ADL TRAINING AND TECHNIQUES

FOR CHILDREN WITH

CEREBRAL PALSY
S.NO TOPIC
01 Chapter 1 Dressing

 Introduction
 Suggestions for buying new clothes
 Teach your child to take off his lower garments
 Teach your child to put on his lower garments
 Teach your child to take off his upper garments
 Teach your child to put on his upper garments
 Teach your child to button and unbutton
 Teach your child to take off his shoes
 Teach your child to put on his shoes
 Teach your child to take off his socks
 Teach your child to put on his socks

02. Chapter 2 Cleanliness

 Brushing teeth
 Positioning
 Bathing
 Positions for bathing
 Teach your child to bathe himself
 Care of nails
 Cleanliness of nose
 Care of hair
03.
Chapter 3 Feeding
 Seating your child on the lap
 Independent sitting
 Adapted floor seating
 Adapted chairs
 Positioning for special problems
 Eating
 Food
 Feeding with
 Chewing
 Biting
 Swallowing
 Drooling
 Choking
04.
Chapter 4 Toileting
 Introduction
PART A
 Positioning
 Seating for babies and toddlers
 Seating for older children and adults
 Washing after using the toilet
PART B
 Learning to use the toilet
 Bed wetting
DRESSING FOR THE CHILD
WITH CEREBRAL PALSY
 INTRODUCTION

Y oung children learn to dress and undress themselves fairly early in life.
They learn to take off their socks, shoes and underpants before they can take
off the more complicated clothing like shirts and dresses.
Teaching handicapped children to take off and put on clothes may take time.
Owing to their physical or mental handicap, it may be difficult for them to learn
these skills on their own.
If you follow some common rules, you may find it easier to help your child to
learn how to dress and undress.
Choose a good position. Decide the position in which your child is most
steady, with or without support. This will make dressing and undressing easier
for him. It will also help him to dress or undress himself if he has the physical
ability to do so. Some suggestions are given in this booklet which will help you
to choose a good position.
Involve your child. Involve your child every time you dress or undress him.
Give him clear instructions or show him how to straighten his arms and legs.
This will help him to cooperate with you as he grows older.
Start with simpler clothing. Always start with a simple item of clothing like a
loose shirt with front buttons open. He will find it easier to take it off and put it
on. This will make teaching and learning more successful.
Teach undressing first. First teach your child to take off his clothes as it is
much easier than learning to put them on.
Start early. Normally parents help their children to dress and undress till they
are four or five years old. But if your child is handicapped, start teaching him
as early as possible since it will take him more time to learn the skill.
 SUGGESTIONS FOR BUYING NEW CLOTHES

 Buy or make clothes one size larger. Whenever you get your
child new clothes always make sure that they are one size larger.
 Shoes must be of the correct size, otherwise the child will find it
difficult to walk.
 Have front openings on clothes. It will be easier to unfasten if the
fasteners are at the front of the clothes.
 Fasteners should be as simple as possible. Instead of buttons, use
zips on pants and shirts. Use elastic instead of string on pyjamas
and buy all clothes with front openings.
 Loose T-shirts without any fasteners are easy to wear.

 Dress your child in clothes that are suitable for his age.
TEACH YOUR CHILD TO TAKE OFF HIS LOWER GARMENTS

Lower garments including long pants, short pants, underwear,

pyjamas, lungi, skirts and salwar.

Start by teaching a child to take off shorts or panties and then move on
to pants and salwar.

When you are teaching him to take off his lower garments, make sure
that your child is wearing an underwear. This will teach him that he
should not undress in front of anyone and he will develop a sense of
privacy. For an older person, it will be less embarrassing for him to take
off his pants in front of others if he is wearing underwear.

Once your child has learnt to take off other types of lower garments, he
can practice taking off his undergarments in private.

Practice is very necessary for your child to improve. So make sure that
you give him the opportunity to practise. Choose a time when you are
not in a hurry to dress him so that he can take his time.In the beginning,
he will need extra time to learn.

As suggested earlier, lower garments will be easier for

your child to take off if they have elastic on top. For
adults, pants with elastic on either side and buttons or zips
in front are more appropriate.
Given below are suggestions on how your child can take off different garments
and the most suitable positions for doing so.

If your child can stand with very little support, then teach her to take off her
shorts or panties by:

Helping her to hook her thumb in the

top of the panties. She can do this by
standing against the wall for support.

Or she can stand holding a towel rail or

grill. Then teach her to push the panties
down to her heels and kick them off her
feet.
If she cannot stand, she can either get
into a crawling position or kneel and pull
down the panties to the knees.

Then she can sit down and pull them off

her feet.

If your child cannot kneel or get into a crawling position, then teach him to sit against the
wall and take his shorts off by:

First turning to one side and pulling

down the shorts on that side and then
turning to the other side and pulling it
down until the shorts are below the
knees.
Then he can bend his knees and pull
them off his feet.
 If your child cannot sit, then
teach her to lie on the floor and
take off her pan-ties. She has to
first turn to one side and pull
down the panties on that side,
then turn to the other side and
Then she can push them down again pull it down on that side,
to the ankle with the other leg until the pan-ties are below the
knees.
and shake the panties off her feet.

When your child is comfortable taking off shorts or panties, start teaching how to
take off long pants or salwars in the same way.
 TEACH YOUR CHILD TO PUT ON HIS
LOWER GARMENTS

Wearing pants is more difficult to learn. Choose a position in which your child
will find it easier to hold the trousers and wear them.

If he is unable to stand with support, he

can either sit on the floor against the
wall

or on a chair.

Start by teaching him to locate the leg

openings through which he will have to
put in his feet. Then teach him how to
hold the top band of the pants with one
or both hands.

Let him put one leg at a time

into the leg openings of the
pants. If one leg is more
physically affected, he should put in that leg
first.

Once he has both legs in the

respective trouser legs, let him
If he is seated on the floor, he can get into a pull the pants up above the
crawling position and pull the pants up to his knees.
waist from his knees.
If he can stand, he can pull up the pants
from the ankle to his waist in one move-
ment.

If he is lying on the floor, he can roll

from one side to the other while he pulls
the pants up to the waist.

Once the pants are up to his waist, he may need your help to fasten the buttons.

10
 TEACH YOUR CHILD TO TAKE OFF HIS
UPPER GARMENTS

Upper garments include shirts, T-shirts, blouses, sweaters, vests,

dresses and kameez.

When you start teaching your child to take off his upper garments make sure
that it:

has a front opening (shirt or a blouse) and

is one size larger.

Put him in a sitting position for teaching

him to take off his upper garment. If he
needs support, place him against the
corner of a room

or make him sit in a corner seat.

