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Self-care skills

Learning to look after yourself is an essential skill.  As a parent you start off feeding, cleaning and caring for your children, but also teaching them how to do it for themselves.

Remember

• Don’t take over
• Break the task into smaller chunks
• Teach by showing, talking through the steps, doing the task together
• Problem-solve – don’t correct but discuss ways to fix it.
• Practise, practise, practise! Give your child opportunities to practise every day.
• Set up activities for success, like looser clothing, shoes positioned the right way round

Dressing

Success is important; therefore begin with breaking the dressing activity into small, straightforward steps. Tackle one step at a time and give help where needed with the other steps of the task, e.g. help the child to pull the t-shirt over their head and then allow them to put their arms through the sleeves.

Dressing can be a complex activity. Children need to be able to master a number of skills.

These include:

• Motor skills where a child needs to be able to move his or her limbs and body in a full range of movements requiring muscle strength and flexibility at their joints.

• Co-ordination where a child needs to be able to create co-ordinated movements, using one arm and both arms. A child also needs the control of hand movement that require fine motor skills, such as fastening buttons.

• Balance – being able to maintain their balance whilst changing posture/position both with eyes open and shut.

• Fine Motor Skills – being able to reach, grasp and release objects in order to complete tasks such as buttoning or holding the item of clothing.

• Perception – having an understanding of various sizes and shapes of buttons and also knowing the size of arm holes.

• Stereognosis – being able to feel their way without relying on sight such as finding arm holes with a jumper over his or her head or fastening buttons behind at the back.

• Body Schema – being able to tell right from left and the difference between arms and legs. 

General Principles

• Ensure that your child is sitting in a stable position, e.g. on the floor (where it is easier for children to reach their feet) or sitting on a chair or firm bed with his or her feet supported. If sitting balance is poor, try sitting against a wall. Some children may sit better in a corner where both walls give added support. Alternatively stand against a wall.

• Sit next to, in front of, or directly behind your child during activity and guide them through the task.

• Undressing is usually easier than dressing. Dress in front of the mirror to provide visual cues and use to check all is correct before going out.

• Start with undressing. Undressing before bed and helping to put on pyjamas is a good time to start as you have more time at night than in the morning.

• Follow a consistent sequence and technique when dressing:

o Clothes can be placed in a pile in the order in which they need to be put on.

o Follow the same technique for each garment, e.g. t-shirt is put over the head first and then the arms are put through the sleeves.

o The order and technique can be written down so that it can be followed by other carers and school staff. You could use pictures as a visual prompt to help your child remember the clothing order/technique.

• Describe actions and parts of the body as you are helping your child to dress, eg ‘put right foot in,’ ‘now stand up whilst I pull your trousers up your legs.’

• Instead of automatically correcting a mistake, get your child to look (maybe in a mirror) and feel if all is correct. Then encourage them to identify and sort out what needs to be done, e.g. T-shirt needs pulling down; shoes ‘feel wrong’ because they are on the opposite feet.

• Try to avoid fastenings, tight clothes and lots of layers. Instead use loose fitting clothing, e.g. tracksuits, sweatshirts. Use clothes with wide neck and arm holes to make it easier to locate these. Initially it may be easier to practise with clothing a size too big.

• Try not to watch all the time; your child may do more when left alone.

Development of dressing skills

Dressing should not be seen as a chore. Try to keep it fun by playing dressing up games and dressing toys. This will give your child a clearer idea of how to organise dressing

Development of dressing skills

Dressing skills and stages of development

12 months	• Helps with dressing by holding out arm for sleeve and foot for shoe. • Cooperative in dressing. • Likes to pull shoes off.
18 months	• Takes off shoes, socks, hat but rarely able to put back on.
2 years	• Puts on hat and shoes. • Removes unfastened coat. • Helps push down garments • Finds arm holes in t-shirt
2 1/2 years	• Tries to put on socks • Undresses loose pull down garments
3 years	• Able to put on shoes without fastening (may be wrong foot) • Can pull zips up and down, but unable to insert or separate shank.
4 years	• T-Shirt on/off independently but may be back to front. • Pull up garments on independently
5 years	• Dresses and undresses independently but may still need help with small buttons, zips and laces. • Clothing may still be put on back-to front on occasion.

