Child Crying During Physical Therapy, After Cast Removal

Hi, Les,

This blog of yours is so good because we can share with each other the experiences we have with our kids.

I have a son named Kian. He had hip dysplasia, and underwent major surgery to his right leg. He was in a hip spica cast for 2 months, and they took off the cast last week.

The orthopedist advised us to take Kian to a physical therapist (PT) to help him recover the use of his right leg.

Today he had his first session and he cried out, saying it was painful for him.

My question is: Is it normal to force him to straighten his leg or even move it?

For us moms, it pains us to see our children getting hurt.

The physical therapist told us to come back every day to the clinic.

I just want to know, Les: did your PT allow you to continue your son's exercises in your home?

Thanks,

Karen from the Philippines

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Dear Karen,

I just want to say I visited Manila once and loved it. The people were extremely friendly, I rode in a Jeepney, and was amazed at how beautifully Filipinos can sing. I went to an outdoor karaoke party and a girl from the audience stood up and sang a song with notes higher than Mariah Carey! Amazing.

To answer your questions:
My son's orthopedist told us not to straighten his leg. We were told that my son would straighten his leg on his own, and he did, the first night he was home (he did it in his sleep).

What I am wondering is why your son hadn't straightened his leg after being home a whole week. My boy was eager to play with his brothers, so this motivated him to get up and start running around (this took a long time, however: the running around).

Does Kian have any siblings? Did you take him to a park or to a relative's house so he can see other kids running around? This may motivate him to get up and get moving.

But I don't want to give you medical advice because I'm not a doctor. Ask your physician or your son's orthopedist if it's normal for a hip dysplasia patient not to straighten his leg after being home for a week. Perhaps for your son's condition this is normal. I don't know.

About doing physical therapy in the home, I don't know if that is offered where you live. I know it is very expensive here. What we did -- as we really couldn't afford to take our son to the PT every day -- was ask for a list of exercises from the physical therapist (with pictures describing how to do them), and I put my son through the exercises every morning myself. (I then took him to the PT once a week just to make sure I was doing the exercises correctly and that my son was making progress.)

Is it normal for a PT patient to cry out? I asked my PT friend this question and he said, "It depends." With children, he said, oftentimes they scream or cry out more because of fear rather than pain. "The way to check if any damage was done to the child is to see if he has less range of movement after the session than before," my friend said. Or, if your child can move around (crawl perhaps), was he less able to do this after the session? Has he complained about pain since the session? 

I know with my son he was terrified immediately after his hip spica cast was removed, just because the weight he had gotten used to was gone. In fact, he cried very loudly after the cast removal, and this was solely out of fear.

He never cried once during the physical therapy, however, although he did complain about his leg being "tired" (which probably meant his leg muscles were sore). 

Again, ask the orthopedist whether the way your son is reacting is normal. It's always good to get a second opinion in matters like this, especially if your son might be experiencing real pain. 


Les

Moving Around with the Cast and After Cast Removal

Les, 

I was curious what your and other readers' experiences were when a child will start to walk post-cast removal. My son's cast went to his ankles in both legs and we are 6 days post-cast.

He started scooting on his bottom after about 4 days, crawling about day 5 with a bit of limited standing (while holding and we have to put him in the standing position). He definitely has more movement in the "whole" leg, and won't really bend the right leg that was broken.

Our doctors said no physical therapy is necessary so I have read your posted exercises with interest and will be taking Ned to a therapy pool a few times a week until I return to work. Also, as a multiple, his sister can push him to do more - he will get annoyed with her and try to take away toys and/or chase after her (crawling) if they are having fun.

Last night he even crawled up into her toddler bed. Did you notice the same thing with your boys?

As an aside, my son NEVER learned to crawl in his cast or move around at all other than a little spinning on his back when we changed his diaper. He didn't even like to spend much time on his stomach and couldn't lie on his side. I suspect that is because it was a rather reclined cast and went down to his ankles.

I also wonder if this means he will be slower to recover from his injury since he was very inactive during his 5.5 week cast time. I know you had much more movement out of your son but I wanted to present another experience for your readers.

We were told that he had the cleanest spica cast they have ever seen - probably because he didn't move around much.

Best regards, Mommy, Esq.

Read about the removal at: http://www.mommyesq.com/2011/01/cast-is-past.html

Hip Spica Questions: Meal Times, TV, Winter

Hi, my son (2.3 years old) just had a spica cast put on and he'll be in it for at least 5 weeks. I've appreciated the questions and answers you've provided but had a few additional ones: 

- Eating. Obviously the high chair is out. My son is a difficult eater to begin with (read: toddler) but I want to try to keep his meals as nutritional as possible. He is also a decently neat eater but of course being 2 it is all relative. What did you feed your son and where? How did you try to head off the mess? 

- Limiting TV time. My son has a twin sister and a 6 month old sister and therefore my attention is divided. How to keep the TV from becoming the focus of our lives? 

- Winter: Your son was in his cast during the summer but we are handling this during the wintertime. Any advice from other readers as to what to wear and ways to get out? 

You can find us on mommyesq.com. 

Thank you!

