Tuesday, August 9, 2011

Spica Logistics

Diapering. As new parents, we expected to do our share in the diapering trenches, but we were not prepared for just how involved this would become with a baby in a spica cast! When we first brought our daughter home from the hospital we quickly learned how many diapers a little sparkle can go thru! We soon became diapering pros, Addison's dad took great pride in his diapering abilities and after a few explosive situations and a lot of laughter we both had figured out that it wasn't all that bad! So when Addison went into the hospital to get her spica cast to correct her hip dysplasia we had no idea what a production diapering would become. And so we continued our diapering education!

Within an hour of her surgery, Addison had a major diaper situation going on. I had read a lot on line about how parents of kids in spicas dealt with diapering so I went into her surgery day with some information and from what I had read I fully expected the nursing staff in the recovery room to have "petaled" her cast with water-proof tape. However, as the nurses wheeled her out of the recovery room the first thing they told us was that they had administered morphine for Addie because she was inconsolable in the recovery room. As a result, they had not even put a diaper on her as she was too upset and they suspected it was a bit painful due to the incisions made in her groin during her surgery. So, there she was, spica cast on but no diaper in the cut out where the diaper was meant to be! So, while her dad and I tried to comfort her as she came off her sedative, we didn't really pay much attention to the diaper situation. As any parent knows, it is hard to see your child in pain so diapering was the last thing on our minds. It didn't even occur to us how yucky that would be if we didn't deal with it ASAP. So, of course, she had a blowout. And I mean a good one. It went up the front of the cast, up the back of the cast and all over the hospital bed. If it wasn't so difficult to see her in such pain, we would have had a really good laugh at how ridiculous it was!

Her dad and I just looked at each other in desperation and scrambled to press the nurse call button! Surely they would know what to do! How wrong we were. I don't think the nurses see many infants in spica casts. She brought us some wipes meant for sponge bathing infants and we went to work wiping down our little girl and her bright pink cast. Once we had the worst of it wiped up, we decided we needed something to help soak up the wetness. The nurse brought us some abdominal pads which we stuffed up her diaper, then we placed a smaller diaper inside the cast and a larger one over that! Over the next few days, we got more and more comfortable with the whole diapering situation. Once we were home, and with a little practice and trail and error, we got it down to a science.

At first we thought a maxi pad would be the perfect situation to help dam up the diaper area in the back, as we had a few incidents of explosions that went all the way up the back of the cast. Because you can't actually fasten the inner diaper closed, it is very loosely stuffed inside the opening, leaving lots of room for accidents inside the cast. So, we thought, a maxi stuck to the inside back of the cast would be the perfect solution. We started out putting that in place first, then placing the smaller diaper over that, and then the larger diaper over that. What we soon learned was that with the combination of the glue on the back of the maxi and the moistness and warmth of the diaper area in general, the glue began to make the casting very very sticky and difficult to work with. Not to mention, when we would turn Addie over to complete the diaper process, the cast began sticking to her back...not much fun for her. Back to the drawing board. We went in search of something different and found cloth diaper liners at our local drugstore. Perfect, we thought! They were very long, so we cut them in half and began putting those in the back of her cast, then the smaller diaper, then the larger diaper. Within about a day, she developed a nasty rash. Turns out when you cut those disposable diaper liners in half, the materials used to make those liners super absorbant also gave our little peanut a horrible allergic reaction. So...we decided to return to the abdominal pads we had used in the hospital.

What we also found was that Addison needed a bit of help too as she had to lay through what had now become a 5 minute diaper change job. So we adapted her change table as well. We purchased a pregnancy wedge for her change station to elevate her back during the whole process and make her a bit more comfortable. Because the changing process had become that much more involved and more time intensive we decided we also had to rig something up to entertain her while we fussed over cleaning the cast and diaper area so we got a mobile that we could hang above her as we worked on keeping her clean. These worked great.

The arsenal required for a simple diaper change these days!

We get a LOT of questions about how, exactly, we change her. So here it goes, step by step. Hopefully this will answer some questions and maybe help other parents who have babies in a spica.

1. We lay her on her back on her change table, back cozily propped up a bit on the wedge and ensure she is in reaching distance of her mobile (so she can entertain herself). We then remove the soiled inner diaper, leaving the larger diaper underneath her in case she decides to do some business in the middle of the change...which happens very frequently!


Getting ready for the diaper change

2. We wipe down the front of her diaper area with either a pre-moistened, alcohol free wipe or, if she has a rash, a washcloth with warm water. We then use a blowdryer (yup, you read that right) to dry the area completely.

3. We then flip her onto her tummy and  repeat the cleaning and drying procedure in that area.

Clean and dry!

4. Once clean and dry, we take an 8x10 kendall tendersorb abdominal pad, which we have cut in half, and stuff it up the back of her diaper, leaving just a bit overlapping on the outside diaper area.




Placing the cut in half abdominal pad


5. We then take a size 2 diaper, which we have cut the fastening tabs off of, and stuff that up the back of the diaper, over the abdominal pad. That gets the back done!


Size 2 diaper over the abdominal pad

Make sure it is tucked in well
6. We then flip her over, and stuff the front of the size 2 diaper up the front opening of the cast taking care to ensure the leg area is not bunched up by smoothing out the leg ruffles and tucking them into the legs of the cast.


Flip her over and tuck in the front of the diaper to the cast area

Make sure it is tucked in well
7. We then take a size 6 diaper and put that over the whole cast, to hold the smaller diaper and abdominal pad in place...and we're done!


Place the larger, size 6 diaper over the whole cast to hold everything in place

Now, as you can imagine...this is not an exact science and there is plenty of room for disasters! To keep the area as clean and dry as possible, we also have lined the cast opening with waterproof tape to help delay cast breakdown when the area gets wet. Because waterproof tape is plastic and we felt not all that comfortable against baby's tender skin, we also found moleskin in the foot care section of our local pharmacy and decided to put that over the water proof tape.  After trying a few different brands, we decidd that the Dr. Scholl's Moleskin Plus Padding roll is the best.
http://www.drscholls.com/drscholls/productSearch.do?method=doProductDetailsLookup&searchArg=84

It provides a nice soft surface against Addie's skin. When the moleskin gets wet or soiled, we simply peel it off and apply new moleskin as needed. It takes quite a bit of time to petal the cast opening area with waterproof tape and moleskin, but it is worth it! I find it is best to do this in the mornings when Addie is much easier to get along with in general. She is very patient in the morning. If we have to do a spot replacement of the moleskin later in the day, I get her dad to make faces at her or sing to her as I do it which helps to pass the time and calm her down a bit.

With a little patience, a lot of trial and error and even more laughter, diapering has gone from something we initially dreaded to something totally manageable. Just another interesting part of having a baby in a spica!

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