Post Procedure Swelling

One thing I really wasn't prepared for with the closed or open reductions was the swelling and discoloration that is caused to the diaper area. With both procedures Kennedy experienced swelling to her genitals, especially after the open reduction. With these procedures you can expect for some swelling to occur, usually on the affected side, that can last (in my experience) up to a week. With Kennedy's closed reduction the swelling was mild and only lasted two to three days but the swelling from the open was much more significant, making diapering difficult for the first couple days. But, after four to five days the swelling resided and was almost gone by a week's end.

The first three to four days following the open reduction, Kennedy was so swollen that I was unable to stuff the inside diaper up the front opening. During this time I used panty liners to line the cast opening and, although I don't recommend using them regularly, they were a big help in protecting the cast by providing a barrier between the cast and her skin. Considering the diarrhea that Kennedy had post op, the panty liners were a real blessing the first week. So, although I discourage their use regularly they were helpful in avoiding disasters immediately following surgery.

Trial & Error: My Diapering Nightmares!

Like everyone else, I've had my shares of troubles with the dreaded spica casts. Kennedy only had her first cast for 5 weeks and it was a dirty smelly one. I was embarrassed and sad to see how she was covered in horrible diaper rashes. I attribute my first cast failure to several mistakes - not regularly changing her diaper at night, not wiping out the inside diaper opening during diaper changes and not tucking the back of the inside diaper into the cast (it was a very tight opening - I should have used the spatula trick). After the cast change I became diligent in all these areas (hubby says I'm obsessed) and Kennedy is still smell-free after 10 wks in this cast.

My second mistake was lining the cast opening with pantyliners. Many women petal the opening with pads or moleskin and have great results. However, I was not one of them. I'm sure my technique was wrong but I would never mess with that again. In my experience, repeatedly taking the pads off caused the tape to tear away from the lining and the cotton inside the cast became soaked in urine and Kennedy just reaked. I was devestated that the cast stunk and all my efforts had been in vain. However, with a lot of time and effort it was fixable. I simply took all the tape off and used a blow dryer on the cool setting to dry out the inner lining (between the gortex and the fiberglass). Once the lining was mostly dry I blotted it with a little white vinegar on my fingers to neutralize the smell and then blew it completely dry. I did this while laying Kennedy over my legs for optimal working room (it was just in the back) and had many toys in front of her to occupy her while I worked. Luckily, Kennedy actually fell asleep since it took me about two hours to dry her completely and tape her back up. I am happy to report that although it was a terrible experience, we survived and you would never have known it had happened. Drying her out while blotting vinegar worked and she didn't smell after that!

Nighttime Diaper Changes?

Firstly, your success in keeping a spica cast clean and smell-free hinges on frequent diaper changes, ideally every 2-3 hours. During the day I have been diligent regarding changing Kennedy's diapers regularly and know this has lead to my success in keeping Kennedy clean. However, I have often faultered in changing her diapers during the night and this lead to utter disaster with her first cast. Although she was only in her first cast for 5 weeks (half the time for her current cast), towards the end of that time she smelled awful and I was very eager for her cast change. After the cast change I vowed to change her diaper regularly at night as well. During this cast, I typically change Kennedy's diaper twice at night. She goes to bed in a new diaper and then gets changed around midnight & 3 - whenever she wakes up during these times. I understand how difficult it is when all you want to do is sleep! To help me remember I would put the diapers and pads together before bedtime so it was all ready - I also didn't wipe the cast out then unless it was necessary so she would fall back asleep easier. Although many women say that nighttime diaper changes aren't needed, I believe it's important to have at least one diaper change to help prevent moisture from wicking up inside the cast because while the moisture can get everywhere, there are only so many places we can clean out.

Having said all that I never woke Kennedy up for diaper changes, she regularly woke up 2-3 times at night while in her cast. I do not know if I would have been as diligent if I was having to wake her up for it (it would have been hard enough to wake myself up!).

Mastering Diaper Changes

There are several different methods to diapering that people swear by but everyone will agree that diapering is one of the trickiest and most frustrating aspects of the spica cast adventure. After several failures (that I explain in other posts) I've settled into an approach that has worked for Kennedy and I for the past ten weeks. One of the most important steps is to reinforce the tape petaling around the cast opening to help prevent tears in the gortex lining and leaks into the cast material. The best way to do this is to petal the opening w/ duct tape (you can find colored tape at craft shops if you prefer), approximately 2" strips, starting with the inside of the cast and wrapping around the edge to the outside of the cast. This way, as you wipe the interior of the cast during diaper changes, you don't need to worry about the integrity of the lining. Otherwise, tears can occur in the lining and the original tape can come undone, leading to leakage into the lining and a smelly cast (see in "diapering problems" post).

Diapering should consist of a smaller diaper lined with a pad (either for female uses or inconstinence) that is tucked into the cast along with a larger diaper over the cast to hold it all in place. Personally, I prefer using Stayfree sanitary pads because they don't have wings to mess with and you can buy them in regular for daytime use and heavy for nighttime use. In my experience the inside diaper will be a size or two smaller than your normal diaper and the outside diaper will be a size larger. For example, Kennedy is now 1 year old, about 17 lbs and regularly uses a size 3 Pampers diaper. With her I use the size 1 Pampers Swaddlers diaper (extra soft against her skin) for the inside diaper and the size 4 for the outside diaper. Tucking in the inside diaper can be tricky and frustrating but it will get easier and everyone develops their own technique. An important tip is to try and smooth out the back of the diaper between your child's skin and the cast since this section is especially tight and bumps and wrinkles can be uncomfortable and lead to welts (that's why I use the softer Pampers Swaddlers). I've always used my fingers for this task but many people use the wide end of a skinny spatula if it is especially difficult. Typically, the outside diaper doesn't get much use and I usually only change it in the morning.



The best way to keep your child's spica cast clean and smell-free is to change the inside diaper frequently, ideally every 2-3 hours. This will help prevent the diapers and pad from getting overloaded and moisture from wicking up inside the cast. Another way to keep your cast clean and smell-free is with diligent cleanings at each diaper change. While changing diapers I go through a lot of wipes. To keep the cast as clean as possible I run a wipe the length of my finger all along the inside of the cast, as far as I can reach. This helps ensure that nothing has wicked up or crept up inside the cast. To clean out the back of the diaper opening I lay Kaylee face down over my leg (with a toy in front of her so she can play) while I run a wipe along the inside. This way I can fit my fingers inside and reach as far in as possible. Additionally, I then blot the inside with paper towel to keep the area dry and, again, to prevent moisture from wicking up inside.



I know there are a lot of other methods out there but this is what has worked with me. I welcome you to take from my methods what you will and adapt it to accomodate your own situations. If you have any questions or problems that arise I encourage you to post on the Hip Baby message board as there are many parents with spica experience willing to help!

http://groups.yahoo.com/group/Hipbaby/