These ages are a guide only, but can help determine a young child’s readiness for dressing independently

Pre-dressing skills activities

• Musical dressing up (a variation of musical chairs): the children put items of clothing on from a pile until the music stops, at the end of the game the child with the most clothes on is the winner.

• Using a variety of large shirts or smocks, get the children to get ready for wet play, painting or cooking.

• Button boards, play cubes, cloth button or popper books to give the child practice types of fastenings. • Dressing dolls give good practice opportunities

• Matching sock game. Place a variety of socks in a pile, and your child has to find pairs and put them on.

• Package wrapping. Making parcels and tying them up with different sorts of ties.

• Play ‘Simon Says’ and get your child to identify various body parts. Do the ‘hokey cokey’ as a way to learn left from right.

• Completing threading activities. Getting them to copy a pattern of various sized beads on thread (wool is better for larger beads) to improve pattern recognition. Adapt the task by getting the child to pull desired bead from bag.

• Complete lacing activities using lacing boards to develop fine motor skills such as grip, release and eye-hand co-ordination. A shoe shaped piece of card or shoe box with holes in can be used to practise lacing and tying shoes.

• Posting coins. Let your child use pincer (finger and thumb) grip to post coins into a money box. This will help develop pre-button skills.

• Completing jigsaws and form boards will assist with visual skills.

• Foot massage. Give the child a foot massage to increase awareness of feet. This can also be achieved by walking on various surfaces barefooted, grass, concrete, etc. Do these as a preparation for putting on shoes and socks, tying shoelaces.

• Clothes pictures. Make a picture representation of the clothes your child is wearing and get him or her to talk through what order to undress/dress in. These pictures can then be used as a reference point for future dressing sessions.

Ways to learn dressing skills

Backward chaining

The adult begins the task, with the child only doing the last step. Gradually the adult does less as the child is able to do more of the task themselves. This way the child always gets the reward of finishing the task, e.g. the adult puts the T-shirt over the child’s head and helps them to get their arms through the holes. The child then pulls down the t-shirt at the front.

An example of backward chaining

Taking off a shirt:

Step 1: Let the child remove the last half of their arm from the sleeve

Step 2: Let the child remove their whole arm from the sleeve

Step 3: Let the child remove shirt with one arm in and one arm half in

Step 4: Let the child remove shirt when pulled off shoulders

Step 5: Let the child remove the shirt

T-shirt.

 Step 1: Let the child remove the T-shirt from their head

Step 2: Let the child remove T-shirt from their neck

Step 3: Let the child remove T-shirt with one arm in and one arm out

Step 4: Let the child remove the T-shirt with one arm in and one arm half out

Step 5: Let the child remove the T-shirt with both arms in and T-shirt pulled up to shoulders

Step 6: Let the child remove the T-shirt

Forward chaining

This is when the child starts the task (e.g., putting the T-shirt over their head), and the adult helps with the later stages the child needs help with (e.g., putting their arms through the sleeves). The child needs to be motivated to begin the task themselves.

Always demonstrate the correct technique first, telling your child what you are doing at each stage e.g. I am unbuttoning the shirt, I am taking your arm out of the sleeve, and so on. Try to maintain the same order of this activity time for consistency.

Order and orientation of dressing

Ensuring clothes are the correct way round

Children may find it difficult to know the correct order in which to put on each item of clothing, i.e. knowing to put on underwear before trousers. Also they may find it difficult to know that they have put on clothes the wrong way or inside out. In these situations there are different strategies that can be used to help your child.  

 

In the correct order:

• Make it fun – sing songs/rhymes about the correct order, play dress up with your child’s toys/dolls.
• You can use visual aids such as dressing chart, with pictures of each item of clothing in the order they should be put on.
• As you are helping your child to dress, talk about the order, i.e. ‘now you put on your trousers’ also prompt them ‘what do you put on next?’
• To begin with prepare the clothing for your child by laying them down in the correct order.
• Give your child time to work things out for themselves and to self-correct, provide prompts and questions if needed. And when assisting talk through what you are doing.  