11
Teach him to take off the shirt or the blouse in the following way. He will find it
much easier.

Let him hold the collar or neck of the

shirt or dress, either with both his hands
or with his stronger hand

and pull it over his head. Remind him

to bend his head well forward.

He should take it off the least affected

arm first

and then shake it off the other arm.

 YOUR CHILD TO PUT ON HIS
UPPER GARMENTS

Putting on the upper garment is more difficult. The easiest way to teach your child to
wear his shirt or blouse is by choosing a garment which is one size larger and has a
front opening.

Keep the shirt in front of the child with the

collar towards him and the opening of the
shirt on top.

Some children find it helpful if the gar-

ment is placed on a table in front of
them. This makes it easier for them to
wear the shirt.

Teach him to locate one arm hole and put in

one hand. If your child has one hand which
is more affected than the other, teach him to
put in the more af-fected arm first.

13
Then he can put the other hand in the
other arm hole.

He should next pull up the sleeves to

the elbows.

Once both the sleeves are up to the elbows, teach him to gather the end of the
shirt

14
and pull it over his head and down his back.

Remember:

Your child must keep his head down and forward while wearing his
shirt as it becomes easier to take the shirt over the head.

He can then pull the front of the shirt together and put on the buttons
if he is able to. (Refer to the section 'Teach your child to button and
unbut-ton').

He can wear T-shirts, kurtas, vests and sweaters in the same way as
a shirt or a dress.

Your child will also need to learn to reverse and fold his shirt. You can
teach him to do this after he has learnt to wear and take off his shirt.
Only then can we say that he is totally independent in wearing his shirt.

However, if your child is very physically handicapped, he may not be

able to wear a shirt on his own. In this case, teach him to help you
when you dress him. He can do this by:

• sitting still and not struggling

• allowing you to guide his hands when you dress him

• choosing clothes of his choice.

15
 TEACH YOUR CHILD TO BUTTON AND
UNBUTTON

Many physically handicapped children do not have good hand function. So

but-toning and unbuttoning may be difficult for them.

To learn how to button, your child must have the ability to hold small objects
between the finger and thumb.

Your child will need a lot of practice be-

fore he learns to use buttons.

It is easier to teach a child buttoning

when he is not wearing the garment. At
first you can give a garment with larger
buttons to practise. Then give him a gar-
ment with smaller buttons.

Once he learns to button and unbut-

ton clothes that he is not wearing, teach
him to button and unbutton clothes that
he is wearing.

16
Always teach him to fasten the bottom
button first and gradually move up to the top
button.

17
 TEACH YOUR CHILD TO TAKE OFF
HIS SHOES

Shoes include sandals, chappals and shoes with laces or straps.

Positions suitable for taking off and wearing shoes:

• Make sure that your child is in a stable position:

• If he can sit without support, then he can.

b) Sit on the floor

b) Sit on a chair or a stool.

18
If your child needs supports to sit, then he can:

a) sit against the wall

b) sit in a corner seat

c) sit on a chair or a wheelchair with arms.

19
 The foot from which he is taking off or
putting on the shoe can be crossed over
the other leg to help him reach the
shoe more easily.

Steps for taking off shoes:

Teach your child to take off his shoes step by step. If he has difficulty in
opening his laces, teach him to do so separately. (Refer to 'Fasteners' on
page 26.) Once you have unfastened the laces, start by teaching him to:

Insert his thumb into the back

of the shoe

2) Push the shoe down

over the heel

20
 3) and take it off his foot com-
pletely.

Repeat the same steps with the other

foot.

When you start teaching him, give him a lot of help initially and gradually reduce the
help until he can do it on his own.
Some children who find it difficult to take off their shoes in the usual way can be
taught to take them off by pushing off the shoe with the other foot. This is possible
after the lace or Velcro has been loosened by you. Even if this does not make the
child totally independent, it gives him a sense of achievement.

21
 TEACH YOUR CHILD TO PUT ON
HIS SHOES

Wearing shoes is much more difficult than taking them off. Your child will need
help and time to learn to do this.

Start by teaching him:

To identify the correct shoe (right shoe
for the right foot and left shoe for the
left foot.)
If he finds this difficult, you can mark
the inside of one shoe with a little paint.
Most children know which hand they eat
with. So it will be easier for him if you
mark the shoe for the same side as the
hand he eats with.

Next, teach him to locate the open-

ing of the shoe and put his toes in.

22
and push his foot into the shoe.
Then he can pull it up over the heel until the
foot is completely inside the shoe.
Help him to hold the back of the
shoe firmly. Some shoes have
loops which make them easier to
hold.

23
Children who are severely physically handicapped and have poor hand
control, will not be able to learn this skill.

Fasteners

Shoes are now available with velcro fasteners which are easier to handle. If
your child has good hand control, he may also be able to tie laces with a lot of
practice.

Remember

Shoes are worn to give extra support and should always be tied firmly.
 TEACH YOUR CHILD TO TAKE OFF HIS
SOCKS

Positions suitable for taking off and wearing socks:

Refer to the earlier section on 'Teach your child to take off his shoes'.

Steps for taking off socks:

Start teaching a child to take off his socks by practising with a pair that is large
for him.

1) At first, take off the sock up to the

toe and teach your child to pull it
off.

2) Next take off the sock up to the

heel and let your child pull it off
from there.

25
3) Once he has learnt to do the earlier
steps, take the sock down to above the
heel and teach him to pull it over the
heel off the foot.

4) Finally he should learn to take

off the sock entirely on his own.

The advantage of teaching in this manner is that at each step the child will
complete the task of taking off his socks and will feel a sense of achievement.
At first give him all the help he requires but gradually reduce your help until he
can do it on his own.
The socks can be gradually changed to the correct size. At first he will find it
difficult to take off the socks. But with a lot of practice he will soon learn.

26
 TEACH YOUR CHILD TO PUT ON HIS
SOCKS

Putting on socks can be difficult for a child. But it will be easier for him if you:

Buy cotton socks which have different

coloured heels and toes.

Teach him to wear the socks in the same way as he learnt to take them off.

1) Put on his sock over the heel and

teach him to pull it up to the calf.

11
2) Next put on the sock up to the
heel and he can pull it up over
the heel and up to the calf.
4) and pull it over the heel up to the
calf.

3) Finally teach him to locate the

opening of the sock and put in
his toes

In this way he will learn to wear the sock step by step. Remember that each
step may take many days of practice and training before he can move on to
the next step.

Children who have difficulty in holding things with their hands may not be able
to take off or put on their socks on their own.

But you can teach your child to help you to take off his socks or put them on
for him by keeping his legs in place and not moving.
CLEANLINESS WITH THE
CHILD OF CEREBRAL
PALSY
 BRUSHING TEETH

Children learn to brush their teeth while they are still very young. A handicapped
child may have many difficulties while brushing his teeth independently. Parents
may also face problems when they brush their child's teeth.

