You have 10 minutes before your child's school begins for the day and you're running late. Your son is still in his bedroom wearing his pajamas and hasn't had a thing to eat since last night's dinner. You're exasperated as you ponder what the ensuing 20 minutes will look like in your attempt to leave the house. "This is going to be painful," you say to yourself.
Autistic children with fine motor and sensory processing delays can have difficulty with learning self-help skills such as feeding, dressing, grooming and bathing which can lead to very challenging mornings for parents with autistic children. These are some general suggestions that might help your child. Our occupational therapists are well equipped to deal with such challenges and have provided us with a few powerful and needed strategies.
Many autistic children have trouble developing the muscles for chewing food or are sensitive to the quality of foods: taste, texture, temperature. You can start with a vibrating teether or toy that they can play with on their cheeks, lips and progress to inside their mouth. A vibrating tooth brush can assist with stimulating the muscles as well as help with desensitization. Don’t forget to brush the tongue; start on the sides and avoid the back of the tongue which can make your child gag. Encourage or teach them to use a straw/straw cup; make thick smoothies to help increase swallowing skills and strengthen their lip/cheek muscles. For children who are sensitive to food tastes/textures, allow time for food play with their hands – stress foods of different colors, texture, temperature and taste.
Learning to use an open cup can be challenging. Start with small cups such as medicine cups, doll cups, etc. Practice with small amounts of water: 2-3 ounces, and support their chin (finger under chin). Using a spoon and/or fork can be difficult for some children. To encourage success, start with a toddler fork vs. a spoon for table foods; it is easier to spear than scoop. Using child sized utensils will help your child learn faster. A toddler spoon/fork that can be bent to the right or left at the bowl will assist with learning to coordinate the motions. Use a child safe knife/cheese spreader and let your child learn to begin to cut soft foods such as a cheese stick, banana, etc.
Set up your child for success! Taking off is easier than putting on; start with undressing. Use larger and looser clothing (dress up with your clothes!) with large buttons, zippers, etc. Purses and backpacks also can be a place to start. Have the child practice in front of them first before they practice on their body. Use a the concept called backward chaining. For example you start the process of putting on a shirt or socks, etc. Have the child finish the last step and praise: “You put your shirt on! Yay!” Then have them do the last 2 steps and so on. “Setting up” the clothing such as bunching the shirt at the head hole or placing shorts directly on the floor before the child, will facilitate success. Dressing from a small stool or on a chair will also be easier for some children who have difficulty with balance.
Grooming/Hygene - Tooth Brushing
See also Oral Motor suggestions for more ideas. Start with brushing teeth without toothpaste. Learning to “squeeze” the toothpaste tube is a great fine motor task! Suggested tooth brushes: The Collis Toothbrush allows you to brush both surfaces of the teeth at the same time, while a vibrating toothbrush provides sensory stimulation. Use a timer, music or song, etc. to have your child brush for longer periods. “This is the way we brush out teeth, brush our teeth, brush our teeth...every day! For some children tooth brushing can be quite traumatic. To make it more pleasant for you both, try using a preferred song/video on your phone to distract them, snuggle with them in your lap, use a heating pad or wrap around their shoulders, etc.
Begin with cleaning “hands” with a wipe, washcloth, paper towel, etc. Have your child stand on a stool in front of the sink. Use a pump soap dispenser and model the steps. Guide with hand over hand in the beginning. Use a song such as, “This is the way we wash our hands, wash our hands, wash our hands....before we have something to eat!”
This is a skill that 2-year old children can begin to learn. Start with learning to “blow” from their mouths such as bubbles, cotton balls, etc. Use a straw to “blow out” and paint, etc. Start with them “wiping” their nose with a wipe or tissue, encourage the “pinching” at the end of the nose to teach adequate cleansing. Help them “blow out of their noses” by holding a loose tissue before their nose and have them “make the tissue dance”. Model blowing your nose and practice in front of a mirror.
Encourage independence by using child wash mitts – these will help children learn their body parts as well how to clean! Shampooing can be difficult for some children. Use a wash cloth and “wipe” with water vs. pouring water. Try a shampoo visor that blocks the water from running down their face. Use bubble baths and water toys to make the experience more enjoyable.
Through these essential self help skills, mornings will no longer be an exercise in frustration and the school day won't always have to begin 30 minutes after the bell has rung. We hope you've found them useful!
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