Most sutures (stitches) are dissolvable and do not need to be removed. If your child has staples in place, plan to come back in two weeks to have them removed. Once the bandage is removed, check the suture line for any redness, swelling or drainage.

Also check that your child does not have a fever (>101 degrees F). Notify the doctor if a fever persists for longer than 24 hours.

General Cast Care

A cast is a rigid casing wrapped around a broken bone to keep it from moving while it heals. The cast must remain in place until the doctor removes it. If the cast is broken or damaged, the bone might not heal properly. Swelling sometimes occurs when a bone is broken; it can be helped by elevating the affected limb.

Ask the doctor how active your child can be while the cast is on.

• Keep the cast dry and clean.
• Keep the casted limb (leg or arm) elevated on pillows
• Have your child move his or her fingers or toes to reduce swelling and prevent joints from getting stiff.
• If any of the following problems occur, return to the doctor, clinic, or emergency room:
  - The cast breaks.
  - The cast is too tight.
  - Your child's fingers or toes turn blue or pale or become cold.
  - Your child's fingers or toes get numb (can't feel).
  - Your child has a high fever.
  - Your child is in increasing pain.
• DO NOT get any water on or near the cast.
• DO NOT pull the padding out of the cast.
• Make certain your child DOES NOT put any objects down the cast. If your child experiences itching, tell your doctor.
• DO NOT cut the cast.
• Make sure your child DOES NOT walk on the cast unless your doctor tells you this is appropriate.

Spica Cast Care

A cast which includes the trunk of the body and one or more limbs is called a Spica cast, just as a cast which includes the "trunk" of the arm and one or more fingers or the thumb is. For example, a shoulder spica includes the trunk of the body and one arm, usually to the wrist or hand. Shoulder spicas are almost never seen today, having been replaced with specialized splints and slings which allow early mobility of the injury so as to avoid joint stiffness after healing. A hip spica includes the trunk of the body and one or more legs. A hip spica which covers only one leg to the ankle or foot may be referred to as a single hip spica, while one which covers both legs is called a double hip spica. A one-and-a-half hip spica encases one leg to the ankle or foot and the other to just above the knee. The extent to which the hip spica covers the trunk depends greatly on the injury and the surgeon; the spica may extend only to the navel, allowing mobility of the spine and the possibility of walking with the aid of crutches, or may extend to the rib cage or even to the armpits in some rare cases. Hip spicas were formerly common in reducing femoral fractures, but today are rarely used except for congenital hip dislocations, and then mostly while the child is still an infant.

In some cases, a hip spica may only extend down one or more legs to above the knee. Such casts, called pantaloon casts, are occasionally seen to immobilize an injured lumbar spine or pelvis, in which case the trunk portion of the cast usually extends to the armpits.

Keeping the cast dry is very important. It prevents skin irritation and breakdown. It also prevents cast odors.

Gortex lined casts may be wiped with a damp washcloth to clean.

Check the baby's toes/feet to make sure they are warm, have good color and are not swollen.

Do not pull the padding out of the cast.

Make sure that the child does not put any objects down the cast.

These steps and supplies have proven to be effective in preventing urine and stool from staining the cast:

• Place a POISE Bladder control pad front to back around the baby's bottom and up under the cast. In the young infant who is less than 1 year, it should just reach the top of the cast.
• Next, fit a small diaper (in young infants the newborn size fits well) under the cast and tucked around the sides.
• Finally a larger size diaper fits over the cast and keeps everything in place.
• It is important to check/change the diaper frequently. It may be necessary to only change the POISE pad with each diaper change.
• If urine or stool leak out of the diaper and up under the cast, clean the skin well with a damp washcloth or diaper wipe. Examine the skin every day.

For skin beakdown, a thin layer of Desitin may be used on diaper rash. Do not use babypowder under the cast.

Clubfoot Cast Care

When casting is used as an initial treatment, the infant's foot/feet will be placed in a short or long leg cast for a total of approximately 12 weeks.

An appointment will be made every 1 to 2 weeks to check the correction of the foot/feet's position, and to apply a new cast(s). You need to remove the cast(s) before each appointment. Do this the morning of the appointment. Soak the cast(s) in warm water and vinegar. You'll often need two people to do this. It will take about an hour before the cast starts to unravel. Inspect the skin for any signs of redness or irritation. Tell your doctor if the skin is irritated. We may need to wait to put on the next cast.

Check that all the toes are warm, with good color, and they move easily. If the infant can pull their foot/feet back up into the cast so that you cannot see the toes, soak the cast off, call the doctor and make an appointment. If the cast cracks or becomes soft, call the doctor, make an appointment and soak the cast off before the appointment.

Preparing for Your Child's Surgery

Once the physician completes the surgery-scheduling sheet, he or she will send it to our pre-certification office. You may contact the surgery scheduler at (212) 305-0622 to set up a date for the surgery and give our scheduler any information that may be needed by your insurance company.

Once the surgery date is obtained you will need to make an appointment with your pediatrician. Please try to make this appointment for the week before surgery. The purpose of this visit is to ensure that your child is ready for surgery and does not have any colds, viruses, ear infections, strep throat, etc.

A few weeks prior to the surgery you will receive a conformation letter with the date of the surgery, a Surgery Consent form and a "Pediatric Medical Questionnaire"; please fill this out and bring it with you on the day of surgery. On the last page of this questionnaire is the Physician History which is filled out by the pediatrician. Ordinarily we do not require blood work or a urine sample to be done prior to surgery. Please have your pediatrician fill out the history and physical and fax it to the surgical scheduling office at (212) 305-7314.

Preparing your child for surgery and hospitalization can be difficult. The Child Life Program at NewYork-Presbyterian Morgan Stanley Children's Hospital offers tours of the hospital geared towards your child's developmental level. They can also provide guidance on how to prepare your child at home and what to bring with you for the hospital visit. They may be reached at (212) 305-2607. Morgan Stanley Children's Hospital also offers a virtual preoperative tour. Go to www.childrensnyp.org/mschony/ and click on "A Pre-Surgical Tour: Just For Kids!".

The night before surgery, the Ambulatory Surgical Unit will call you between 4 pm and 9 pm to tell you what time you should come to the hospital. If surgery is scheduled for a Monday, they will call you the Friday evening before the surgery. Morgan Stanley Children's Hospital's entrance is at 3959 Broadway between 166th street and 167th street. There is valet parking in front of this entrance. Stop at the security desk and they will direct you to the 4th floor for admission. Self-parking is available at the hospital parking lot on the corner of Fort Washington Avenue and 165th street.

You may walk with your child into the OR and once the operation is complete and your child has been transferred to the recovery room, you may stay with him in the recovery room. The surgeon will speak with you after the surgery, therefore, please let the surgery unit staff know where you will be.

One parent may stay over night at the child's bedside. There are parent beds available. Please speak to the nurse on the unit. If your child goes to the intensive care unit (ICU), one parent may stay overnight at the child's bedside.

Guest accommodations are available in the Milstein Hospital building. Please call in advance to make arrangements at (212) 305-4820. These accommodations need to be reserved early. They cost about $200 a night. The Radison Hotel in Fort Lee, New Jersey is also available and can provide shuttle service to the hospital. Their number is (201) 871-2020.

If you think your child will need special equipment, i.e. wheelchair, hospital bed, etc, or placement in a rehabilitation hospital postoperatively, please contact your physician's office a few weeks before surgery to make these arrangements.