Follow these guidelines to ensure the best care for your child.

• Check the cast daily for cracks and dents.
• Always make sure that your child has enough room in the cast to breathe comfortably. 
• Do not pull your child up by the arms or the armpits. Instead, hold your child by supporting them at their back and below their buttocks.
• Whenever there is a cast in place, it is important to make sure it is fitting well. 

Be sure to check the following several times per day:

• The color of your child's toes should be pink and warm to the touch.
• Your child should be able to feel all sides of their toes when touched and wiggle their toes.
• Your child should be able to wiggle their toes the same as before casting.

• Check your child's skin every day. Press their skin back around all edges of the cast. Use a flashlight to give more light, and carefully look for red areas of skin under the cast. Feel for blisters or sores under the edges of the cast.
• Do not use lotions or powders on your child's skin. These tend to irritate the skin.
• Do not allow your child to stick any objects (coat hangers, pencils, coins, erasers) under the cast because it may injure the skin. If your child does put an object down the cast, call the nurse immediately.
• Call your child's doctor if your child has persistent itching, pain or discomfort.
• This cast must remain dry.
• Do not place your child in the bathtub or shower while they are in this cast.
• For bathing you may use a damp washcloth and sponge bathe the visible areas of your child’s skin.
• You may use a hair dryer on a cool or cold setting to blow cool air under the cast edges. Make sure the dryer air is cool. Warm and hot settings can cause burns.

• Position your child so their head and upper body is elevated at all times.
• Prop them on pillows or elevate their entire head off the crib mattress.
• Turn your child from front to back or side to side every two hours during the day, and as often as you can during the night.
• A car seat expert will help you determine the best way to transport your child home in your car. They will provide you with a special loaner car seat or safety vest if needed.
• Beanbag chairs or recliners can be used to help position your child when at home.

You can transport your child in several ways:

• Smaller children may fit in a stroller or a wagon using pillows and a seatbelt.
• If your child is older they will use a rental wheelchair from the hospital or equipment company.

• Your child should stay on the ground floor whenever possible in case of fire. A bed may be moved down to the first floor to allow sleeping at night.
• Keep side rails up on cribs.
• Use safety belts on strollers and highchairs.
• Prevent small objects, such as toy parts, coins or crumbs from getting down into the cast.

• Plan for quiet play activities. Books and crafts can be fun. Having friends visit and play board games or video games can help pass time.
• A reclining wheelchair or reclining lawn chair can be easily moved to different parts of the house, or even outside, for a change of scenery.
• If your child must remain at home while in the cast, contact the school principal or counselor to arrange for home teaching.

• To prevent constipation, offer your child more fluids, fruits and vegetables, whole grain cereals and breads, and any other fiber foods.
• Avoid overfeeding. Offer smaller, more frequent meals.
• Do not send your child to bed with a bottle or cup

When choosing your child's clothing, think about:

• Shirts, dresses and skirts may be worn normally over the cast.
• Pants, shorts and underwear can be adapted by splitting the side seams of the clothing and inserting Velcro strips to fasten at the sides of the cast.

Using a Bedpan
Your older child will be discharged from the hospital with a bedpan and urinal. Remember:

• Make sure to dry the buttocks well after using the bedpan to prevent rashes.
• Keep a pad or towel under your child when they urinate to help keep the linens dry.
• If the bed linens become wet be sure to change them to prevent the cast becoming soiled. 

Using Diapers

• Always use two sizes of diapers.
• The first diaper should be tucked into the cast. This diaper should be smaller (typically one size smaller than what your child normally uses).
• The second diaper should cover the first diaper and outside of the cast.
• Using the double diaper technique prevents the cast from becoming soiled with urine and stool.
• Change your child’s diaper often to keep the cast clean and dry.
• A sanitary napkin or maxi pad may be inserted into the first diaper to absorb more urine, especially at night.

• Your child's toes are cold to the touch or appear pale or blue.
• Your child complains of tingling and / or numbness of toes.
• Your child cannot move their toes.
• Your child's toes become very swollen.
• Your child has persistent uncontrolled pain that is not relieved with pain medications.
• Your child complains of rubbing or burning under the cast. It can be a sign of a pressure sore.
• Your child or infant experiences continuous, unexplained fussiness.
• Your child has a foul smell coming from the cast or if staining of the cast occurs that was not present when your child went home. This can be a sign of a pressure sore, especially if the patient is complaining of heel, calf, or knee pain.
• Your child has a breakdown of skin under the edges of the cast.
• Something falls down into and becomes lodged in your child's cast.
• Your child's cast is too tight or too loose.
• Your child's cast breaks, cracks or becomes soft.
• Your child has trouble breathing in the cast.