How should we take care of the cast?
The first 24 hours after the cast is applied, your baby may be restless but he/she should be comfortable after that time. Please perform the following: 

1. Check the circulation in the foot every hour for the first 12 hours after application, and then four times a day. This is done by pinching the toes and watching the return flow of blood. The toes will turn white and then return quickly to pink if the blood flow is good to the foot. This is called blanching.
   If the toes are dark and cold or do not rapidly return to pink when released, the cast may be too tight. If this occurs, call us immediately and inform the hospital about this condition. In all likelihood, we would ask you to remove the plaster ASAP and then report to our hospital.
2. The top of the toes should be exposed. If you cannot see the toes, it may mean the cast has slipped and correct reduction is not being maintained. If this happens call the hospital ASAP.
3. Keep the cast clean and dry. The cast may be wiped with a slightly dampened cloth if it becomes soiled. Keep the top of the cast outside the baby’s diaper to prevent soiling.
4. The new cast should be placed on a pillow or soft pad because hard surfaces may dent wet plaster. Whenever your child is on his/her back, place a pillow under the cast to elevate the leg so the heel is just beyond their pillow. This prevents pressure on the heel.
5. Use disposable diapers and change the baby often to prevent cast soiling. Apply the diaper above the top of the cast to prevent urine/stool from getting inside the cast. Diapers with elasticized legs work well. Notify us if you notice the following:
   • Any drainage on the cast.
   • Any foul smelling odors coming from the inside of the cast.
   • If the skin at the edges of the cast becomes very red, sore or irritated.
   • If your child runs a fever of 38.5˚C/101.3˚F or higher without an explainable reason, such as a cold or virus.

   Removal of the cast before every plaster:
   Though Agashe Paediatric Super Speciality Care has very advanced instruments for cutting the plaster, we prefer that the parents of the child remove the plaster on their own a few hours before reporting for the next plaster at home. This can be done by dipping the plaster in lukewarm water for a few minutes till it becomes soft and then actually unrolling the plaster rolls in the reverse direction of application. We always keep small knobs at the end of each plaster roll, so that the parents know exactly where to unroll it from. This is a much more child-friendly practice than the cast saw as it has been noticed that the noisy cast saw can cause severe stress to the child and has a great danger of cast saw burns on the delicate skin of the child.