On the right way round:

• Identify the clothing label – teach your child to understand where labels should go and how to use the clothing label to help them understand which way the clothes should be put on, e.g. for a top the label is usually at the back.
• You can also do this with coloured thread inside the clothing item.
• Having clothes that have pictures/colours/pattern on one side of the clothing and help your children make the association that the picture, etc. goes to the front
• To begin with prepare the clothing for your child by laying them down the correct way round.

 

Gripping the clothes

• Roll up clothing to create ‘more’ to grip, e.g. roll up bottom edge of the t-shirt before putting on.

• Use adult’s hand over child’s hand to assist grip (hand-over-hand technique).

• Avoid slippery fabrics.

Clothes and fastenings

Due to modern advances with clothing and fastenings e.g. Velcro instead of laces or buckles and generally more stretchy, looser materials, children no longer necessarily have the opportunity to practice skills such as tying shoelaces.

Socks

• Place socks partly over your child’s foot, then encourage them to perform the last part.

• Sport tubular socks are easier than those with a heel.

• Socks with coloured heels and toes also make it easier to work out the correct way round. Alternatively mark the back of the sock with thread on the inside, top edge.

• Make sure that the elastic is not too tight, avoid tight fitting socks.

• Prompt your child to use their “magic thumbs” to help pull the socks on. i.e. isolating their thumbs to get them under the socks to pull up.

• Roll down the top of the sock to make it easier to get the foot in. Use a loop on the back of the sock for the child to hold as they pull them up.

Shoes

• On the inside of the shoes and pumps, mark the inside border of each piece of footwear with indelible ink. The child can then place these two marks together to ensure that the correct foot is inserted into each shoe.

Coat

• There are many different strategies, but this one is quite effective. Drape the coat over the back of a chair with the lining facing outwards and the sleeves freely hanging. The child stands with their back to the lining and puts each arm in turn into the sleeves. The child bends down to get the coat onto the shoulders and then moves up and away to release the coat.

Fastenings

Buttons

Buttons are a hard skill to learn. Both hands need to work together but make different movements.

• Start by teaching unbuttoning first.
• Start with larger buttons and work to smaller ones.
• Make it fun and practise as part of play. Dressing teddies and dolls. See (attached) button information sheet for ideas.
• It is easier to practise with the clothes lying flat on a table so they can see what they are doing.
• Once unbuttoning is mastered move onto buttoning.  Finally, get your child to put the clothes on and undo and do up the buttons this way.

Helpful strategies

• Only undo the top few buttons when taking off a shirt/blouse, and then remove the garment over the head. It can be put on over the head and only a few buttons will need to be done up.

• Choose trousers or skirts with elastic waist bands if buttons and buckles are difficult.

• Velcro can be used instead of buttons, e.g. on a coat/shirt use Velcro and sew buttons on to top flap.

• Try leaving the cuff buttons done up. Alternatively sew a piece of elastic or a button attached with elastic thread across the cuffs so that it can be stretched open when the hand is pushed through.

•  Talk through each stage of the task in terms of what the next step is – ‘find the button’, ‘open the hole’, ‘push it through’, ‘grab it’.

• Buttonholes on new clothes are often tight and may need snipping slightly to open them up or just stretching by pushing the button through and back repeatedly.

Zips

• When buying a coat with an open ended zip, test the zip thoroughly as the ease of fastening can vary a lot.

• Attach a key ring or curtain ring to the zip to aid grip.

Shoelaces

Learning to tie shoelaces is hard. Learn to tie shoelaces when your child is ready and wants to wear shoes with laces.  Children don’t usually have the skills they need to be able to tie shoelaces until they are between 5 and 7.

Help with tying shoelaces

Shoelaces are best learned in a step by step way. It is helpful to master the first step before moving onto the next. This technique is useful as you are in effect teaching a series of knots and your hands don’t have to perform as many different moves.

Helpful tips and strategies

Before moving onto shoelaces, it may be helpful to play some games that help you to learn some of the skills used. Here are some ideas to try:

• Ripping paper/card - to increase hand strength needed when tightening the lace

• Paper weaving, constructional toys, lacing games – can help you understand how the lace goes behind and is posted through

• Tying bows with ribbon, as this is less likely to slip

• Complete lacing activities using lacing boards to develop fine motor skills such as grip, release and eye-hand co-ordination. A shoe shaped piece of card or shoe box with holes in can be used to practise lacing and tying shoes or Shoe templates can be purchased from Early Learning shops and are recommended for practice purposes.