The following suggestions and ideas will make it easier for you to teach your
child.

POSITIONING
Encourage your child to use the toilet area of the house for brushing his teeth
like the other members of the family.

You may be able to help your child to brush his teeth independently if he has
the ability to:

a) hold the brush

b) and take it to his mouth.

Some positions which will make it easier

for your child to brush his teeth are men-
tioned below.

If your child can stand without help, he

can brush his teeth standing independ-
ently.

If he finds it difficult to stand without sup-

port, help him to hold the sink or the win-
dow grill with one hand and his brush
with the other hand.
He can also sit on a chair or a wheel-
chair in front of the sink.

If you do not have a sink in the house, give him a plastic bowl and a bucket of water.
Place the bowl on a low table in front of him. He can use the bowl as a sink and take
water from the bucket with a glass.

He can sit either on the floor

or on a low stool.
 Tell your child to do the same.

If she finds it difficult to hold a glass,

fix
the glass in one place. Teach her to use
a straw and then rinse her mouth.

Some children find it difficult to gargle

and spit out the water. If this is the case
with your child, take a glass of water and
pour a little into her mouth.
Then quickly tip her head forward so that
the water is thrown out. Do this several
times to clean the mouth properly.

Make sure that you teach your child to

wash and put the toothbrush back in its
proper place. This could be in some con-
tainer or on the shelf.

You can also teach your child to put toothpaste on the toothbrush. Many physi-cally
handicapped children find it difficult to do this and may need to practise for a long
time. Give your child the opportunity to practise regularly under close supervision, so
that too much paste is not wasted.

Alternatively, you can put some toothpowder in a wide-mouthed container. Teach your
child to dip his toothbrush into the container and brush his teeth.

Children with severe physical or mental handicap may never be able to brush
their teeth independently.
You can teach them to cooperate by opening their mouth and allowing you to brush
their teeth.

If your child struggles and refuses to cooperate when your brush his teeth,
you will gradually have to teach him how to sit or stand still. The following
suggestions may help:

a) Try not to use force. The more you force him, the more he will struggle.

b) Use a soft brush. Be extra careful to ensure that you do not hurt him.

c) Constantly talk to him and praise him for being good while you brush his
teeth. This may keep him calm.

d) After brushing his teeth for a few seconds, reward him with something
he loves. You could give him a toy or let him play with water.

As he gradually learns to cooperate with you, give him a reward only after you
have finished brushing his teeth.

8
 BATHING

Most children enjoy bathing as they love to splash and play with water. Using suitable
positions and adaptations, you could make bathing fun for your handi-capped child.

A young child is usually given a bath by an adult. However, if your child is older and
unable to bathe himself because of his handicap, it can be very difficult for the family.

Given below are a few suggestions and adaptations which may be helpful under such
circumstances:

• Choose your bathing area carefully.

• Bathe your child in the bathroom or verandah where the water can drain
out. This will avoid the unnecessary effort of cleaning up the room after
he has had a bath.

• Keep the necessary items like soap,

towel, mug and bucket close at
hand.

c) Bathe your child after he has used the toilet. This will save you the
trouble of dressing and undressing him twice.
POSITIONS FOR BATHING
Sit in a position that will be convenient for you to bath your child.

If you bathe her on the floor, sit on a low

stool with your child seated in front of
you.

If your child is small, use a plastic tub or

bowl. While he is seated in the tub, soap
the top half of his body, his legs and feet.

10
Then hold him up and soap his bottom and
thighs.
If he is too big for a tub but does not have
sitting balance, then put him in a corner seat
and bathe him.

Keep a low wooden chowki next to

you and spread a towel over it. After
his bath, place him on this chowki to
wipe and dress him.

11
You can also place your child in a large
plastic basket and bathe him. As the wa-
ter will drain out of the basket, you can
wipe and dress him in the same position.

If you find it easier to bathe him sitting in

a higher position, you can seat him on a
plastic chair or a potty chair with the pan
removed. You can wipe him in the same
position.

If your child does not have good sitting

balance, you may need to tie him loosely
to the chair with an old dupatta. This
will prevent him from falling forward.

12
If you have a commode which your child
uses for toileting, use it as a seat to give
him a bath.

TEACH YOUR CHILD TO BATH HIMSELF

Teach your child to bathe, preferably using the bathing area in the house where all of
you have a bath.

Tell him to keep the soap, towel, mug and

bucket of water close at hand.

If he is not very steady while standing, he

can:

Sit on a chair or a low stool and keep all the

things he needs next to him.

13
Hold a support and stand.

Sit on the floor or on an old towel or rub-

ber mat so that he does not slip.

14
Teach your child to scrub himself with soap and clean himself thoroughly.

A brush with a long handle which is

avail-able commercially, could be used
to scrub his back or any other area
which is diffi-cult for him to reach.

He can also put an old sock on his

hand when he soaps himself.

Teach him to rinse himself by sitting

under the tap or shower.

15
He can pour mugs of water over himself
from a bucket.

If he finds it difficult to do this, you can

attach a pipe to a tap or, in the absence
of running water, to a drum filled with
water. He can use the pipe to rinse him-
self.

Teach your child to open and close the tap if you have a tap or a shower.

16
Teach him to wipe himself by using a towel
or a 'gamcha'. If your child is unable to
wipe his back, teach him to fling the towel
or 'gamcha' on his back and pull it up.

You can place a 'gamcha' or a towel

along the back and seat of a chair and
ask your child to sit against it. This will
help her to dry her back as well as her
hair.

Always remember to teach your child to clear up the bathing area after
bathing.

He should hang the towel or 'gamcha' for drying. He should put the soap, bucket and
mug back in place.

From the beginning, allow your child to participate as much as he can while
you are bathing him. As he gradually learns to do it himself, reduce your help.

17
 CARE OF NAILS

To ensure cleanliness of nails you can:

Clean your child's nails with soap and a soft brush while you are bathing her.
You can also teach her to do it herself.

If she finds it difficult to clean her nails with a brush, you can teach her to dip
her fingers in a solution of soap and warm water and then rinse her hands.

Keep the nails short by cutting them once a week. This will prevent any dirt
from collecting in them.

18
If your child struggles and does not cooperate while you are cutting his nails, you
will have to teach him to sit still. The following suggestions may help:

c) Try not to use force. The more you force him, the more he will struggle.

d) Be careful to ensure that you do not hurt him.

e) Keep talking to him and praising him for being good while you cut his
nails. This may keep him calm.

f) After cutting each nail, reward him with something he loves. It could be
a small piece of sweet or a sip of his favourite drink. This will
encourage him to cooperate with you.

