Serial Casting
These instructions are for caregivers of Children's Hospital of Philadelphia (CHOP) patients with serial casting.
Important information:
Your child is wearing a cast that was applied by a therapist to stretch their muscles. The purpose of serial casting is to make muscles more flexible and to improve joint range of motion. Casts will be changed every 4-7 days. This will continue for weeks or months, depending on your child's plan of care.
Patient instructions for cast care:
Check blood flow.
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Check your child's fingers or toes every hour on the first day of casting and 4 times a day each day after. This helps make sure the cast is not too tight and that enough blood is reaching the fingers or toes. Once the cast has hardened, the skin should be warm and dry, and the fingers or toes should be the same size and color as the one on the opposite side of the body.
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Your child should be able to move all their fingers and toes and feel you touch them.
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If you press on a fingernail or toenail and let go, the nail should return to its original color right away.
Keep the cast dry.
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Wrap the cast in a plastic bag and keep it out of the tub for baths.
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Your child may not take a shower.
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Do not let your child play in water.
Do not put anything inside the cast.
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Do not let your child put anything inside the cast.
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Cover the cast during meals to prevent food from falling into the cast.
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Do not remove the padding or try to add padding.
Keep the skin clean and dry.
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Do not use lotions, oil, or powder on the skin under the cast.
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You may use rubbing alcohol or skin astringent on the skin under the edges of the cast. This will toughen the skin and protect it from irritation.
Call your healthcare provider if your child has a fever.
Instructions for positioning:
Leg cast
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Change positions every two hours.
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When sitting in a chair, raise the casted leg with pillows or prop it on another chair. This will help prevent swelling of the toes.
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When lying on the back in bed, raise the casted leg by placing pillows under the calf (lower leg). Do not put pillows under the heel.
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When side-lying in bed, place one or two pillows between the legs to raise the cast.
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When lying on your stomach in bed, let your toes hang off the bed. This is a good way to stretch the muscles in the legs.
Arm cast
Raise the arm above the level of the heart with pillows while sitting or in bed.
The cast needs to be removed immediately by a medical professional if:
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There is a bad smell from the cast.
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Your child's finger or toes are cold, blue/gray, or swollen.
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Your child complains of numbness or tingling in the toes or fingers.
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Your child complains of severe pain from the cast.
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Your child cannot move his toes or fingers.
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The cast gets soaked with any liquid.
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The cast is cracked, soft, stained, or there is drainage from inside.
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There is a change in the position of the toes or fingers in the cast.
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Something gets dropped inside the cast like a toy or small object.
Do not attempt to take the cast off yourself.
This cast may be removed by a qualified medical professional should an emergency arise as noted above OR at the request of the child's parent or legal guardian.
To have the cast removed:
During the day, call:
At night or on the weekend:
Reviewed on January 10, 2023, by Megan Beam, PT, DPT; Stacey Caviston, PT, DPT; Ken Knecht, PT, MS