Mehta Casting

Written by Pediatric RN, Sarah Tollison

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What is Mehta casting?
Mehta casting is a series of casts that are changed every 2-3 months that gently straighten a child’s spine. The cast is made out of either plaster of paris or fiberglass and is shaped around their torso. There is a hole for their lungs and stomachs to expand and most of the time there is a hole for their backs to breathe, as well. It is almost like a “turtle shell”!

Who is Mehta casting for?
Mehta casts are primarily used in young children who are rapidly growing but have been diagnosed with early onset scoliosis. Casting is usually suggested for children who are 6 months to 5 years old, since they are worn all the time and allows the spine to straighten as the child grows quickly during these young years.

What is the process to get a Mehta cast placed?
Since casting is mainly used for children under 5 years old, it is hard to have them stay still for the time it takes to place the cast and form it in the proper way for it to create the tension needed to help straighten the spine, so they are usually placed in an OR. The orthopedic surgeon and their team will go through the same process they do for any surgery; having the patient go from pre-op, to the OR, to anesthesia, to placing the cast, then waking up in the Post-op area.

The child will most likely be placed under anesthesia and won’t remember anything that happens in the OR. While sleeping, the surgeon will place the cast on the child and will shape it so that it will cause traction on the spine to grow in better alignment. Once the surgeon is happy with the shape and possibly checked placement with an x-ray, they will send the child to wake up in the post-op area.

If the cast is fiberglass there is no real drying time so it can be wrapped in color soon after the child wakes up. If the cast is made out of plaster of paris, this material needs time to dry and a cast dryer will be placed to help speed this process up. It usually takes about an hour for the cast to fully dry when using a cast dryer, and then the cast can be wrapped in color. Most children go home the same day as casting. Casts are worn for a few months until it is time to replace it with a new one.

Do Mehta casts hurt?
Since a Mehta cast covers most of the torso, from under the arms to above their hips, it will take some time to adjust to having one on, but it should not hurt the child. At first the tension on their spine may be uncomfortable, but it should not take long for the child to become accustomed to the new change. As far as the edges of the cast go, a soft “t-shirt” is placed under the cast to prevent any skin breakdown or rubbing. Once the cast is in place, any rough edges will be trimmed, as well. Moleskin can also be used under the arms and in any areas of concern for rubbing under the cast. Overall, a Mehta cast should not cause any pain to the child except for having to work through any discomfort for the first day or 2, until they adjust to the cast.

What concerns to look for once at home?
Circulation is the main concern parents need to watch out for. Parents should check that their child’s skin is warm and their normal color, with good movement in their arms and legs and all sensation is normal. If any paleness (not related to temperature changes), numbness, or weakness occurs, the parent should call the hospital. If the child has any trouble breathing, the parents should take garden shears or tin snips and cut off the cast and call 911 if needed.

Skin and pressure problems are another concern. Parents should check any areas of possible rubbing, such as under the arms, around any edges, and around the hips for signs of redness, sores, or complaints of heat or tightness. If any of these issues arise, contact the hospital.

How to care for the cast?
The main two instructions on cast care are to keep the cast dry and make sure nothing gets placed inside the cast. Try to keep the cast as clean as possible by keeping the child out of any grass, water, sand, or mulch. Sponge bathe the child and wash their hair separately to keep the cast nice and dry. Skin under casts can get itchy so be on alert to make sure the child does not stick anything down inside the cast.

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References

1. https://www.cincinnatichildrens.org/health/m/mehta-casts
2. https://www.shrinerschildrens.org/en/pediatric-care/mehta-casting

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About the Author

I’m Sarah, and I am a Pediatric Registered Nurse! I currently work at Shriners Children’s Hospital, and we specialize in pediatric orthopedic surgery. I love it here for many reasons, but it’s the patients and their families who are at the top of that list! I always wanted to work with kids, and I loved that I was able to start my nursing career at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, where I worked for a little over a year. I got married during that time to my amazing husband and we decided to move to SC soon after we were married. I love living near the mountains, and when I’m not at work, you can find me walking or hiking with my German Shepard, Sadie Mea! I love traveling and exploring this beautiful world!

 

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