• Obstacle courses – practising concepts of under, over, around and through. Try copying these in a sequence

• Practice with two different coloured laces to make following the shoelace tying instructions easier.

• Try the technique below with a skipping rope over the child’s foot to get the hand of the movements required

Sometimes it can be useful for the child to write down the steps for tying their shoelaces using their own words, which may make it easier for them to understand when they next try again. You can include pictures to help

General principles

• Sit in a comfortable, balanced position, with your back against something

• Always practise using thicker “fluffier” or flat laces as opposed to thin elastic type round laces that you may find in some shoes. The thinner laces tend to come undone much more quickly. Ensure that the laces are long enough to comfortably tie a bow.

• Use long, wide shoelaces initially and it is sometimes useful to colour-code them i.e. one blue lace and one red lace.

• It is easier to practise laces if the shoe is on your lap initially rather than on the foot. Once your child has got some idea about the task, it is easier for your child to see what they are doing if they are seated with their foot (and shoe) on a small stool or chair in front of them.

Shoelaces are best learned in a step by step way.  It is helpful to master the first step before moving onto the next.  Don’t practise shoelace tying until your child is wearing shoes with laces as they will need to practise this skill daily.

There are generally 2 ways to tie shoelaces, the 1-loop or the 2-loop (bunny ears method)

Steps to follow for one loop method: Making a knot

Making a bow

Steps to follow for two-loop method (bunny ears)

• Alternatives: Toggles, elastic laces, springy spiral laces, slip on shoes, Velcro, Greeper laces (www.greeper.com)#
• A very useful website for more information https://www.nhsggc.org.uk/kids/life-skills/self-care/dressing-myself/

Handwashing

Handwashing is an essential skill for children of all ages.

• https://www.nhsggc.org.uk/kids/life-skills/self-care/going-to-the-toilet/hand-washing/

The resource above includes access to:

• Visual aids for handwashing
• The Health Hub video ‘Washy Washy Clean' song to help young children wash their hands.
• https://www.nipcm.hps.scot.nhs.uk/resources/hand-hygiene-wash-your-hands-of-them
• Handwashing song for children - NHS: 

Toileting

Going to the toilet

Toilet training is a complex task. It includes knowing when you need the toilet and learning all the skills to be successful and some perseverance on your part.

Going to the toilet has a lot of steps. The child needs:

• to know that they need to go
• to be able to let you know
• to get to the potty or toilet in time
• to be able to take down their pants and trousers
• to be able to sit on the potty or toilet safely
• to have a wee and/or a poo
• to learn to wipe or wash themselves
• to be able to pull their clothes up and flush the toilet
• to wash and dry their hands.

Toilet training

Toilet training is challenging for everyone. Children vary in the speed with which they are toilet trained from days to much longer.

Practice and patience are needed; as with all new skills this task will take time to learn. Break the task down into its separate parts (e.g. managing clothes, wiping or washing hands etc). Teach one task at a time with you helping with all the other tasks.

It is important your child feels secure when they are sitting on the toilet. Using a toilet step or a sturdy box under their feet will make them feel safer. It also helps them to be in the right position for pooing. A toilet seat insert can help your child feel safer too.

There is lots of help available. If you have questions about toilet training then speak to your Health Visitor. Nursery staff have lots of experience with this too so might be able to help. If your child is older then the school nurse will be able to help. If your child starts having accidents once they are toilet trained it is important to take them to the GP.

The HCT continence service includes some advice and links in their “useful information” page and there a couple of other useful links here:

• https://www.hct.nhs.uk/service-details-/service/children-and-young-peoples-continence-service-12/
• https://www.autism.org.uk/advice-and-guidance/professional-practice/toileting
• https://autismlittlelearners.com/free-toileting-sequence/

 

Bottom wiping

This is a skill that needs to be taught and when teaching a new skill we often start at the beginning.  This can be challenging for children who are struggling to master a skill.  One way of learning a new task while giving your child a sense of achievement is to use the backward chaining technique. 

Backward chaining is useful when learning self-care skills.  It can also be helpful when teaching younger children and those who have difficulty learning new skills.