Gradually as he learns to cooperate, give him a reward only after you have cut all
his nails.

Teach your child to use a nailcutter if he can. If he finds this difficult, you can teach
him to rub his nails on a nail file which has been fixed to a wooden board.

19
 CLEANLINESS OF NOSE

It is important for all children to keep their nose clean.

You can teach your child to keep his nose clean by:

Reminding him to blow his nose every morning when he brushes his teeth.

If he is unable to blow his nose on his own, you can assist him by holding his
nose over the sink and asking him to blow. Then wash his face with water.

Always encourage him to carry a

handkerchief. He should use this to clean
his nose.

20
If he cannot clean his nose with a hand-
kerchief, tie a 4" wide band of soft old
cloth or towelling on his wrist. He can use
this to wipe his nose.

Make sure to change it regularly.

You can try and teach your child to blow his nose by demonstrating it yourself and
asking him to imitate you.

Children who are very severely handicapped and cannot learn to blow their nose
have to be assisted. You can do this by using a handkerchief and gently pressing
his nose with your fingers.

Teach your child to cooperate while you are cleaning his nose. The following
suggestions may help:

4) Try not to use force while cleaning his nose. The more you force him,
the more he will struggle.

5) Keep talking to him and praising him for being good while you clean his
nose. This may keep him calm.

After cleaning his nose, give him a reward. It could be something he

loves such as a toy or something he enjoys eating. This will encourage
him to cooperate with you.

21
 CARE OF HAIR

Cleanliness of hair is very essential.

You can teach your child to keep her hair clean by:
Reminding her to comb her hair thoroughly.

If she finds it difficult to hold a comb, give

her a brush or a comb with a handle for
better grip. This may help her to comb
her own hair.

If your daughter has long hair which she cannot comb properly, you may have
to consider cutting her hair short. This may make her independent in combing
her hair.

Some children may not be able to comb their hair in spite of being helped.
You will need to teach such a child to cooperate by sitting in one place while
you comb her hair.

22
If your child struggles while you are combing her hair, you will gradually have to
teach her to sit still. The following suggestions may help:

a) Try not to use force. The more you force her, the more she will
struggle.

b) Be careful to ensure that you do not hurt her while combing her hair.

c) Keep talking to her and praising her for being good while you brush her
hair. This may keep her calm.

d) After brushing her hair, reward her with something she loves such as a
toy. Or you could let her play for a few minutes. This will teach her to
cooperate with you.

Shampoo and oil her hair at regular in-

tervals. If she finds it difficult to soap her
hair, teach your daughter to use a plastic
bottle with a nozzle and squirt liquid soap
(shampoo) on her hair.

Then she can use one or both hands to

build up a lather.

23
If she finds it difficult to dry her hair, she can wrap a towel on her head for 10
minutes. The towel will soak the water from her hair.

Teach your child cleanliness from a young age. Encourage him

constantly. Even if he is unable to be totally independent, he will improve
to the best of his ability.
FEEDING WITH THE CHILD OF
CEREBRAL PALSY
M any children with cerebral palsy have problems in eating and drinking
which can cause a lot of difficulty for the parents. However with appro-priate
management, these problems can be reduced considerably.
It is important to remember that the sooner correct management is introduced,
the better are the chances of reducing the problems. The first step to appropriate
management is seating your child correctly while he is eating and drinking.

POSITIONING
Mentioned below are some ways of seating your child which will be more
com-fortable for him. The positions will also make it easier for you to feed him.

SEATING YOUR CHILD ON THE LAP

A mother usually feeds a child who is
very young by making him sit on her lap.

Let your child sit on your lap. Place your

arm around his neck so that his head is
kept straight and facing forward. This
position is suitable while he is being fed
or given a drink.

Do not feed your child while he is lying on your lap as there is a danger
of choking.
To make feeding and drinking easier for your child, try and get your child to sit
by himself on the floor or on a chair if he can! It will also make him more
independent.
INDEPENDENT SITTING
If your child can sit by himself, you can
place him on the floor for feeding. A
floor table can be put in front of him. In
this way, he will spill food while eating.

You can also seat him on a chair with

a table kept in front. The height of the
chair should be such that his feet are
flat on the ground.

It is more convenient to feed your

child when you sit facing him.
ADAPTED FLOOR SEATING
If your child cannot sit by himself on the floor or on a chair, placing him in one
of the following positions may be helpful.

If your child has not learnt to sit by

him-self without support, then seat
him against the wall and place a floor
table in front of him. The table will
give him support from the front.

if the floor table does not give enough

support, your child may still tend to fall
sideways. In this case, a cut-out table
will be more comfortable. It will fit
around his chest and also give support
to his elbows. i

If your child needs more support, then

make her sit in the corner of a room
on a cushion or on a rolled up blanket.
Place a floor table or a cut-out table in
front of her to provide additional sup-
port.
If you find that your child is pushing away
the cut-out table, you can fix it to the
wall with latches. This will secure it firmly
in place while the child is being fed or is
eating by herself.

You may find it difficult to seat your child in the positions mentioned earlier
due to his physical problems or his lack of understanding. A list of adapted
seats is given below. When you choose a seat for your child, consider the
difficulties he has as well as the space available in your house.

If your child is able to hold up his head,

place him in a corner seat. If he tends to
fall or slip forward, fix a cylindrical block
of wood in the seat between his legs. This
will prevent him from slipping forward.

Try using a floor seat if your child still

continues to have problems. This kind
of seat will give more support to the back
and sides. If he slips forward while sit-
ting, then fix a cylindrical block of wood
on the seat between the child's legs.
Your child can be fed while he is sitting in
a corner seat or a floor seat by placing a
small floor table or a cut-out table in front
of him.

ADAPTED CHAIRS

If your child finds it difficult to sit on a

chair
without arms, make him sit on a chair with
arms and place a table in front of him.

The chair should be of the correct

measurement and height so that his
thighs are supported by the seat and
his feet are resting flat on the ground.
If the chair is too high, you can place
a stool under his feet.
In case your child tends to slip off the
chair, fix a cylindrical block of wood
on the seat of the chair.
If your child is on a wheelchair, then use a cut-out tray.
Two long pieces of wood are attached
length-wise underneath the cut-out tray,
at both ends. Grooves are cut on these
pieces which enable you to slide the tray
over the arms of the wheelchair and hold
it firmly in place.

If the tray still tends to slip forward,

attach two hooks on either side of the
cut-out tray. Put some thick string or
cloth through these hooks and tie the
tray securely to the wheelchair.

Before you make your child sit on his new seat to feed him, let him use the
seat during play or any other activity. This will ensure that he does not feel
uncomfort-able or insecure during feeding. Your child should use the seat
regularly in order to get used to it.
POSITIONING FOR SPECIAL PROBLEMS
Sometimes it might be difficult for you to feed your child even with the help of the
adapted seats. This may be due to the following reasons:
e)The child may keep his head
stiffly turned to any one side
or push it backwards.

