Spica Cast and Diapering- Everything You (Never) Wanted to Know

This post is for anyone looking to manage an older toddler's spica cast and diapering, or those just curious.  As you can see in the photo above, her cast extends up most of her back.  We were thrilled to see it did not reach her armptits, as we were first advised it would.

It is supposed to have enough space for us to insert a hand at the top.  Our daughter's cast adds far more than the inch or two we were expecting.  I measured her "waistline" and it is six inches larger than before surgery.  I measured her legs' width and her knees measure 20 inches apart, with her toes there is an approx 27 inch spread.  She is casted in a rather low seated position, with her rump no more than seven inches from the floor in a true "standing" position.  It adds over 10lbs to her weight and, as with all casts, cannot get wet.

The casting around her ankles should have enough space for us to insert a finger. The edges of her cast, top and bottom, are lined with this thin, fuzzy material.  This material also lines the diapering area... just imagine the potential to harbor soiling without an appropriate waterproof barrier.  I shudder.  Onto diapering...

First, a very wise person recommended I trim the tabs off of all the diapers I plan to tuck inside the cast.  This has made a big difference in how the diaper tucks, not to mention it is more comfortable for our daughter.

Then, we take a menstrual pad which has been cut in half.  I was previously advised to use Equate incontinence pads, but they only work if you do not need to trim them.  Our daughter's diaper opening is surprisingly narrow and short and we have to trim her padding  Snip one Equate pad in half, and you subject yourself to a super messy, jelly filled diapering center.  Learn from my experience- do not do this to yourself.  Scottish Rite used Kotex type pads, but we have had a lot of success with the Always Maxi, overnight extra heavy flow pads.

Next, insert the pad into the diaper.  I recommend facing the cut edge toward the diaper's center.  Leave enough room at the top of the diaper for tucking.

Now, we slip the diaper under the cast, between the cast and a larger diaper.  We were originally advised that Scottish Rite would use a size one, but they opted for a larger diaper due to our hippie's age and size.  We used size twos in the hospital, but she was not eating much and somewhat constipated due to the narcotics.  I began using size threes at home.  She usually wears size four.

It is time to begin tucking...

And tucking..

And here is a neat front tuck.  You also have a good view of the Duck Tape we used.  Can you imagine fuzzy liner here?  I am very pleased we followed our peer advisement to bring duct tape to the surgery appointment.

(Note:  Scottish Rite has since banned the use of duct tape, as it has latex.  Other latex-free, waterproof tape is provided by the hospital.)

Now turn over... back side must also be tucked!

I always begin tucking on the sides.  It seems to work easier this way.

And now we have a rear tuck with a little poofiness, to allow room for diaper contents.  But wait- we are unfinished.

I prefer to finish the diapering with an oversized diaper on the outside of her cast.  When she first returned from the OR and recovery, she had a very wet diaper, which was hanging a bit from the cast.  I have found that adding the outer layer prevents such unsightly and leak-prone situations.