For all of my regular readers, you may want to just pass on this post. I’m diverting from my usual attempts at wit and humor to give a shout out to any other parents who might be madly tearing up Google in search of any insight on how to best handle a toddler in a hip spica cast. That first awful night, when my husband was in the ER and I was home with our newborn, I found enormous comfort and some really great tips from parents who also had wee ones in hip spica casts. So I just wanted to share our experience in case it could in any way be a help to others. Here is what we have learned:
1. Bean bag chairs are truly your best friends. Get them, borrow them, use them. We found them to be helpful in an array of sizes for different purposes (stacking them so we could position him in different ways, etc.), but it was really helpful to have the very large Lovesac I had bought off Craig’s List last year. This has been our central hub for TV watching, eating, etc. It was also nice that it is ours, so I’m not paranoid that we’ll ruin someone’s chair if he spills his juice 🙂
2. The bigger, the better…We can still pull size 2T shirts over his cast, and I thought I would be able to get away with 4T pants, but this size is even tough. We have had a lot better luck with size 5 and 6. The problem isn’t so much the pant legs fitting around the cast legs, but the waist band being able to stretch over the weird spread of the cast. My son’s break is high on his femur too, so his cast is actually way straighter than most kids in this situation. Since most of the pairs are too long, we just roll them up. Obviously, if it’s summer, I would go with shorts all around. It will probably be easier–and cooler! Some kids may be fine without pants, but it’s cool here in PA and my son seemed bothered by having his diaper hanging out…
3. As far as footwear…Some kids might not care, but my son is very weird about wearing socks (he gets it from his neurotic mother, of course), so I just hit the $1 aisle at Target and got cheap socks that wouldn’t matter if they got all stretched out. Since it was pre-Christmas season when his break happened, let’s just say my son was rocking out Santa socks very early this year (much to the chagrin of his father, who is VERY opposed to Christmas before Thanksgiving). One other note here: even though my son can’t walk, he seems to find it very important to put on his left shoe (the cast covers the right foot) whenever we go outside, so we do. Routine is so important to toddlers, and since it will be totally rocked in these weeks, anything you can do to promote consistency is a plus.
4. Battling the pain…At first we tried to be all purest about this and only gave Tylenol to our son when he seemed especial cranky or in pain. Then I had a chat with our pediatrician and got a little more realistic…we started dosing on a pretty regular schedule. Has this helped? Maybe he’s a little less cranky and maybe he sleeps a little better, but in this situation, you gotta cling to the “maybes” that are positive. We forewent the prescribed Tylenol with codeine b/c this has always made me very sick to my stomach and bought a six pack of generic children’s acetaminophen on www.walmart.com.
5. Diapering, diapering, diapering. In short, good luck. It’s a mess. The good news is, if you haven’t yet potty trained, this is the one time you can give yourself a pat on the back, b/c all that hard work would now go to waste (unless your child would be male and old enough or smart enough to figure out how to use one of those handheld urinals). See my previous post on this topic (A Sanitary Situation), but after 4 weeks of this, this we have developed this method as our best shot at preventing leak-throughs (you will still have them no matter what you do and this does NOT make you a bad parent): We put a size 1 with two sanitary napkins stuck horizontally across the inside top back of the diaper. You cover the whole thing up with a size 4 or 5 (obviously these sizes might be different, dependent on your child’s age/size. At night we use one of my daughter’s size 3 overnites in place of the size 1 and put it on backwards as since he primarily lies flat on his back, most of the urine collects in the back of his diaper. As I said, even with all these techniques in place, he most surely still leaks through at least once a day. We started putting a waterproof crib pad underneath him when he sleeps at night, so we aren’t changing his sheets every morning. We do try to change him frequently during the day and at least once during the night, but keeping urine from leaking out of this cast is a beast! As far as poop, good luck. Constipation is a battle b/c your child is not moving and (especially at first with us), will often eat very little. However, we have learned those hard occasional poops are far preferrable to their runny counterparts. Without getting into graphic details, let’s just say secondary to bean bags chair, wipes are your other new best friend…
6. Bathtime–not so fun any more. I think your particular technique will just depend on your particular child and his/her particular cast. For us, my husband holds his top half over the tub and I use a cup to wet his hair, I soap it up and then rinse it with the cup. I then soap up his top half and “rinse” it off with a wet washcloth. We then wrap a towel around his head/top half, and my husband sits down and holds my son’s top half in his lap. I hold his feet in my lap, creating a bridge of sorts, take off his diaper and repeat the soaping/rinsing on his bottom half. I then pull my son up so he is vertically standing in my lap while my husband stands and then takes him from me. Excuse any tedious detail, but it took us a while to figure this one out, and it works pretty well for us.