Hold the top of his head with one hand

and help him to face forward, keeping his
head straight. This will make it easier for
you to handle him during feeding.

You may also find it difficult to

feed him if he cannot control the
move-ment of his arms during
feeding.
After putting him on his adapted seat,
tie a pair of gaiters on his arms to keep
them straight.
If his head tends to extend backwards,
hold the top of his head firmly and bring
it forward.

Put gaiters on his arms if they come in the way of his plate. Help him to hold
on to the end of the table or a fixed peg in order to prevent his arms from
moving around.
However, if he is moving his arms purposely, then you may have to initially
keep the food on a separate table.

8
 EATING
It is important to start teaching a handicapped child to eat independently as early as
possible. The earlier you start the training, the better will be the progress.
It is important to keep a few things in mind before you start teaching your child.

If your child is still on a liquid diet, gradually start giving him solid food such as:
• Suji and milk or bread and milk.
Start giving him solid food like rice or roti to help him to learn to bite
and chew.
• Use a steel spoon which is neither too deep nor too big for your
child's mouth.
• A child with a physical disability often does not move around as much
as other children. Therefore, he may need less food, especially
carbohy-drates. Hence food such as potatoes, rice, bread, ghee and
butter should not be given too often. It may make your child gain
weight and make it more difficult for him to move
Do not overfeed him. A child who is never hungry is not likely to coope-
rate when you try and feed him. Overfeeding may also make him vomit.
d) It is very important to remember to place your child in a correct
position. (Refer to the earlier section on 'Positioning'.) It will be much
easier for your child to learn how to eat if he is sitting comfortably.
Ensure that his head is slightly forward. This will help him to chew and
swallow the food more easily.
 FOOD
It is important that you teach your handicapped child to eat normal solid food
as early as possible.
If he is four or five months old, he should have semi-solid food like mashed
potato, mashed banana, suji and milk.
By the age of 10 or 12 months, he should start eating solid food like rice, roti,
vegetables and fruits.
If your child is older but still on a liquid diet, start by giving him semi-solids
with a spoon.
Once he gets used to semi-solids, gradually start giving him solid food. This
will take time but if you give it regularly, he will learn quickly. He will cooperate
more willingly if you give him the solid food when he is hungry. To start with,
give him the kind of solid food he enjoys.
Give your child a variety of food with different tastes such as sweet, salty and
sour. Give him the opportunity to have an assortment of food with different
textures like chips, sugar cane, muri or biscuits.
Give your child the opportunity to:
g) make a choice of food offered to him
h) refuse what he does not like
i) ask for food when he is hungry
j) ask for more food during a meal.
He can do this by:
pointing to the preferred food
e) saying the word
f) pointing to the picture of the food. You must provide him with the
pictures.

10
 FEEDING WITH A SPOON
Mothers usually start to feed their children solid food with their fingers. However, a
child with cerebral palsy may have to be taught how to open and close his mouth as
well as how to chew and swallow food. It is easier to teach a child to do this if you use
a spoon.

You can sit opposite your child to feed

him with a spoon. Sometimes you may
find it easier if you sit by his side.

If he does not close his lips over the

spoon when it is inside his mouth, gen-
tly press his lips together around the
spoon with your fingers. Make sure that
you do not scrape the food against the
child's teeth. Then pull out the spoon
slowly. Once he learns to close his lips
over the spoon, gradually reduce your
help.

11
 CHEWING
Does your child find it difficult to chew?
If your child is unable to chew solid food like rice, roti or biscuits, start by giving
him semi-solid food like mashed potato, boiled apple, suji and milk. Gradually
introduce him to normal solid food.

Help him to learn to chew by placing

the food in one side of his mouth,
between his cheek and teeth.

Then gently make circular movements

on the child's cheeks with your fingers.

12
 BITING
Does your child find it difficult to bite solid food?
If your child finds it difficult to bite solid food like roti, biscuits, toast or fruits, start by
teaching him to bite soft solid food like bananas or finger chips. Introduce the solid food
gradually.

Help him to learn to bite by placing the

food between his teeth. You can sit by
his side and place your arm around his
neck. Close his mouth by gently push-
ing his chin upward. Be very careful that
you do not push his head back.

SWALLOWING
Dose your child find it difficult to swallow food?
Your child may be finding it difficult to swallow food because:
4) He is not sitting properly. Seat him comfortably and keep his head well
forward while he is being fed.
5) He is not chewing the food properly. Teach him to chew. Refer to
'Biting' and 'Chewing'.

To help him to swallow, stroke his throat

gently with your fingers. Make sure that
you keep his head bent slightly forward
while you do this.

13
 DROOLING
Does your child drool while eating?
One way to decrease drooling is to continuously remind your child to close his
mouth and swallow.

If your child cannot follow your instruc-

tions, help him to close his mouth by
gently pressing his lips together while
the food is in his mouth.

After he has chewed the food, gently

stroke his throat with your fingers. This
will help him to swallow.

14
 CHOKING
Does your child choke sometimes while eating?

If your child chokes, bend her body

forward and downward.

Never tap your child on the back or on his head. It may make it worse.
In order to prevent choking, the following steps can be helpful:

Always make sure that your child is in

an upright position. This is necessary
whether he is sitting on your lap

or sitting against the wall

15
or on a chair.

Always keep his head bent slightly for-

ward. If the head falls back, it may cause
him to choke.

Place the food on either side of the

mouth between his cheek and teeth. It
should not be put in the middle of his
mouth.

Introduce small amounts of food into your child's mouth. This will reduce the
chances of choking. Make sure that he has swallowed the food in his mouth
before you give him more food.

16
 VOMITING
Does your child have a tendency to vomit when you feed him?
Your child may vomit for several reasons. It may be because he is not hungry.
Feed him less during each meal. You can reduce the number of meals or give
him food a little later.
Do not force your child to eat when he is not hungry.
Teach your child to say "No" or to shake his head and indicate that he does
not want to eat.
Your child may not be chewing his food properly. This can also make him
vomit. Give him practice in chewing solid food. Refer to 'Chewing' where
management of chewing solid food has been discussed.
You may feel that your child is only trying to seek your attention by refusing
his food. In this case, leave him for a while and try to feed him again later.

PROBLEM BEHAVIOURS DURING EATING

It is important to remember that sometimes feeding may become very difficult
if your child does not cooperate. He may cry, spit out the food, refuse to sit
quietly or even throw the food.
To overcome these problems, you must reward your child with something he
really loves every time he cooperates with you. It could be with sweets,
pickles or a favourite toy. Follow this routine regularly and consistently.
You will find a definite improvement in his behaviour. Reduce the reward
gradu-ally until you need to give it only at the end of the meal.