Back chaining:

Start by breaking the task down into small steps and teach your child the last step first.  Complete all of the steps except the last one and have your child practice the final step.  Your child will enjoy the success that comes from completing a task.  Once your child has mastered the last step you complete all of the steps except for the last two.  You teach your child the second from last step and they then complete the last step themselves.  Even more success!  Continue like this until you are teaching the first step and your child is completing all the other steps.

Click on this link for more information and advice: https://www.nhsggc.org.uk/kids/life-skills/self-care/going-to-the-toilet/

The link above includes: 

• A bottom wiping activity sheet
• Manipulating toilet paper activity sheet
• Wipe clean game

 

Washing and bathing

Washing and Bathing – functional skill

Introduction

Becoming independent in self-care tasks is an important life skill that can give a child a sense of achievement. Even if a child can become independent in completing part of their self-care tasks can create a sense of provide and increase engagement during self-care routines.

Backward chaining approach:  

• The backward chaining approach can be used when completing self-care tasks to provide your child with a sense of achievement.
• When completing a backward chaining approach we first need to break the task down into small achievable steps.
• Teach your child the last step of the task first. The adult completes all the steps of the task except the last one. Request your child to practice the final step.
• When your child completes the final step they will experience a sense of achievement from completing the task.
• Once you child has mastered the last step, you complete all steps of the task except the last two steps. You teach your child the second last step and then they complete the last step themselves.
• Continue completing this approach until you are teaching the first step and your child is completing all the other steps.
• This handout created by NHS Greater Glasgow and Clyde provides additional information for backward chaining - Backward chaining information sheet (nhsggc.org.uk)

Tips of help improve independence:

• Creating a consistent routine around washing/bathing. Aim to complete the washing/bathing routine at the same time in the day, using the same resources and completing the actions in the same order every time.
• Ensure your child is safe and secure when standing in the shower and when transitioning in/out of the shower. A non-slip mat placed on the shower floor may be helpful to increase stability and safety. If your child has difficulties with balance, it may be easier for them to be seated in the shower. This will assist them with being able to focus on completing the washing steps rather than focusing on maintaining their balance.
• Your child may benefit from having access to a mirror to look in whilst learning the steps for washing/bathing. This will provide the child with visual feedback and assist with co-ordinating the movements.
• When your child is initially learning the actions to complete the skill, they may require hand over hand support (placing your hand over theirs and completing the action together) to build skill and motor planning.
• Many children may benefit from being provided with visual supports/prompts that outline each step required to complete their washing/bathing routine. Ensure the visual prompts are in a place where the child can see them e.g laminated and stuck on the shower door. Guide your child as to what the next step of the routine is by pointing or prompting with the next picture/step in the routine.  Examples of showering schedules are below;

• Visual schedules for showering routines can be found here; Looking After My Body | NHS GGC

Sleep is important for health well-being learning and development. Making sure that your child is getting the right amount of sleep is important.

Sleep facts

• Internal body clock (circadian rhythm) tells us when to sleep and when to wake up, regulating a sleep pattern. 
• Moving in a 24 hour daily cycle this circadian rhythm responds mainly to daylight. 
• We all go through sleep cycles, moving through light sleep, deep sleep, dream sleep, waking and then going back to sleep.
• Each of these cycles last for approximately 90 minutes, brief waking after each cycle is part of a normal sleep pattern.

 

Sleep duration

The amount of time children need to sleep for changes as they get older. The amount of sleep your child needs will be different depending on their age. As children are all unique, so is the amount of sleep they need, they may need more or less sleep than others.

Having a nap in the daytime can prevent young children becoming overtired. Daytime naps should be scheduled to ensure your child does not have a prolonged nap in the late afternoon, too close to bedtime.

The Sleep Foundation.org publish information, up-to-date research on topics related to sleep and health:  https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-really-need 

 

Sleep support videos

https://www.nhsggc.org.uk/kids/life-skills/sleep/

Aim to:

• Help understand sleep in children and young people
• Help understand good sleep practise
• Offer you a range of strategies to help you feel more confident in managing your child sleep routine

It may take several months for any strategies you use to improve your child’s sleep to become effective.

Sleep diary

It is helpful to keep a sleep diary, for at least two weeks. This will help you identify any patterns around the bedtime routine and sleep and have a log of where the problem areas may be.

