Nappy (diaper) changing in a Spica cast

This is something I really wanted to share because for me this has been one of the hardest parts of the Spica cast. Just trying to figure out how to put a nappy on Curious George required some serious Internet research. We found some very helpful websites and YouTube videos. Take a look....

Hip Spica-Baby-Toddler-Toileting - The Steps Charity You Tube videos on Spica Casts so look the others up as well.
Caring for an Infant/Child in a Spica Cast
Hip Spica Cast: Info for the Worried Parent
Spica Cast.com - Cast Care Tips. On this site have a look at the images of the pads around the cast as well. This is where I got my idea from.

Dr Greg told us that we must keep the cast clean and dry otherwise it would really start to smell terrible. We had also read some others experiences with this. So the first few days were very stressful for this perfectionist mom trying to keep the cast perfectly clean and dry. You'll be relieved to know that after a week and half I eventually gave up and realized that with a little one in nappies this really is not 100% possible.

At first Curious George had diarrhea from the antibiotic he was on which made things even more difficult. Once that calmed down things definitely got easier but it was still taking us at least 20 min each time and we were really struggling to keep the cast clean and dry around the edges. We put together a Nappy (diaper) changing box of tricks with all we needed so we could change him where ever we are in the house.

1. Change the nappy regularly. We eventually settled on a schedule which worked for our child. Change the nappy every 3 to 4 hours during the day. When there's a poo change it straight away. At night we eventually worked out a nappy and pad combination that allows us to change him just before bed, half way through the night and as soon as he wakes up. We did this because waking him up with a nappy changes through the night was terrible for him and us.

2. We used strips of cotton wool around the top of the legs of the cast, as in the photo. We cut strips of cotton wool about 3cm wide and long enough to fit from the back of the cast leg (on the bottom side) all the way around the cast edge to the front (the penis side). We pushed the edge of the cotton wool into the edge of the cast on each side. This words very well, especially for poo, as it causes a dam that keeps everything away from the cast edge.

3. Protecting the cast with pads and panty liners around the edges works very well. However we were not able to do this during the first week as the cast was still quite tight around the edges. As he wore the cast in and the padding got squished up a bit I was then able to fit more padding around the edges.

4. We tried all sorts of tape to stick the nappy and pads to the cast and discovered that the best was Micropore. It is an opaque fibre medical tape, a little like masking tape, just much more pliable. We did read that some people used masking tape but we found it didn't bend enough or stick very well. Unfortunately Micropore is expensive but it works the best and so we have just incurred the cost and written it off to a sanity necessity. Our motto has become; anything that can make life in the cast easier is worth it. With the Micropore you must rub the tape into the cast with your fingers, espceically round the edges, to get it to stick really well. We used 45mm x 10m rolls and so far have used up 10 rolls (do not do the math.... at R40 a roll.... you'll freak out).

5. Just as shown in the YouTube clips we used a smaller nappy inside a larger nappy. We pushed the smaller nappy into the front of the cast, pushed it in around the edges of the legs (making sure the little elastic skirt was under the cast around the legs) and pushed it in at the back. We then taped each side to the cast. See photos below. Each Spica cast is formed slightly differently and so the space your inside nappy will need to fit into will differ. We used number 5 pampers active inside and a number 6 pampers active outside.

We remove the tabs of the inner nappy as they are not needed and the front ones add extra bulk and the back ones stick to the skin.

6. To deal with leaks we always wiped the area as best we could under the cast using a baby wipe. For bad leaks we then dried the cast edges with a hair dryer on low on the cool setting. At the moment I dry the back edge of the cast every morning because it gets drenched with sweat at night and was beginning to rub his skin and smell.

7. To deal with the inevitable cast smell (no matter how careful you are it WILL start to smell) we used the bicarb bags, baby cologne and vanilla essence. I will expand on this in another post as this post is getting rather long. Here's the post on Dealing with cast smell.

8. At night we add an adult pad, Moli Med midis, to the back of the nappy to stop urine from running around the edges of the cast and off of the absorbent centre core of the nappy. See photo below.

9. My last tips is that you will need loads of patience and perseverance. There were a couple of times when we had big poo leaks up the front of the cast or into the leg of the cast. These made me really panic and being a perfectionist mommy did not help. These changes took about half and hour to make sure we had all the poo out (or as much as we could possibly get to).

In the mornings we do a long nappy change which includes drying the back of the cast and adding all the pads for the day. So for this change we lie Curious George on his tummy on some cushions on the couch and he watches TV. This change started off taking about an hour it now takes me 20min.

This is what the back edge of the cast looks like before we add the maxi pad. You can see the dirt which has seeped through. We discovered that this is actually body dirt and sweat more than anything else. This photo was take around week 2.5, the dirt stain is now much worse.

The top edge of one of the cast legs before the panty liner is put on.

I bought a super absorbent kitchen cloth to absorb some of the moisture under the cast edges. It turned out to be most useful for protecting his skin from the hairdryer while I was drying the cast.

After the cast is is mostly dry I stick on the Bicarb Bag, with Micorpore to draw out smells and damp.

Next I add a maxi pad over the whole back cast edge. I pull off the wings then stick the one side to the cast with Micropore. Then expose the pads own sticky strip and wrap it over the edges and tuck it under the cast edge.

Here, along the front side of the cast, I stick panty liners around the edge of the cast legs in the same way I stick the maxi pad on. At the top edge of the cast near the penis I stick a panty liner up the front of the cast and then tuck a part of the liner inside the cast. Its difficult to see in this photo but there is also cotton wool around the cast edges around the legs.

Here I am tucking the elasticated wings of the nappy inside the edge of the cast leg after all the pads are in place.

I then stick the nappy to the edge of the cast from the back, along the leg to just beneath the bottom to hold it in place.

Then I put the bigger nappy (size 6) over the smaller inner nappy (size 5). This nappy goes over the cast and around the waist and holds the more delicate under nappy in place and helps with any little extra leaks that might happen.