Casting and splinting are fundamental skills in pediatric orthopedics that impact both patient outcomes and healthcare costs. The current chapter provides practical, evidence-based techniques to help clinicians improve their casting skills and avoid common pitfalls. Key topics include the use of elbow extension casting to improve stability in certain upper extremity fractures, cast wedging to correct angular deformities and minimize the need for repeat reductions, and effective padding methods to prevent pressure injuries under the cast. The chapter also offers strategies for minimizing cast slippage, tips for the safe use of cast saws, and approaches to prevent and manage problems associated with wet casts. By implementing these high-value strategies, clinicians can reduce complication rates, limit the need for secondary interventions, optimize resource use, and enhance value.