17
 RINSING
At the end of every meal, ensure that no food is left in your child's mouth. You
can teach him to clean his mouth by:

a) sipping water

b) gargling

c) and then spitting out the water.

However, if he is unable to do this, ensure that he drinks a glass of water after

every meal. This will help to clean the inside of his mouth.

18
Alternatively, allow him to sip water

and then tip his head forward. In this

way,
most of the water will come out. This will
help to clean the inside of his mouth.

19
 EATING WITHOUT HELP
Normally a child starts to eat by himself from an early age. Owing to his disabil-
ity, your child may be unable to eat on his own. So it is necessary to feed him. But
given an opportunity to learn, many handicapped children can eat without help.

Your child is ready to learn to eat independently if he can:

• sit comfortably with or without support
• take his hand to his mouth
• bite, chew and swallow solid food.
Some points which may help are:

He can start holding a roti or a biscuit

and taking it to his mouth.

She can also start holding the spoon and

taking it to her mouth. Initially, you will
need to direct the spoon. Refer to 'Eat-
ing with a Spoon'.

20
When he starts —

1) Make him eat a few mouthfuls of food himself. In the beginning, he

may be clumsy or untidy. However, he will improve with practice.
2) Teach him to eat on his own when he is hungry. Let him 'ask' for the
food he loves.
3) Allow him to eat with whichever hand he finds easier— left or right.
4) Praise him every time he eats by himself. You can even give him
some chutney or salad or a small piece of sweet as a reward after
every two or three spoonfuls of food. Never mix sweets with the rest
of his food in order to encourage him to eat.

SPECIAL SPOONS
Some children who are physically handicapped may find it difficult to eat with their
fingers.
A handicapped child may be able to learn to eat on his own if he is taught to eat with
a spoon.
The type of spoon and plate that is used for your child is very important. Correct
positioning also helps a child to eat by himself. Some points which may help are
discussed in the following pages.

21
Use a medium sized spoon which is nei-
ther too big nor too small for your child.
The spoon should not be too deep. It
should be unbreakable.

If your child cannot hold the spoon with

a firm grip, pad the handle of the spoon
to make it thicker.

You can do this by inserting the spoon into

a cylindrical piece of wood and making
a thick handle.

You can also pad the handle with

sponge or wrap a cloth around it.

22
TYPES OF PLATES

Use a thali with a high edge or a

bowl. This will make it easier for your
child to scoop the food with a spoon.

To prevent the thali or plate from slip-

ping, place a wet jharan under it.

You can cut round holes on a wooden

tray and fix it on a table. The thali and
glass should fit into these holes.

Alternatively, you can cut a round hole

on a floor table into which the thali fits.

23
TEACHING INDEPENDENT EATING

Always place the elbow of the hand

he will eat with on the table. This will
help to keep his hand steady. Place
his other arm across the table. If he is
able to, he can hold the edge of the
table to keep himself steady.

You can fix a bar on the table. He can

hold the bar to keep himself steady.

Sit facing him when you teach him to

eat with a spoon. Help him to hold the
spoon with his dominant hand, which
may be either the left or the right one.
Put the spoon in his palm. Hold his wrist
between your thumb and fingers. If his
fingers tend to open, your thumb can
keep them closed around the spoon.
 24
Help him to scoop up the food in this
position.

Take the spoon to his mouth and

bring it back to the plate.

As he improves and learns each step,

reduce your help by holding him at the wrist.
2
Gradually give help by holding his elbow
only when he needs support.

He may ultimately learn to eat without

your help by using his dominant hand.

Children with very severe physical problems may never learn to eat on their own.
In such cases, you can teach the child to cooperate by:

a. Bringing his head forward when

he takes food into his mouth
from the spoon.

26
b) Chewing and swallowing the food without spilling.

c) Eating all types of food.

27
TEACHING OTHER SKILLS WHILE FEEDING
Feeding time can be used to teach your child many

things; a) a) You can teach him the names of:

Objects - glass, thali, spoon.

Food Items rice, roti, dal.

— sweet, sour, bitter.

Taste --

b) You can teach him manners:

• Eating without spilling food on the table.

• Eating with one hand only.
• Saying "thank you".
c) Meal times give a chance to teach your non-verbal child to
communicate by using pictures or by pointing to the objects.

Give him the opportunity to:

• Ask for food or drink.

• Refuse if he has eaten enough.
• Talk about the different kinds of food he eats.

This may help to improve his skills to communicate.

28
 DRINKING

A baby would normally be breast-fed

and drink water from a bottle.

As he learns to sit up by six or eight

months, he starts drinking from a glass.

Because of his physical handicap, your child may not have learnt to hold his
head erect and sit up by six or eight months.

However, it is still important that you

teach him to drink from a glass as soon
as possible. This can be done by putting
him in an upright position.

29
Your child may have problems while drinking. Some of these are mentioned below.
Identify his problems before you start teaching him to drink correctly. This should be
done at the earliest opportunity.
Does your child's head fall forward or backward when you make him sit
up and drink?

If it does, place your arm around his

neck. With the same hand, hold his chin
from below. Hold the glass with your
other hand and take it to his lips. En-
sure that you do not tip his head back-
wards.

Does your child find it difficult to sip when you hold the glass to his
lips?
If he finds it difficult, teach him to close
his lips around the rim of the glass. Hold
the rim of the glass between his lips, not
his teeth, and gently push his lower lip
against the glass. This will help him to
close his lips around the glass and sip.

Do not have too much water in the glass. Tilt the glass to allow only a little
water to go into the child's mouth.
Your child will gradually learn to manage without your help. He may spill some
water while drinking, but this will reduce with continued practice.

30
Remember that you should not allow your child to hold the rim of the glass
between his teeth.

Always give him a steel or a plastic glass that will not crack or break.

Does your child find it difficult to hold the glass himself and drink?

Start by helping him to sit in a comfort-

able position. You can make him sit on
the floor

or in a corner seat

or on a chair with a table in front.

31
Place both his elbows firmly on the ta-
ble. This will give him better control over
his arms and help him to control his
action of drinking.

If necessary, help him by holding his

wrist and directing his hand holding the
glass towards his mouth.

Teach him to keep his head well forward

while drinking. Do not allow him to push
his head backwards.

In spite of all your assistance, your child may find it difficult to hold the glass
because of his inability to grasp properly.

32

If he cannot manage to hold a glass, give

him a mug with a large handle. This will be
easier for him to grasp.
If your child still finds it a problem to hold a
glass and drink, teach him to use a straw.
Drinking with straw can be taught to a child
who is able to under-stand your instructions.
A child who can drink from a glass can also
be taught to use a straw. It will be an
additional skill for them.

