Hip Spica Cast - Diaper Changes and Cast Care

I took pictures of it when I changed it out tonight...because I want to remember this and be able to help others who may go through this. He gets his cast off on Monday, and assuming he doesn't soil it in the next three days, that was the last overhaul of the padding and stuffing on his cast. This is what I've had to figure out to keep this little man comfortable and dry. Here we go!

"Petal" the moleskin around the edges of the cast, to help keep the cast dry and the child's skin protected from the sharp fiberglass. How-to: cut small squares of moleskin (I bought mine here and believe me, I almost bought more. You'll need a lot of it!) and stick around the edges. Some tutorials advise rounding the corners of the half of the petals that lay on the outside of the cast....but the use of duct tape(see below)  makes it irrelevant.)

Moleskin is pretty sticky stuff, but it's no match for fiberglass casting - so duct tape my the fastener of choice. Besides, it comes in so many fashionable colors!

Petaling around the crotch area.

The array of feminine sanitary napkins needed.

Take one of the thin pads that has been cut to 3" and tuck the manufactured edge up into the cast. (Don't tuck the cut end in, it will wick any moisture straight to to the cast liner, defeating the purpose.)  I tucked one bit of pad in the front and two nearest the crotch area of each leg.

Duct tape down. Duct tape is your friend! :P

See the two pads on each leg? They are tucked inside about as much as they are showing on the outside . He hates this part the most, because I have to poke my fingers into the leg holes of the cast. But it is important! I've been glad of these for at least three runny-poo sessions, and been able to simply change out the pads and tape instead of the nearly impossible task of cleaning up and drying out poo from the cast liner.

I use two of these as padding in the front of the cast, partly to make sure the that the inner diaper stays in place. Monk had lost some weight and the cast was very loose, so the thick pads have a double purpose of wetness-insurance and padding. (Hint: at the beginning I was snipping off the wings of the pads, but it's just as effective to fold them back.)

Placing the front pads. These are changed out every few days, because he's so active crawling and such -  plus they have heavy strain on them at each diaper change when the clean diaper is being pulled into place - they only last a couple of days before needing to be replaced. They're well worth it, though, especially if he leaks urine out the front of his diaper, these pads catch a lot of it.

These are huge overnight, heavy-flow, wings everywhere, basically-depends-for-young-people from Always that have been a HUGE cast-saver. These are tucked all the way around the inside of the cast, three of them as padding and wetness control.

They don't stick very well to the cast, but the outer diaper will hold them down sufficiently. Or you can duct tape it...

Tear off the tabs of the diaper that will go under the cast - you won't need them and they're only in the way.

Pull the inner diaper into place. (I used both hands, one to push from the crotch area and one to pull from the top.) Tuck and arrange under the cast as though it were to be fastened normally - spread it out and tuck it around his sides. It is important that the diaper be spread out underneath the cast, because if any part of the diaper's inner material is flipped toward and touching the cast liner, it will seep.

Tuck around the crotch.

Tuck the diaper up the back, spreading it out the same as you did the front. It takes some doing, so just keep working on it.

It should end up neat and tidy, as though he is wearing a regular diaper under his cast.

Then place the outer diaper over the whole cast, tucking up the front through the support bar (which I've duct taped because in this eleventh hour it is deciding to come loose.)

Attach the tabs as usual, tucking in the outer diaper in the crotch area to ensure that no part of the inner material of the diaper is touching the pads lining the crotch. (To further avoid seepage.)

And there you have it! How to keep a hip spica cast [mostly] clean. :D

Edit:  I only change the inner diaper every time. I replace the outer diaper approximately every day, and the system of pads are replaced when they're soiled or worn out (every 4-7 days). I'm not changing out EVERYTHING each time he wets a diaper, unless it was leaked upon. :)