Everything You Need to Know About Your Child's Arm or Leg Cast

Chances are good that at some point, your whirling dervish of a child will run too fast or leap too high, then fall too hard and—snap!—break a bone. Unfortunately, broken bones in kids are common. According to the American Academy of Pediatrics (AAP), fractures are the fourth most common injury in kids under 6.

"When kids fall, they reflexively put their hands out to catch themselves, so they're likely to break their forearm or elbow," explains Jennifer Ty, M.D., a pediatric orthopedic surgeon at Nemours Children's Hospital in Wilmington, Delaware.

According to Nationwide Children's, up to 40% of girls and 50% of boys experience a broken leg or arm in childhood, half of which are forearm fractures. But 1- to 3-year-olds are also prone to a "toddler's fracture," which involves the tibia or shinbone. "Tripping over a toy or falling while running is usually the culprit," says Dr. Ty.

How do you know it's broken? According to the American Academy of Orthopaedic Surgeons (AAOS), the following are signs of a broken leg or arm:

• Swelling and tenderness
• Deformity in the limb
• Bruising
• Bone punctures through the skin
• Complaint of extreme pain
  

If you see bone protruding from an open wound or an obvious deformity in the limb, or if you or your child heard a snap or a grinding noise during the injury, call 911 or head to the E.R., as surgery or setting the bone may be required. If you're not positive there's a break, but your kid is complaining of pain, try an urgent-care center. X-rays will confirm the break.

Of course, getting diagnosed with a break is just the beginning of the journey. The real challenge is managing the three to six weeks your kiddo will probably be stuck in a cast.

Read on to learn from doctors and parents who have survived cast life. They share the whole experience—from placing the cast to the long-awaited "saw off"—and share what they did to help cheer up a kid with a broken leg or arm and make it less of an ordeal.

Getting the Cast

Once an X-ray confirms a break, your child may need to wear a splint for a day or two until the swelling goes down. That will buy you time to make an appointment with an orthopedist, a doctor specializing in bones, who will put on the cast. Some casts can be made with water-resistant fiberglass and a quick-dry lining.

"Arm casts that don't extend over the elbow are the best candidates for these materials," says Dr. Ty. Most casts are applied while your child is lying down. First, a stocking is slipped on, followed by several layers of quick-dry material or cotton, and then fiberglass or plaster. It'll all morph into a protective shell in two to five minutes.

How to make the experience easier

Help prepare your child for the procedure by reading a book like Charlie Is Broken! by Lauren Child, or I Broke My Trunk! by Mo Willems. Taking a lovey or a paci to the appointment can be comforting, too, says Dr. Ty.

Another tactic: Talk up the prospect of picking a funky purple or bright-blue cast, suggests Jennifer Weiss, M.D., a pediatric orthopedist at Kaiser Permanente Los Angeles Medical Center.

If your child has sensory issues and an upper-body fracture, ask about a material called soft-cast casting tape, suggests Dr. Weiss. It can be unraveled later on, so you can avoid the loud buzz of the saw.

Dealing With Disappointment

If your kid is old enough to know what a cast is, they may be crushed by the prospect of missing out on soccer season. Jacquie Fisher's active kids have racked up multiple breaks, and the mom from Kansas City, Missouri, says it's usually during the car ride home when the emotions start to fly.

There's sadness and annoyance, but anger prevails. Fisher recalls her daughter saying, "My talent show is this week. Why did this have to happen now?"

How to make the experience easier

It's all about coming up with a plan B. For instance, Fisher's daughter ended up being the show's emcee instead of dancing in it.

Maybe your child missed a birthday party. Promise them a bigger and better celebration, with swimming and all the fun things they missed out on during their months in a cast!

Taking a Bath With a Cast

Taking a bath or a shower is fine if your child gets a fiberglass cast with a quick-dry lining. Still, Dr. Ty says it's best not to immerse the cast daily, especially during humid summer, to allow it to dry thoroughly inside.

If the cast is plaster or doesn't have a water-resistant lining, submersion is off-limits. You may be tempted to buy a waterproof cover for your child's cast, but Dr. Ty encourages parents to "view it as a splash protector to be worn while draping that arm over the side of the tub." She says that wet, uncomfy casts are one of the main reasons kids require recasting.