Mommy, Esq.

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Dear Mommy, Esq.,

You have beautiful children, and I'm very sorry to hear Ned broke his femur. To answer your questions:

Feeding:

What we did with my son when he was in a hip spica cast was put him in a recliner that was pulled out enough so he could lie on it, but at an angle, so that he was still sitting up. We fastened a large plastic bib that covered his whole body, and draped towels over the arm rests and on the back of the recliner (in case he spilled or threw food). Then we put his food on a tray that was placed across the arm rests in front of him. He wasn't at the kitchen table, but he could see it from where he was in the living room, so he still felt he was part of the family meal. One of us (my wife or I) had to sit with him, in case he needed help.

TV:

Put him on a mattress on the living room floor and give him reading materials and toys within reach. If you want him to be mobile, do what this inventive parent did and build a "spica cast skate board." (To see a video of the patient actually using it, watch the video at the end of this post.)

Winter:

You've got to get out, and so does he, or you'll both go stir crazy. Try to do this every day. Buy or rent a wheel chair (insurance will cover it) and go to the nearest mall where you can push him around. He will appreciate it and you will be able to stay sane.

Re nanny:

You're going to need one person to stick with Ned at all times. This includes sleeping in the same room with him at night. (I cared for him during the day; my wife slept next to him at night.) Night care is necessary b/c you'll want to flip him and/or help him shift positions so he doesn't get bed sores and suffer other discomfort.

Yes, the extra childcare will be expensive. Be thankful it will only be for 5 weeks. For us it was 7.5. 

Hang in there. The good news is that with more one-on-one time with your son (for you and your hubby, who should help out when he can), you will develop an even closer bond with him.

Les

After the Spica Cast Comes Off

Dear Les,

I just can't thank you enough for the information you've provided me with. I've been searching the Web like crazy, and most of the stuff I've read is irrelevant!

My son also fractured his femur, but it was due to a bone cyst that he was apparently born with, but that we didn't know about until he had his fall.

He had an operation where they fixed a plate and 8 screws. It has been exactly one month since he had the operation and hopefully we will remove the cast within the coming two weeks.

However, I'm so worried about the coming phase, which is him without the cast. I don't know what to expect, and since it has been 2 years since your son fractured his femure, maybe you can tell me when to expect that he can go back to his old self.

He is 5 and a half, by the way. I hope your son is doing great now.

Thanks again, and I really can't wait to hear from you.

Sasha

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Dear Sasha,

My son has completely recovered; there is no difference in the length of his legs, and he has no trouble walking, running, or engaging in all other activities with children his age.

When the cast was first removed, however, it was a much different story. The healed leg was thinner than his other leg and the muscles had atrophied (the leg in the cast was also strangely hairy).

Akira was terrified when the cast was removed, as he was used to the heavy weight of the plaster. We put a pillow on his legs, and this calmed him as we wheeled him out of the surgeon's office. It acted as sort of a substitute for the cast.

Akira also couldn't bend his leg. In fact, he didn't bend it until the next day (he did it in his sleep).

Whatever you do, don't force him to bend it. The orthopedic surgeon told us that. Let him bend it when he is ready.

Akira laid on his stomach for a few days, just as he had when the cast was on. Then he eventually got up and started walking. Seeing his brothers running and playing around him was his motivation, no doubt.

Our orthopedic surgeon recommended we take Akira to a physical therapist (PT), and we did. We also put him through a little more than six weeks of daily leg-strengthening exercises. I did these at home, and took Akira to the PT periodically to make sure I was doing them correctly. (The surgeon wanted us to do the exercises with the PT at the clinic, but the copay was expensive--and we had to pay it on each visit!--so I asked for a list of the exercises from the PT and put Akira through them myself).

Your son's situation sounds very different from Akira's, however. He is older and he has a cyst, correct? Thus he may take longer to heal (the older we are, the longer it takes) and he may need different exercises than Akira required.

Be sure and ask the orthopedic surgeon. Ask lots and lots of questions.

One piece of advice: be sure he's around playing children after the cast is off. What I mean is, if he doesn't have any siblings near him in age, take him to the park or have him visit friends or relatives his age. Seeing other kids hopping around will give him a reason to get up and get moving again.

Hip Dysplasia Questions

Dear Les,


My husband and I just found out our two year old daughter has hip dysplasia and will need surgery. I would love to hear from other parents on a few questions:


1. Did you have x-rays taken of the spine and ankle of your child to make sure they were not misaligned as a result of hip dysplasia? This is a concern of mine.


2. Is traveling in a car with a child in a spica impossible? I mean, we would have appointments of course, and would need to get our daughter home after her surgery. What did you do when traveling in a car?


3. How were you successful in preparing your child for surgery?


Thank you,
Maiden Mom


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Dear Maiden Mom,


My son did not have hip dysplasia--he fractured his femur--so I know very little about this condition. But I will try and answer your questions as best I can (and hopefully other parents whose children have hip dysplasia can add insightful comments of their own).