You can help him to hook his fingers

through the handle of a cup and hold it.
Seat him in the correct position and
place a table in front of him. Initially use
a short straw with a length of about 6".
It should be a transparent plastic tube
as in water bottles, with a diameter of
1/4".

Your child will find it easier to suck from

a short straw. Place the straw in a cup of
water or milk and hold it-near his mouth.
Teach him to hold the straw between his
lips and not his teeth.

Show him how to suck so that your child can imitate the action. Initially he may
spill a lot of water while drinking. But this will reduce with continued practice.
When he has learnt to suck from a short straw, give him a longer straw. If he
can manage, give him an ordinary straw that is commercially available. Put
the longer straw into a glass. The glass should be close enough for your child
to bring his head forward and drink.

34
If your child can hold a glass and drink, can he put back the glass upright on
the table?

If this is a problem, teach your child to

put back the glass on the table by hold-
ing his hand and guiding it. Give him a
lot of practice untii he is able to put back
the glass himself.

Some children with behaviour problems throw down the glass after drinking. If your
child does this, reprimand him.
If that does not work, put your hand over his hand as soon as he finishes drink-ing.
Guide him to bring the glass back to the table and release it. To emphasize that he
has done the correct action, you can reward him by:

• praising him
• patting his back
• giving him something he enjoys like a small piece of sweet.

This will act as a reinforcement and he may soon learn to put down the glass on the
table without your guidance.

35
Remember
Always make your child sit up before you give him something to eat or
drink. Do not give him liquids or solids in a lying or a semi-lying
position. This will increase the chances of choking.
Encourage your child to take sips of liquid from a glass. Do not use a
'jhinuk' or a spoon or a glass to pour water into his mouth.
Give your child the drink he likes best when you teach him to drink. It
could be lassi, fresh lime juice or milk.
Help your child to eat and drink correctly every day. Allow him to make a
choice from different food items and drinks during his meals or snacks.
Teach him to ask for food or a drink when he is hungry or thirsty in any
way that he prefers. It could be by talking, gesturing or pointing to a
picture.
All handicapped children may not become totally independent.
However, each child will improve to the best of his ability.
TOILETING WITH THE CHILD
OF CEREBRAL PALSY
 INTRODUCTION

A early
mother starts training her baby to use the toilet at regular intervals fairly
in the baby's life.
She usually starts by taking him regularly to the toilet until the child can go on
his own.
If your child is handicapped, he may find it a problem to use the toilet on his
own without your help. However, if you start teaching him from an early age,
he may learn to become more confident about using the toilet independently.
There are two kinds of problems that your child may face when he is learning
to use the toilet.
The first problem is physical. This means that your child may be unable to go to
the toilet independently. He may be unable to squat or even sit on an ordinary
toilet seat. He may also have problems in washing himself after using the toilet.
The second problem involves his level of understanding. This means that he may
not have the ability to understand where or when or how he should use the toilet.
Part A of this booklet ('Positioning') discusses the physical problems and
suggests some ways in which you can deal with them.
Part B of the booklet ('Learning to use the Toilet') gives some suggestions for
teaching your child how to use the toilet.
 PART A

POSITIONING

Choosing a position which enables a handicapped child to use the toilet with
minimum or no help is very important.

If you start seating your child correctly from the beginning, it will be easier to
teach him to use the toilet.

Before you start teaching him to use the toilet, teach him to sit comfortably in
a good position on any chair. This will help him to sit on the toilet seat without
any fuss.

It is important to provide a suitable and

comfortable toilet seat for your child from
the beginning.
There are several kinds of toilet seats. You should choose one for your child that is:

1) suitable for his physical abilities and needs

2) suitable for her age

3) convenient to fit into your home

A cane toilet chair. This is easily avail-
able in the market.
If your child is unsteady when you seat
him, you can tie him to the potty chair
with a saree or dupatta to ensure that
he does not fall.

A wooden toilet chair. You can make this

easily by using an old wooden chair. Cut
a hole on the seat and place a bucket or
tin under it.
A box type potty chair. This is a plastic
potty seat mounted on a wooden chair
with high sides. This will prevent your child
from falling sideways.

An earthen pot or a plastic potty placed

in a wooden box will provide support on
all three sides.

If your child tends to fall forward, insert a

rod, which can be removed when neces-
sary, through two holes made on both
sides of the wooden box.

You can safely leave your child on any of

the above seats and continue with your
household work.
 SEATING FOR OLDER CHILDREN AND
ADULTS

If your son or daughter can sit either independently or by holding on to a

support, you can use normal toilet facilities.

Some adaptations may have to be made to the toilet in order to allow him to
use it on his own.

If your house has an Indian style toilet

and your son has a problem squatting
over it, you can attach a rail to the side
wall. He can hold the rail to squat safely
and comfortably.

If your older child is unable to squat on

the Indian style toilet, place a stool or a
chair with a hole cut out on the seat. He
can sit on this when he uses the toilet.

8
If your toileting area is out in the open, you can
fix a bamboo pole into the ground. Your child
can hold this as a support.
If your house has a western type toilet, you can
If your son or daughter needs more
attach a bar to the side wall. This will assist
support, you can build back and side
your older child to get on and off the seat and supports with bamboo around a mud
hold himself steady while sitting. If his feet are and brick structure. A bamboo or a
not flat on the floor, put a low stool so that he wooden bar can also be added
can rest his feet. across the front so that the child does
not fall forward.
If your child needs more support, you can
cut a hole on an ordinary wooden chair,
attach wheels and slide it over a western
style toilet

or an Indian style toilet.

Sometimes it is convenient to use a port-

able urinal or a clean bottle for severely
handicapped boys who are wheelchair
bound.

10
For boys who are heavy and unable to
move from the wheelchair to the toilet
seat independently, a bottle or urinal can
be held on the wheelchair itself. The in-
dividual can also be taught to hold it him-
self when he wants to urinate.

It can be cleaned by someone else later.

11
WASHING AFTER USING THE TOILET

Many handicapped children find it a problem to wash themselves after using

the toilet. In order to become as independent as possible, it is important that
we start teaching a child to wash himself as early as possible.

A young child needs help to clean himself after he has used the toilet. But he
should be allowed to participate in the washing.

For a youngster who squats on an Indian style toilet with support, cleaning and
washing can be difficult as both the hands are not free.

Remember it is always easier to wash

herself from the front in between the legs
than it is from behind. You can use a stool
which has a hole cut in it. This will leave
her hands free and enable her to clean
herself.

12
If your child uses a toilet chair or a west
ern style toilet, teach him to wash him-
self with a mug of water from a bucket or
a tap.

