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Published on: May 20, 2019
The Impact of Cast Immobilization on Return to Daycare
Michael J Heffernan1, Scott A Barnett1, Matthew E Nungesser2
1Department of Orthopaedic Surgery, Children's Hospital New Orleans.
Insights
Children with spica or long leg casts face significant barriers returning to daycare (RTD). Orthopaedic immobilization type greatly impacts readmission, necessitating policy review for socioeconomic implications.
Area of Science:
- Pediatric Orthopaedics
- Public Health Policy
- Childcare Management
Background:
- Children treated with cast immobilization often face restrictions from returning to daycare (RTD).
- These restrictions create a substantial burden for parents and caregivers.
- Understanding the factors influencing RTD is crucial for supporting families.
Purpose of the Study:
- To assess the impact of cast immobilization on a child's ability to return to daycare.
- To determine the prevalence of RTD after orthopedic immobilization based on daycare facility policies.
- To identify specific cast types and policies affecting RTD.
Main Methods:
- A survey study was conducted on 73 randomly selected daycare facilities serving 6662 children.
- The survey included questions on daycare policies, experience with immobilized children, and facility characteristics.
- Immobilization types were visually presented to facilitate accurate reporting.
Main Results:
- Daycare facilities with policies for RTD were common (81%), but only 38.5% had cared for an immobilized child recently.
- RTD rates were higher for upper limb injuries (90.5%) versus lower limb injuries (79%).
- Spica casts showed the lowest RTD rates (16-22.5%), with experienced facilities reporting higher RTD.
Conclusions:
- The type of cast immobilization significantly influences a child's ability to return to daycare.
- Children with long leg and spica casts experience disproportionately higher restrictions.
- Surgeons and policymakers should consider the socioeconomic impact and develop standardized re-entry guidelines.
Background:
Children who are prohibited from returning to daycare (RTD) after treatment with cast immobilization place an increased burden on parents and caregivers. The purpose of this study was to assess the impact of cast immobilization on RTD. Specifically, we sought to determine the prevalence of RTD after orthopaedic immobilization based on daycare facility policy.
Methods:
This was a survey study of randomly selected daycare facilities servicing a total of 6662 children within 10 miles of a major metropolitan city center. The 40-question survey included information on daycare policies and experience caring for children treated with orthopaedic immobilization. The survey also included questions about daycare type, enrollment, and geographic location. Photographs of the types of immobilization were embedded in the survey to facilitate understanding. Daycare facilities were randomly selected based on a power analysis to estimate a 50% prevalence of RTD after spica casting within 10% margin of error.
Results:
Seventy-three daycare facilities completed the survey study. The average child-staff ratio was 5:1 and most daycare facilities (78%) did not have a nurse on staff. Predetermined policies regarding RTD after injury were available at 81% of daycares. Twenty-eight (38.5%) facilities had encountered a child with a cast in the previous year. The rate of RTD for children with upper limb injuries was 90.5% compared with 79% for lower limb injuries (P=0.003). Spica casts showed the lowest RTD rate: single leg (22.5%), 1 and a half leg (18%), and 2 leg (16%) (P<0.0001). Experienced daycare facilities (>5 y) had a higher RTD rate compared with less experienced facilities (P=0.026).
Conclusions:
The ability to RTD is dependent on immobilization type. Children with long leg and spica casts are disproportionately restricted when compared with other cast types. At minimum, surgeons should consider the socioeconomic implications of orthopaedic immobilization. There is also a need for orthopaedic involvement in policy formation at the local level to provide standardized guidelines for re-entry into childcare facilities following orthopaedic immobilization.
Level Of Evidence:
Level IV.
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