During your child's elbow surgery, the surgeon put the bone in a good position for healing and used special steel pins to hold it in place. The cast protects the pins and arm while the bone heals. You can help your child heal well by going to all follow-up visits and taking good care of the cast.

• To reduce pain and swelling in the first 24–48 hours:
  • Use pillows to raise the cast above heart level when your child is sitting down or sleeping.
  • When your child is awake, put cold packs wrapped in a towel on the cast for 20–30 minutes every 3–4 hours. Don't put ice directly on the cast because it must stay dry.
• For pain:
  • Give your child acetaminophen (Tylenol^® or a store brand) or ibuprofen (Advil^®, Motrin^®, or a store brand) as recommended by the care team. Follow the package directions for how much to give and how often. 
  • If your doctor prescribed a pain medicine but your child still has pain, ask the doctor or pharmacist if it is OK to also give your child acetaminophen or ibuprofen.

Daily cast care:

• Remind your child to wiggle the fingers to keep blood circulating normally.
• Check that the fingers have normal feeling, warmth, and color.
• Check the edges of the cast: Make sure your child isn't picking at or removing the padding from the edges of the cast. Make sure the skin near and under the cast isn't scratched.
• Don't put anything in the cast. Make sure your child doesn't put toys, food, or other objects into it.
• Keep dirt, sand, lotion, and powder away from the cast.
• If given a sling, your child should use it when up and walking around. Don't let your child wear the sling while sleeping.
• A wet cast can cause infection. To keep the cast dry:
  • No swimming.
  • Give sponge baths to kids younger than 5 years old.
  • Older kids should take baths instead of showers.
  • Put a plastic covering over the cast when your child bathes. Put the arm and cast on something to keep them completely out of the water.
  • If the outside of the cast is accidentally splashed, gently blow air onto it from a hair dryer on the cool setting.

Problems to watch for:

• Sharp cast edges: Put tape or moleskin (available at drugstores) on any rough spots.
• Itching: Tap lightly on the cast or use a hair dryer on the cool setting to blow air in and around the edges. Don't let your child scratch under the cast or put anything into it.
• Swelling: If the fingers look puffy, raise the arm above the level of the heart for 1 hour. If the swelling doesn't get better, call your health care provider.

Be sure to:

• Schedule a follow-up visit with the surgeon if you haven't already.
• Have your child avoid gym class, sports, and playground equipment and activities until the surgeon says it's OK.

Your child has: 

• fever of 100°F–101.5°F (37.7°C–38.6°C) for longer than 2 days after surgery
• fever higher than 101.5°F (38.6°C)
• swelling or numbness of the arm that isn't better after raising the arm on pillows for 1 hour
• pain that isn't helped by pain medicine
• red or raw skin around the cast

Your child is very upset and can't be calmed down (this could be due to pain).

The cast:

• gets wet
• seems too tight
• might have something stuck inside
• has an odor or drainage coming from it
• is rubbing against the pins

• Your child's hand becomes tingly, cold, blue, or pale.
• The cast gets wet and you can't reach the surgeon.

What can I expect in the next few days? Sometimes kids who are recovering from surgery feel sick to the stomach and don't want to eat or drink much the first day. Mild fever, under 101.5°F (38.6°C), is common in the first day or two after the surgery. Your child should start to have less pain over the next few days and will start getting up and around.

What will happen at the next visit? The surgeon will want to see your child 1–3 weeks after the surgery and may take an X-ray at this visit. Sometimes the cast is taken off for the X-ray and replaced with a new one. This doesn't hurt.

When are the pins removed? About 3–4 weeks after the surgery, the surgeon will see your child again to remove the cast and check X-rays. At this point, there's usually enough healing so that the pins and the cast can be removed. Any discomfort during removal is mild and lasts just a minute (like getting a shot), and most kids do very well. Your child will go home from this visit without a cast.

Will my child's arm be stiff after the cast comes off? It's normal for the elbow to be stiff after the cast is removed. Your child gradually will become comfortable moving the elbow more and more. Most children will have nearly all their motion back in about 1 month. The rest of the elbow motion usually comes back within a year after surgery. Most kids do not need physical therapy.