7. Eating is mess. Some children have more of a seat created in their casts, so they may actually be able to sit up better, but as I said, our son’s cast is very straight, so he largely eats laying down. We have occasionally propped him on our knee and tried to eat with him at the table this way. But in general, he is horizontal, and crumbs get everywhere–in and on his cast, on the couch, in his clothes, on the floor…THIS IS WHY YOU NEED A DUSTBUSTER (see previous post, Eureka!). We tried to do the first week without one, and it was just a no-go. Even my very money-conscious husband agreed, and crumbs have met their match. We also had some luck with those new fruit in veggie purees that come in the pouches with the spout. They are a little harder to spill and you get some of that fiber thrown in. My friend J did blessedly buy us one of those plastic activity desks, which we are able to get over his lap area some when he is propped up on pillows and he has used this sometimes for eating and playing with toys. This brings me to my next point…
8. Adaptive devices. The hospital should provide you with either an adaptive car seat if your child is able to sit, or as in our case, a harness device so he can ride secured lying down across the seat of our van. Do not get yourself into a frenzied panic pricing out adaptive car seats online and thinking you will have to purchase one at $1200 (not that this Mom of the Year would ever have done that…). While the harness keeps him safe, van rides are not a fun part of his cast situation, but our treks to the hospital for follow-up appointments have been greatly helped by the car DVD player my MIL lent us. Other things that have been very helpful have been sippy cups with bendy straws and the now-famous Gyrobowl. Both of these gadgets help with the whole needing-to-eat-lying-down scenario. We also got one of those breakfast-in-bed trays and lay him on his stomach on a footrest and set up the tray in front of him so he can play on his stomach.
9. Getting around. We are now 4 weeks in and he has only figured out how to crawl in the past few days. Sometimes he army crawls on his stomach and sometimes he scootches himself on his back using his arms to pull and his left leg to push (the cast only goes down to his knee on his leg). He also also figured out how to roll over. This does seem to have helped improve his mood somewhat. Which makes sense–he now has a little more control over his situation and has been able to spend more time down on the floor playing with toys. A friend also lent us some physical therapy scooters that he has been able to lie on and pull himself around the house on (see The Party House), which has been awesome.
10. Welcome to newborn sleeplessness…one of the best ways I can describe this is that it is like having the complete helplessness and sleeplessness of a newborn with the behaviors and demands of a toddler rolled into one child. The doctor says it’s possible the sleep problems are due to his leg spasming (almost like restless leg syndrome), but in any case, sleep is bad. And unlike the cries of a newborn, his cries are loud. And keeps the whole house up…and when a toddler doesn’t sleep…let’s just say I was unaware until a few weeks ago that it was literally possible to throw a 24 hr. temper tantrum. We have had some luck trying to position him on his side by propping him with pillows. We also committed a parenting sin and have allowed him to sleep with his sippy cup (of water, not juice) b/c it seems to give him great comfort.
