Which of the following would be the most appropriate play activity for a 3-year-old in a spica cast, considering both safety and development?

Choice A reason:

Bilious vomiting and constipation are not typical manifestations of hypertrophic pyloric stenosis. Bilious vomiting, which is green or yellow, indicates that the vomit contains bile and is usually associated with intestinal obstruction beyond the stomach. Hypertrophic pyloric stenosis typically causes non-bilious, projectile vomiting because the obstruction is at the pylorus, before the bile duct.

Choice B reason:

Abdominal distention and currant jelly-like stools are not indicative of hypertrophic pyloric stenosis. Currant jelly-like stools are a classic sign of intussusception, a different condition where part of the intestine telescopes into itself. While abdominal distention can occur in pyloric stenosis, the presence of currant jelly-like stools points to a different diagnosis.

Choice C reason:

A rounded abdomen and hypoactive bowel sounds can be seen in various gastrointestinal conditions but are not specific to hypertrophic pyloric stenosis. While a rounded abdomen may be present due to gastric distention, hypoactive bowel sounds are not a hallmark of this condition. The primary symptom of pyloric stenosis is projectile vomiting.

Choice D reason:

Ravenously hungry after vomiting is a classic manifestation of hypertrophic pyloric stenosis. Infants with this condition often vomit forcefully after feeding and then appear hungry again because the food does not pass through the pylorus into the intestines. This symptom, along with projectile vomiting, is a key indicator of pyloric stenosis.

The correct answer is c. “My toes feel like they are sleeping and won’t wiggle when I tell them to.”

Choice A reason:

“Watch how well I blow these bubbles” is not a concerning statement. It indicates that the child is engaging in normal activities and is not experiencing any distress related to the cast or the injury.

Choice B Reason:

“My skin is so itchy under there” is a common complaint among children with casts. Itchiness can be managed with appropriate care, such as using a hair dryer on a cool setting to blow air under the cast. However, it is not an immediate cause for concern.

Choice C Reason:

“My toes feel like they are sleeping and won’t wiggle when I tell them to” is a concerning statement. This could indicate nerve compression or impaired circulation, which are serious complications that require immediate medical attention. Prompt evaluation is necessary to prevent permanent damage.

Choice D Reason:

“I was able to ride on the scooter with the PT person’s help” is not a concerning statement. It suggests that the child is participating in physical therapy and is able to move with assistance, which is a positive sign of recovery.