It's easy to teach hygiene to kids with special needs

By Sandy Keefe

Mark is ten years old, and I'm still bathing him every night," Tina complains. "With his ADHD and learning disabilities, he can't seem to focus. He takes a few swipes at his arms and then he's done!"

Knowing that Mark has real problems with motor planning and eye-hand coordination, you're not surprised to hear that he's still not able to bathe himself, but is he ready to learn?

Children with ADHD, autism or learning disabilities often have trouble planning and carrying out activities of daily living. Bathing, grooming and dressing can seem overwhelming to kids with cerebral palsy, Down syndrome or other developmental delays. Impaired proprioception, motor apraxia and cognitive impairments can be frustrating as these children struggle to learn and sequence hygiene activities. Language or thinking problems often jumble the verbal cues given by well meaning parents. And children with sensory processing issues may be exquisitely sensitive to the water temperature or resist the sensation of a rough towel or washcloth.

How can a parent know when the child is ready to learn bathing and other hygiene skills? The seasoned OT can be very helpful in this assessment process. First, encourage the parents to take a look at the child's "get ready" skills. Does the child pay attention when mom or dad is talking? Can he or she hold a washcloth with one hand and apply soap with the other? Does the boy or girl show any interest in self-care skills? Bruce Baker and Alan Brightman provide a helpful list of these building block skills in Steps to Independence, an inexpensive paperback book from Paul H. Brookes Publishing Company. This text is the very best one-stop resource for parents who want to teach self-help skills to their special needs child.

It's also important to teach the child the name and location of all body parts so the parents can use verbal cues to guide him through hygiene activities. One of the most effective ways to teach this information is the "My Body" game. Write out the names of key body parts on small cards and make a fun game out of taping the cards to the corresponding areas on dolls, stuffed animals, parents, and even the child. This way, the child not only learns the word "elbow", but also begins to understand where that elbow is in relation to the rest of his body.

Setting the Stage

Let's say that mom and dad want to start with shampooing as the first hygiene skill, because the child is intensely interested in "washing my hair like Sissy." It's important that everyone who works with the child—therapist, parents, babysitters, and siblings—use the same sequence of steps for hair washing. Write out a list of steps involved in the child's shampooing ritual. Baker and Brightman, for example, list the following steps for shampooing:

• Wet hair thoroughly.

• Put shampoo on hand, then onto hair.

• Rub the shampoo into scalp until it lathers.

• Rinse by putting head under the shower several times, working hands through hair until it squeaks.

• Dry hair with a towel.

Once everyone agrees on the sequence of steps, make a poster with words and/or pictures that the child can easily understand. Colorful cardstock is an excellent choice, and helps draw the child's attention to the poster. It's also a good idea to laminate the poster for durability in the steamy bathroom. Use dry-erase colored markers to check off each step as the child masters it.

Making It Fun

Bathing, shampooing and other hygiene skills are "grown up" activities, and should be celebrated as such. Make the learning process fun and intriguing. A special shopping trip to a discount store with mom, for example, may pique the child's interest in the learning process. Encourage mom to buy a colorful plastic bucket and fill it with small bottles of aromatic shampoo, silky conditioner, roll-on deodorant, tiny carved bars of soap, fragrant bubble bath, fluffy washcloths, a colorful new hairbrush and other grooming supplies.

If the family situation allows, encourage the parents to make some changes in the child's room that enhance the learning experience. Perhaps they can put up an inexpensive shelving unit or small table to hold the bucket of hygiene supplies. An easily accessible shelving unit provides a great place for the child to put out coordinated clothing for the next day. With feedback from mom or dad, the youngster can learn to select clothing appropriate to the weather. It's also a great time to talk about what matches and what clashes!

Checking the Results

Early in the teaching process, the parents will want to monitor the child's hygiene activities pretty closely. Over time, encourage them to gradually lessen the amount of supervision. A full-length mirror in the child's room will provide visual feedback so he can check his own appearance. Once again, a small poster can provide visual cues to remind the child what successful grooming looks like. Use pictures and/or words to convey key questions:

• Did I remember to comb my hair?

• Is my underwear showing?

• Did I put my shirt on backwards?

Rewarding the Accomplishment

As the child masters each step, remind the parents to provide verbal feedback along with small rewards. Comments like, "Boy, you look shiny clean this morning" will make the child glow with success and does a lot to encourage further learning. A young girl who masters the intricate steps involved in shampooing will be thrilled to receive special barrettes for her shiny hair. A young man who independently showers and dries himself will be pleasantly surprised to have his own roll-on deodorant.

Celebrate each accomplishment for what it is—a step forward toward the goal of raising a competent adult!

Sandy Keefe, RN, MSN, is a nurse case manager for children with special needs. Her 11-year old daughter Allie bathes, grooms and dresses herself despite her Down syndrome and sensory integration dysfunction.