11. Crime and punishment. One of the hardest things for us has been addressing his behaviors. They are generally truly atrocious. But how much of this is because the poor kid is immobilized in a ginormous cast and how much of this is because of bratty 2 year-old personality?? And how do you do a time out with someone that can’t move? We have basically settled on verbally reprimanding him and then if he doesn’t listen (i.e. throws his bowl a second time), he gets carried upstairs to his room until he can calm down. I’ll be honest, this has only worked marginally well at best. We are going to have our “regrouping” work cut out for us when this thing comes off…
12. What to do?? The first 3 weeks or so, it was A LOT of TV. The kid was in pain, he was super-cranky and we had to be extra-cautious about him moving around at first while the bone initially set, so it worked for us. Not brilliant parenting by any means, but…we also had a lot of friends lend us toys. I keep all these new toys in a crate and make a big deal of getting them out as “special toys”, which he thinks is pretty cool. The Indoor Sandbox was a fantastic idea, and we use lots and lots of stickers…I am also a big fan of getting outside daily. We lay him down in a wagon (supported by my repurposed U-shape pregnancy pillow–see pic at bottom of Threshold of Hell-ing It) and try to do a walk everyday. When I go it alone, I put the baby in the baby carrier and pull him in the wagon. My son also thinks checking the mail is very cool, so we walk out to the mailbox about 16 times a day. I also try to make a big deal of carrying him out to the driveway to greet people when they come to visit and to walk out with them to wave good-bye when they leave. Even just changing rooms with him in the house is helpful to break things up. When I go up to get dressed for the day, I lie him on the middle of our bed and that’s usually when he has his “iphone time” (see Free Skeeball!).
13. Safety issues. Showering is a mess b/c I don’t feel comfortable getting in the shower, and leaving my son and newborn unattended unless there is another adult in the house. You aren’t supposed to leave kids in hip spica casts unattended in case they roll off of something or fall (esp. at first), but you do have to be realistic. If he seems secure and peacefully engaged with a toy or TV on the couch, I will wash my dishes in the kitchen. He also eventually figured out how to lower himself to the ground from his bean bag chair and he does it slowly enough that I’m comfortable with it. We took away all of his bed except for the mattress so he is very low to the floor. This would be an instance where not having converted your child out of the crib would be advantageous…
14. Oh the cost of things…It’s a mess. The diapers, the wipes, the copays, the medicine, bigger pants and socks, bean bags chairs, special cups and bowls, trays, even the cost of gas to trek down to the hospital…and praise God that I am a SAHM at this point in our lives b/c I’m not sure how it would work to take him to daycare right now and that would be a major FMLA hit. The only thing I can say here is, let people help you–they want to and you will need it. Borrow toys, pants, chairs, etc. so you don’t have to buy it. If people want to bring you a meal, let them. Going out to the grocery store is next to impossible–you obviously can’t take your child out during the day and put him in a grocery cart, and we have found that all hell breaks loose around bedtime here and afterwards, you are so drained from lack of sleep, you want to go to bed yourself, not be looping the aisles at Giant. Also, children in this situation are VERY demanding and needy and if you have other kids…cooking will not be high on your list.
So bottom line, this sucks. Rumor has it that it does end, and I’m a believer, but even though it’s rough you’re not alone! Other parents have gone through this and survived, and I’m told we’ll look back on this time and maybe even laugh about how crazy it was?? In my particular case, taking care of 2 children will seem like a breeze after we are on the other side–maybe then I can actually live up to being a Mom of the Year a little more 🙂
Addendum (added 1/5/12): Should have posted this sooner, but wanted to add this before I totally forgot about it: PRE-DOSE YOUR CHILD WITH TYLENOL PRIOR TO CAST-OFF APPOINTMENT AND TAKE IT ALONG WITH YOU TO YOUR APPOINTMENT!!! I so, so wish someone had told me this. Picture it: my husband and I, all giddy, happy and excited to see our little boy restored to his cast-less state after 6 weeks (actually, one day short of on-the-nose 6 wks.) and as soon as it’s removed, he starts screaming! And didn’t stop for a few days. The pain of moving his little joints after not being able to for so long was apparently excruciating, plus his muscles were just so, so atrophied and sore. It took him 65 days to take independent steps and we’re not fully there with the walking (4 weeks post-cast), but truly, it DOES get better every day–e-mail me: firstname.lastname@example.org or post a comment in the meantime for support. Hang in there!!