1. This sounds like a question you should ask the orthopedic surgeon who will perform the operation.


2. Traveling in a car with a child in a hip spica cast is definitely not impossible. Our son wore a spica cast for seven and a half weeks and we took him to and from the doctor's office and physical therapy clinic in our car repeatedly. He was three years old. What we did was lie him down in the back seat, supported by pillows, and buckled him in place with seat belts. One of us (usually me) sat next to him and made sure he stayed in place. We (usually my wife) drove slowly and carefully.


If you'd rather not do this, or can't, you can buy car seats specifically designed for kids in hip spica casts. There is an example at this website. (They aren't cheap, but your insurance may cover part or all of the cost.)


3. Again, my child didn't have hip dysplasia, but he was put under so that the cast could be put on. I didn't do anything special to prepare him for the procedure, but stayed by his bedside until he was wheeled into the operating room and smiled and laughed a lot to keep him in high spirits. The nurses were also very sweet. They gave him a toy to play with and took his picture (before and after pics were taken). They helped keep him laughing until it was time for the cast to be applied.


What is critical is that you or your husband (or caretaker) be available immediately after the surgery. Once my boy awoke from the anesthesia he asked for me immediately and was very upset. He was sobbing and disoriented, and it was essential that I was there to comfort him. I did my best to hold him and soothe him until he cried himself to sleep.


I hope parents of children with hip dysplasia can add their comments to this post.


Wishing your daughter a problem-free operation and a smooth recovery,
Les

CastCooler Testimonial

A testimonial from a reader who has used the CastCooler product:

When we opened the cast cooler, we were really skeptical. From the first time we tried it, we were convinced. My 7 year old special-needs son is non-verbal. The look on his face when he felt the air through his cast was worth more than words.

Apparently it was quite soothing, as he fell asleep while it was on and had the most restful nap he had had since the placement of his spica cast. Since we began using the cast cooler, we have also noticed a significant decrease in the smell of his cast. Being able to circulate fresh air through his cast is indeed a wonderful thing.

We cannot thank you enough for creating this product.

-Lori

Son Won't Bend Leg After Spica Cast Removed

Hi,

My son is just two years old. He was in a hip spica cast for four weeks and in leg traction for two and a half weeks in hospital.

His plaster came off this Tuesday, Nov. 11, but his leg is still as stiff and straight as it was when it was still in the plaster (cast). He is not bending it at all.

I am massaging it regularly and giving him a warm bath daily, but he is still very scared to use or bend his fractured leg. Can anyone tell me, please, what I can do to encourage him to bend that leg?

If anyone could guide me about simple exercises I can do with him to help him, I would greatly appreciate it.

Thank you,
Sabiha

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Dear Sabiha,

When the surgeon took off my son's cast, he told us specifically not to bend the leg, and to let my son bend it on his own. It can be very painful to bend it, he told us, so we were to let our son bend it when he was ready to do so.

In the case of Akira (my son), he bent it while he slept that first night after the cast (plaster) came off. But it was several days later before he even tried to stand up.

One thing that spurred Akira to bend his leg, stand, and finally start walking (and eventually running) around was seeing his triplet brothers running around. He wanted to join in the fun with them.

Does your son have siblings close to him in age? If so, make sure your son sees them playing. If he doesn't have brothers or sisters, perhaps he has cousins or friends his own age? Or take him to a public playground so he can see other children his own age having fun. This should eventually encourage him to move.

If this doesn't help, then I would suggest you take him to a physical therapist. Ask the orthopedic surgeon who put on the cast to recommend one (my son's surgeon recommended the physical therapist we used for Akira).

I hope this helps.
Les

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Hi again,

Thank you so much for your advice, it was really helpful. I did exactly what you said: I took him to my cousin's house who has three children and Zia started walking and playing with them.

It's been more than week since the plaster (cast) came off, but still he has a limp in his walk. Also I have noticed he is walking on the side of his foot (the foot of the leg that was fractured).

I want to know if it's normal to have a limp at this early stage, and how long it took for your child to walk normally after his hip spica cast was removed.

Thanks again for your tips.
Sabiha
Nov. 20, 2009

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Sabiha,

I'm so glad to hear your son is up and around now. The limp is totally normal.

With regard to walking on the side of his foot, you may want to take him to a physical therapist and ask what you can do about that, just in case braces or corrective footwear is required.

Again, don't worry about the limp. My son didn't fully recover from his broken leg until 6.5 weeks after the cast (plaster) came off. And even at that point, he had trouble climbing stairs and walking long distances.

Remember, Zia has been inactive for six and a half weeks. This means his leg muscles have atrophied, and it will take time for him to rebuild strength and stamina in those muscles.

Be sure and have Zia do leg-strengthening exercises every day. I put my son Akira through 15 to 30 min. of such exercises on a daily basis, and it really helped.

Meet with a physical therapist and have him/her give you a list of exercises to do. Be sure the therapist shows you how to do them, then, after having your son do them at home for a week or so, go back to the therapist to make sure you have been doing them correctly. This is what we did with my son.

The other alternative would be to have the physical therapist put your son through the exercises, but this can be expensive (for us it cost US$50 per visit!).

For more on Akira's experience and what we did to help him recover, see this post.

Les