TABLE 3.

Recommendations for Parents (based on current knowledge)

a. Expect your child to fuss in the brace for the first 2-3 days.

i. This is not because the brace is painful, but because it is something new and different.

ii. The child may have skin sensitivity as a result of the casting

ii. If your child is completely inconsolable and you believe that they are in pain, contact your physician immediately.

b.Play with your child in the brace. This is a key to getting quickly over the child's irritability.

i. Since the child is unable to move his/her legs independent of each other in the brace, you must teach your child that he/she can

kick and swing the legs simultaneously.

ii. Gently flex and extend the knees by pushing and pulling on the bar of the brace.

iii. Try making a game of the motions by singing and/or talking to your child in an encouraging manner.

c. Make the treatment a routine.

i. Your child is less likely to fuss if you make the use of this brace as a routine, non-negotiable part of their daily activities, just like

putting on their pajamas, brushing their teeth, and reading books at night.

ii. When the child is only wearing the brace while sleeping, put the brace on any time your child goes to the “sleeping spot.”

iii. Some parents have made a brace for the child's favorite stuffed animal or doll.

iv. Some parents call the brace “Nite-Nite shoes” or “Magic Shoes”

d. Show your child pictures of other children with clubfoot wearing their brace.

e. Use rewards and incentives to help your child understand the importance of the brace.

f. For older children, ask your physician to talk to the child at follow up appointments about their brace and how it helps them maintain

the correction.

g. Pad the bar. This will protect your child, yourself, and your furniture from being hit by the bar when the child is wearing the brace.

i. A bicycle handle bar pad or foam pipe insulation covered with fabric or tape works well.

ii. Placing a sleep sack on the child at night will also help with padding and keep the baby from pulling at the straps and laces

with their hands.

h. If you notice any bright red spots or blistering contact your health care provider.

i. Some mild redness is normal with use.

ii. Bright red spots or blisters, especially on the back of the heel, usually indicate that the shoe was not worn tightly enough.

Make sure that the heel stays down in the shoe.

iii. Tighten the strap by one more hole or tighten the laces

iv. Remove the tongue of the shoe. Use of the brace without the tongue will not harm your child.

v. If the brace shoe has laces, lace the shoes from top to bottom, so the bow is by the toes.

vi. Check the width of the brace and widen if necessary.

vii. Never use lotion on any red spots on the skin. Lotion will make the problem worse.

viii. If persistent and the foot comes out of the shoe, it may be a sign of early relapse.