If there is no tap nearby, store water in a

bucket or a tin with a tap. Attach a pipe
to this tap. The child can use the pipe to
wash himself with one hand.

He can clean himself by using toilet paper.

She can hold a mug of water with one

hand and splash the water. Then with the
same hand, she can clean herself. This
can be repeated until she has cleaned
herself.

13
He can wash himself under a tap in a
crawling position.

We normally do not wash ourselves with the right hand. However, the right
hand may be the more able hand in the case of your handicapped child. Allow
him to use it as it will give him some independence.

Alternatively, a commercially available

telephone shower or bottom washer can
be used.

14
If she finds it difficult to reach her bot-
tom with her hand, use a sponge at-
tached to a long handle.

Remind your child to clean the sponge after using it each time.

Also remember to teach your child

to wash his hands with soap and
water every time he uses the toilet.

15
 PART B

LEARNING TO USE THE TOILET

Parents teach their children to use the toilet from an early age. You may have
been unable to manage this because of your child's physical or mental handi-
cap (lack of understanding). You will find it easier to teach him to use the toilet
if you do it step by step.

First step

Write down the time when he wets himself daily, for a period of one week.
Make a chart like the one below to record the time.

TIME
DATE
1st
2nd
3rd
4th
5th
6th
7th
Remember
• You must watch him over a period of at least seven days, for five to six
hours each day, preferably during the morning.

• By doing this, you will get an idea of the number of times your child needs
to go to the toilet for urinating or passing stool.
Once you have collected the information, your chart may look something
like the one given below.

TIME
DATE
1st 6.30 7.20 9.00 10.15 11.30 12.30

*P *u

2nd 6.45 7.50

*u *u

3rd 6.00 6.30

*u *p

4th 6.30 7.40

*p *u

5th 7.00 8.15

*u • u

6.30 8.00
6th
*u *p

6.00 7.30
7th
*u *u
*u *u *p *u
9.15 10.30 11.45 1 p.m

*u *u *u *p

8.00 9.30 11.00 12.10 1 p.m.

*u *u *u *u *u

9.30 10.30 12.30 1p.m.

*p *u *u *u

9.45 11.00 12.30 1.10 p.m

*p *u *u *u

9.30 11.10 12.45 1.30 p.m

*u *u *p *u

9.00 11.00 12.10 1.15 p.m

*p *u *u *p

p= potty
u= urine

17
Second step

Study the chart and note the intervals at which your child passes urine. The
chart may show that the child passes urine every one to one and a half hours.
So put your child on the toilet seat at an hourly interval regularly.

You can start on a successful note, if you put him on the toilet seat
immediately after he wakes up and half an hour after he eats. He will probably
pass urine at those times.

Most children cry when they are seated on the toilet seat for the first time. Put
him on the toilet seat and do not take him off even if he cries.

Ensure that he is comfortable and secure. Refer to the earlier section of this
booklet to help you choose a suitable toilet seat for your child.

Keep him on the toilet seat for at least five minutes at a time. As soon as you
take him off the toilet seat, give him something he likes. This can be a hug and
a kiss from you or something he loves to eat or even a favourite toy. This will
help him to understand that he has done the right thing.

Put him on the toilet seat every hour if possible. This will help him to get used
to the toilet seat faster.

Remember that he may not pass urine or stool in the toilet in the beginning.
But do not give up. He will soon learn if he is put on the toilet seat regularly.

18
Third step

In the beginning your child may wet himself before you can take him to the toilet or as
soon as you take him off the toilet.

If he wets himself when he is not on the toilet, scold him so that he realises that he
has done something wrong.

A child who is very mentally handicapped may not understand when you scold him. In
such a case, ignore him by leaving him alone for about 1 0 minutes or by not talking
to him.

Fourth step

You can teach him to tell you when he

wants to go to the toilet by:

Saying a word like 'susu' or any other

word or by making a sign. You must
make the sign every time, before you
take him to the toilet. He will learn to
make it by imitating you.
If he is unable to talk, he can learn to If he cannot do it initially, help him by saying
use a gesture or a sign like raising a the word yourself or making the sign and
finger, to indicate his need to go to the then waiting for him to copy you.
toilet.
Or he can tell you when he wants to
use the toilet by pointing towards the
bathroom.

You can also take his hand and

physi-cally help him to make the sign.

20
Fifth step
Encourage him to go to the toilet on his own in whatever way he may be able to:

e) Walking

f) Crawling

g) Bottom shuffling

If he is unable to go on his own, he

should be encouraged to use an aid such
as a wheelchair or a chair with castors.

21
A rolator or a walker can also be used.

All toilets may not be accessible by a wheelchair or a rolator either because

the bathroom is outside the main house or the house is too small to move a
wheel-chair or walker in- it.

In such cases, you can keep the toilet

chair within the house.

Choose a corner of a room or a veran-

dah to place the toilet chair. Put a screen
around the toilet for privacy.

Do not move the toilet chair from place to place. Keep it in a definite place.
This will help your child to understand that he should toilet in only one place.

22
Sixth step

Teach your child to take off and put on his pants and underpants. He should learn to
take off and put on his pants before and after he uses the toilet. You can make it easier
for him by:

Using elastic or zips on his pants instead

of buttons. Refer to the booklet 'Dress-
ing' for details.

With severely subnormal children, it is

better not to teach this skill as they may
take off their pants even when it is not
required.

Seventh step

Teach him to leave the toilet clean by:

k) Pouring water or pulling the flush after using the toilet.

If the toilet area is in the open, he should cover with soil.

6) Cleaning the toilet seat.

7) Washing his hands.

23
 BED WETTING

The steps mentioned above are useful for teaching the child to become toilet trained
during the waking hours only. If he wets himself during his sleep, then other measures
need to be taken.

If your child wets his bed, you can try and control it by:

g) reducing his water intake in the evening

h) taking him to the toilet just before he goes to sleep and once in the middle of
the night.

If your child still wets at night in spite of these precautions, try to ensure that he does
not wet his clothes. Pad him inside his pants with an old towel or a thick cloth and put a
plastic panty over it. This will soak the urine and prevent the outer clothes from getting
wet. Put a rubber or a plastic sheet over the bed and cover it with a cloth. This will
prevent the mattress from getting wet.

Remember

6)Teaching your child to use the toilet independently will take time.

7)Some children, owing to their physical or mental handicap, may never learn to
use the toilet totally on their own.

8)Teach a child as much as he can learn, according to his ability.

REFERENCES:
 https://asksource.info/pdf/A934_toiletingforthechild_1995.pdf
 https://asksource.info/pdf/A935_cleanlinessforthechild_1995.pdf
 https://asksource.info/pdf/A932_dressingforthechild_1995.pdf
 https://asksource.info/pdf/A933_feedingthechild_1995.pdf
 www.google.com