How to make the experience easier

When her 6-year-old son broke his arm playing soccer, Anupa Chacko-Smit, of Delaware, MacGyver-ed the cast with washcloths and clear plastic bags for holding wet umbrellas.

"For shower time, I would slip his casted arm into an umbrella bag and tuck a small washcloth around the top edge of the cast to catch any drips that might sneak in," she says. "Then I'd seal off the top of the bag using a hair tie to keep the bag from rolling down." Stash some bags in your purse, too, in case you get caught in the rain.

For little kids, doctors have two words: sponge bath. It doesn't need to take place in the tub. When Katie Yohe's 4-year-old son broke his tibia on a trampoline, landing him in a crotch-to-toes cast, the mom from McHenry, Illinois, covered their couch with a vinyl tablecloth, topped that with towels, and used a washcloth to clean his body in sections, drying as she went.

Modifying Playtime

Your child's ability to run and play with an arm or leg cast will depend on the type of fracture they have and the cast they got. If a broken leg can't bear weight, they may be in for the pediatric equivalent of mommy "me time": Netflix, puzzles, and chill.

Walking casts are far less limiting. Jodi Heddy's son was running around like a pint-size peg-legged pirate the same day his cast went on. "The doctor told us we'd be surprised at how quickly kids adapt," says Heddy of Highlands, Colorado.

Arm on the fritz? Plenty of toys can be maneuvered with only one hand, and some kids with an arm cast can be cleared for sports like soccer. Just be aware that while that cast protects the broken bone inside, it could hit another player or lead to a new injury. One of Dr. Ty's patients chipped his tooth from whacking himself in the face with the cast, and another injured his elbow by falling on the casted arm.

How to make the experience easier

Veteran cast dad Craig Persin of Chicago suggests you take a few deep breaths and remember that watching TV is hardly the end of the world. "Sanity and comfort are the two most important things, and if your kid ends up binge-watching shows on the iPad, so be it," he says.

You can cheer up a kid with a broken leg by loading up on the following:

• Arts and crafts
• Board games
• Books
• Lap desk with cupholders and slots for crayons

"A beanbag chair was our lifesaver," adds Yohe. "Sitting in the same position on the sofa made my son too sore, so we got a giant beanbag chair and nestled him in. He napped there and watched TV, and he couldn't really fall out because it molded around him."

Getting Dressed with a Cast

You may need to get creative, wardrobe-wise, especially in the snowy months. For example, long, tight-fitting sleeves can catch and tug on a cast, and pants need to be big enough to accommodate the mummified leg cast and the healthy one.

How to make the experience easier

Yohe, whose son was in a toes-to-crotch cast, recommends the following for dressing a kid with a broken leg:

• Oversize fleece pants
• Fyaway track-style pants with snaps up the side
• Pants with one leg cut off to keep the non-casted one protected
• For dressier occasions, nice pants two sizes too big

Chacko-Smit's son had trouble lifting his arm, so over-the-head shirts were tricky. So instead, for arm-casts, you might want to rely on zip-up hoodies and button shirts that you can help them into, one arm at a time.

Fisher recommends allowing an extra 20 to 30 minutes in the morning to get dressed and swore by slide-on shoes. "It's almost impossible for a child in a straight-leg cast to bend over to tie a shoe on his uncasted foot," explains Fisher, whose kids have had more than a dozen breaks.

Getting Around

Don't fret about the cast delaying crawling, walking, or other developmental milestones if you have a baby or a toddler. Sarah Duncan's son could still climb out of his crib, even with a cast extending from his fingers to above his elbow.

"He had just turned 2, and at first, it was sad to hear him say, 'I can't do it; I only have one hand!' but he quickly figured out how to hook it over the crib and swing himself over," recalls Duncan, of Moline, Illinois.

An arm cast also shouldn't impact little ones in forward- or rear-facing car seats, says Katie Loeb, a child passenger safety technician and pediatric physical therapist in Claremont, California.

For leg casts, rear-facing seats aren't too bad, either, even if your kid's legs are long. "Your child's legs can go wherever they're comfortable, including hanging over the side or resting on the vehicle's seat back," says Loeb.

On the other hand, a leg cast can be a pain for a child in a forward-facing seat. "The cast itself was so heavy, and it was uncomfortable for him to have it just dangling there," Yohe recalls.

