore. If your child is unable to roll themself, turn them every four hours during the night. This can be from side to side or from stomach to back. Ask your child (if able) to extend their arms above their head, which will make the turn easier. Make sure your child’s toes or heels are not pressing against the bed or rubbing on the sheets as it may cause skin breakdown or blisters. Turn your child more often if you notice any redness or skin breakdown.
Do NOT use any talcum or baby powder inside the cast.
Making sure the cast is not too tight
Your child should be able to move their arms, fingers, legs, feet and toes while in the cast. Hands, fingers, feet and toes should be warm to touch and pink in colour. If your child is able to follow commands, ask them to move their arms and legs and wiggle their fingers and toes. If your child is unable to understand, tickle your child’s feet and check for movement. Movement of arms and legs should be the same as it was for your child before the cast was put on. If you find any persistent changes in the colour, feeling and movement of your child’s limbs or if you have any other concerns, contact your child’s orthopaedic technologist or primary care provider. In the event of an emergency, visit your local emergency department.
Changing your child’s diaper or toileting
If your child wears diapers, tuck a smaller size disposable diaper into the front and back of the cast with a larger size diaper worn over the cast.
Change the diapers as often as every four hours, or as soon as the diaper is soiled, so that the cast does not get soaked with urine or stool. If this happens, the cast will have a bad smell and may also cause irritation to your child’s skin. Re-petal the cast as needed if it becomes wet.
At night, you can check or change the diaper when you change your child’s position.
Getting around
The orthopedic team caring for your child will be able to provide you with all of the information you will need for lifting or carrying your child. If your child walks, they will still be able to walk with the cast on. When your child first starts to walk after the cast is applied, they may look imbalanced; but this will improve once they are used to the extra weight of the cast.
If your child uses a custom wheelchair that has lateral supports, these supports may need to be removed to provide enough space for your child with their cast on.
Every effort is made to ensure that your child can comfortably achieve a sitting position in a chair (or car seat, wheelchair, on the toilet). Your child may find it very difficult to sit cross-legged on the floor with a cast on.
Speak to the nurse if you need any advice on getting your child to and from school or home.
Diet
While your child is getting used to a new cast, they may not move around as much as before. This may cause your child’s bowels to slow down or develop constipation. Give your child a healthy diet with fibre and plenty of fluids.
Removal of the cast
Your child’s orthopaedic team will tell you when the cast should be removed and the plan for further treatment, which may include another cast or a brace. If the plan is to continue with casting, the new cast will be applied the day after the old cast is removed. This provides the opportunity for bathing.
An electric cast saw will be used to remove the cast. The saw is large and noisy, and your child might feel scared. Before the procedure, the orthopaedic technologist will explain to you and your child what is going to happen. This will help your child to feel more comfortable. Your child will also be provided with ear protection.
Caring for your child after the cast comes off
After the cast comes off, the skin that was under the cast will be dry and flaky, and you will need to:
- Wash the skin several times with warm and soapy water.
- Apply lotion to soften the skin.
- Do not scratch or rub the skin too hard, as it will be very tender.
You might see a little more hair than usual. This will fall out after several weeks.
After the cast is removed, you will be given more instructions on your child’s activities and further treatment of scoliosis. You may also have an appointment in the orthotics department to arrange a brace for your child for the next phase of treatment.
When to seek medical attention
If your child is having trouble breathing, or is persistently vomiting, please go to the nearest Emergency Department. You can also call or visit your primary care provider.
At SickKids
If you have a specific concern about the fit of the cast, or if the cast becomes soaked or excessively soiled, contact the orthopaedic technologist team at SickKids.
To speak with an Orthopaedic Technologist, call 416-813-5785.
To call the orthopaedic clinic, please call 416-813-5008.