Kids who need a cast often have plenty of questions. Here are answers to some frequent inquiries about casts.
A cast, which keeps a bone from moving so it can heal, is essentially a big bandage that has two layers — a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving.
These days, casts are made of either:
First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.
Absolutely not! A wet cast may not hold the bone in place because the cast could start to dissolve in the water and could irritate the skin underneath it, possibly leading to infection. So your child shouldn't swim and should use a plastic bag or special sleeve (available online or sometimes at pharmacies) to protect the cast from water. And instead of a shower, your child may need to take a sponge bath.
Although the fiberglass itself is waterproof, the padding inside a fiberglass cast is not. So it's still important to try to keep a fiberglass cast from getting wet. If this is a problem, talk to the doctor about getting a waterproof liner. Fiberglass casts with waterproof liners let kids continue bathing or even go swimming during the healing process. Although the liner allows for evaporation of water and sweat, it's still fragile. Also, only certain types of breaks can be treated with this type of cast. Your doctor will determine if the fracture may be safely treated with a waterproof cast.
Definitely! That often makes the whole broken bone experience more bearable for kids. Permanent markers usually work best; washable ones can smear. Feel free to encourage siblings, family members, and classmates to sign it, draw pictures on it, or decorate it with stickers. The doctor might even let your child keep the adorned cast as a souvenir.
Try blowing some air in the cast with a hair dryer — be sure to use the cool setting, though. And you should never pour baby powder or oils in the cast to try to relieve itching or try to reach the itch with long, pointed object such as a pencil or hanger — these could scratch or irritate your child's skin and can lead to an infection.
This can happen if the cast is hit or crushed, has a weak spot, or if the injured area begins to swell underneath. Call your doctor as soon as you notice a crack. In most cases, a simple repair can be done to the cast without needing to remove it or change it.
The cast may be too tight. Redness and rawness are typically signs that the cast is wet inside, from sweat or water. Sometimes, kids pick at or remove the padding from the edges of fiberglass casts. They shouldn't do this, though, because the fiberglass edges can rub on the skin and cause irritation. Call your doctor to have the problem fixed right away.
Some kinds of fractures don't need casts to heal. Certain fractures of larger long bones, such as the femur (thighbone), are hard to keep straight in a cast. Although doctors used to commonly put many of these kinds of fractures in traction (a way of gently pulling the bone straight), these days, surgery is often used instead.
It's not practical to cast ribs and collarbones (clavicles). Even displaced collarbones (in which pieces on either side of the break are out of line) heal well with a sling or special strap called a "figure-of-eight clavicle strap," which the child wears like a vest. Some non-displaced finger and toe fractures (in which the pieces on either side of the break line up) that don't involve the joint or the growing part of a child's bone (called the growth plate) may heal well with a splint or buddy taping (taping the injured digit to the adjacent unaffected finger or toe).
Some pain is expected for the first few days, but it's usually not severe. The doctor may recommend acetaminophen or ibuprofen to ease pain.
The doctor will use a small electrical saw to remove the cast. Although it may look and sound scary to your child, the process is actually quick and painless. The saw's blade isn't sharp — it has a dull, round blade that vibrates up and down. The vibration is strong enough to break apart the fiberglass or plaster, but shouldn't hurt your child's skin and may even tickle.
Once the cast is off, the injured area will probably look and feel pretty weird to your child: The skin will be pale, dry, or flaky; hair will look darker; and the area (muscles especially) will look smaller or weaker. Don't worry, though — this is all temporary. And depending on the type and location of the fracture, the doctor may also give your child special exercises to do to get the muscles around the broken bone back in working order.
Reviewed by: Peter G. Gabos, MD
Date reviewed: November 2010
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