A small change in your routine, for example a bath before bed every night, can make a significant difference to your child understanding of what you're asking them to do.

Below is a template of a sleep diary you can print off and use.

• Sleep diary

 

Developing good sleep habits

Babies are more likely to learn to self-soothe, when they are put to bed drowsy but not asleep. This will help them to fall asleep independently and also go back to sleep when they wake during the night.  Babies who are soothed until they settle to sleep, could become dependent on this routine to fall asleep and this becomes a habit, needing this attention when they wake in the night.

Establishing a good bedtime routine which helps your child settle to sleep and to stay asleep will support them in developing healthy independent sleep patterns.

• During the day: Encourage your child to be active during the day and spend some time outside. Exposure to natural daylight help set the internal body clock and may make them feel more tired at the end of the day so they will have a more restful sleep
• Food and drink: Encourage a healthy diet and regular mealtimes. Avoid a large meal too close to bedtime and caffeine stimulants especially in the afternoon and evening.  Having a light snack at bedtime will ensure your child is not hungry and can help them settle to sleep.
• Bedtime: decide on a bedtime that is suitable for your child's age. Putting them to bed at the same time each night and waking them at the same time each morning; including will weekends and holidays; will help to strengthen their body clock and to develop a regular sleep wake cycle.
• The bedroom: To get a good night's sleep the room should be at a comfortable temperature, not too hot not too cold. A quiet, dark, calm environment with toys tidied away will help encourage sleep. Using a night light will help if your child is afraid of the dark. As much as possible reduce any external noise within the household.

Bedtime routine

Prepare your child for bed

• A consistent routine will help your child learn what to expect in the time leading up to bedtime.
• Blue light from screens stimulates brain activity which delays the onset of sleep, so Electronic devices should be turned off at least one hour before bedtime, including mobile phones, TV, computers and electronic games. 
• Use a quiet, relaxing activity such as building a jigsaw puzzle or colouring or drawing in the lead up to bedtime.
• If your child finds them relaxing baths can be helpful, ideally above should take place at least 30 minutes before bedtime.
• The bedtime routine should last for about 20 to 30 minutes and have an endpoint which your child will know means it is time to go to sleep, such as reading a story, turning off the light, saying goodnight and leaving the room.

Useful resources:

• https://thesleepcharity.org.uk/information-support/children/
• Cerebra: A national charity providing help and information for children with neurodevelopmental conditions, including autism and intellectual disability. Offers a free library with an extensive collection of books. Offers advice from professionals in their Sleep Service. The Innovation service helps identify or create unique equipment for children with disabilities. Tel: 0800 328 1159, Web: www.cerebra.org.uk
• National Autistic Society (NAS): Provides information, advice and support for people with autistic spectrum disorders and their families. Their website includes fact sheets and information about a range of concerns including behavioural difficulties, toileting and sleeping concerns in the context of autism. They also offer an Autism Helpline which provides impartial, confidential information and advice for people with ASD and their families and carers. http://www.autism.org.uk/ 
• Also provides visual supports
• Scope: Supports families of children with cerebral palsy and can provide written information about difficulties, such as toilet and sleep training. They can be contacted on 0808 800 3333. Further information can also be found on their website: http://www.scope.org.uk.
• Children’s wellbeing practitioners service (Hertfordshire Community NHS Trust): Provides online workshops for young people and parents/carers of children and young people in Hertfordshire. They currently offer workshops regarding: emotional wellbeing and self-regulation, sleep difficulties, self-esteem, school transitions and exam stress. A referral is not needed to access a workshop. To book a place onto a workshop visit https://www.eventbrite.co.uk/o/childrens-wellbeing-practitioners-school-nursingservice-hertfordshire-33494371787
• Sleep Apnoea Trust Association: Support with education, advocacy, raising awareness of sleep apnoea, assisting research and development. Sleep clinics in Herts, Barnet, Hemel Hempstead, Hertford and Stevenage.
• SPACE: https://spaceherts.org.uk/space-for-families/#workshops-and-training

 

Products that might help

• All-in-one pyjamas, especially if your child kicks the bedcovers off at night.
• Sleep training clocks – can help a child learn when it is time to get up and when it is time to go back to sleep.