How to make the experience easier

If your child is in a leg cast, Boston Children's recommends the following mobility devices as options for children:

• Crutches
• Walkers
• Wagons
• Wheelchairs
• Reclining wheelchairs
• Kneeling scooters (for older kids)

For riding in a car, try adjusting the car seat to the maximum recline that's safe for your child's weight and age (check the manual) to allow more front-to-back space. Or don't have other passengers sit near your child's cast so their leg has more room to hang. Yohe managed by placing an inexpensive foam cooler on the floor beneath her son, piling pillows over that, and propping his leg on them.

"You want to make certain that any unsecured items in the car are light enough that they won't hurt any passengers if they become a projectile," says Loeb. Unsure if your casted kid is riding safely? Search for a special needs child-passenger safety technician at the Safe Kids Worldwide website.

Going to the Bathroom with a Cast

Kids with leg casts have difficulty getting on and off the toilet. Plus, wiping and hand-washing are trouble in an arm cast.

Yohe says a 2- to 4-year-old who's potty trained but suddenly sporting a full leg cast may need a temporary return to diapers. Pull-ups could work for arm-casted kids, but they can split open on the side if you attempt to force them on over a leg cast.

How to make the experience easier

Kids ages 6 to 10 should be able to manage with some help. For example, try the following:

• Have them practice getting up and down from a chair to prep for toilet time.
• Have them hold on to a nearby sink.
• Use an accessible restroom with a grab bar for a boost.
• Wipe with the uninjured hand to avoid contaminating the cast with bacteria.
• If the cast has a waterproof, quick-drying liner, they can wash their hands as usual.
• Otherwise, use hand sanitizer and antibacterial wipes to clean fingers to avoid getting the cast wet.

Finally, call your doctor if poop accidentally gets on the cast; a recasting may be in order.

Sleeping With a Cast

Many kids can sleep normally in a cast. However, Dr. Weiss notes that discomfort may worsen at night because "it's quiet and their mind isn't occupied." But rest is more crucial than ever: "Sleep triggers the release of chemical substances that support tissue growth and healing," says Parents advisor Judith Owens, M.D., director of Sleep Medicine at Boston Children's Hospital.

How to make the experience easier

If your child's fingers or toes seem swollen, elevate the cast. Chacko-Smit propped her son's arm on a breastfeeding pillow! Casts can get tangled in blankets, so cover them with something smooth.

Removing the Cast

It's the day you've been waiting for—hooray! It involves an electric saw ... say what? After the cast is removed, it's common to notice the following:

• Flaky, dry, or clumpy skin
• Excess hair
• Atrophied limb

These are all typical responses to immobility and the skin not having access to air or exfoliation for a couple of months.

How to make the experience easier

If your child is nervous about the process, explain that the saw's blade isn't sharp. Instead, it has a rounded edge that vibrates from side to side. "It will break through hard materials like fiberglass, but it won't hurt skin or even tear through the cotton lining," Dr. Ty says.

Other ways to prepare your child for cast removal include:

• Showing them a YouTube video of a child happily getting de-casted
• Asking the technician to show how the cast saw is safe
• Rebranding the saw as a "tickle machine" to make it seem less intimidating
• Asking the office for earmuff-style noise protectors or bringing your child's headphones

A few warm baths and gentle scrubbing should restore your child's skin. Yohe coated her son's leg in CeraVe Moisturizing Cream, topping it with a sock to relieve dryness. Excess hair should fall out, and muscle atrophy should resolve within a couple of months.

The Final Recovery

Young kids who were already walking before a broken leg may have a temporary post-cast limp. A doctor may prescribe a short bout of physical therapy to get them back on track. After the cast came off Fisher's 7-year-old son's leg, he ran with a hitch for a while.

"It was noticeable when he played baseball," she says, "but with physical therapy, he was back to his full stride after about four months."

How to make the experience easier

It's common for kids to feel nervous about diving back into everyday activities. "It usually takes as long as the cast was on to regain their confidence with it off," Dr. Weiss says.

When Fisher's son was hesitant to return to basketball after another nasty break, she told him it was normal to feel reluctant and encouraged him to go at his own pace. Also, cheer up a kid with a broken leg or arm by playing up the benefit of gear like bike helmets or shin guards. That extra layer of protection may be all they need to get back in the swing again.