Care & Learning Service Occupational Therapy Advice For

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Care & Learning Service Occupational Therapy Advice For

Transcript Of Care & Learning Service Occupational Therapy Advice For

Compensatory Strategies
Mirrors: Using vision to support touch can help a child to work out where the hard-toreach areas are. They can then also use the mirror to do a final check over.
Wet Wipes: Offer an easier and more effective method to remove faeces than paper.
Cheaper Toilet Paper: Gives more tactile “feedback” than softer more expensive paper.
Position: Your child may find it easier (if their balance is good) to stand up to wipe, with one leg resting up on the toilet seat or bin. They can then look down to see what they are doing. If a rail is available encourage them to hold on with their non-wiping hand.
Addressing Postural Issues
 Consider the way your child sets themselves up.  Are their feet flat on the floor? Are they leaning forwards slightly? Is their trunk
strong enough to brace or do they need to rest down on an arm across their legs or lean on a rail? Do they feel stable?  Is the toilet paper within easy reach so the child does not have to stand/twist and so will avoid any “squishing”?
Addressing Planning Issues
 Help your child organise a plan. Talk about starting from the front (forwards of rectum) and working from the left side across the middle and out to the right side. Working in “rows” start moving backwards (past rectum) until they reach far enough back that the toilet paper is clean. Then go back over the entire area for one more check. Using the same pattern of movement will help the child self evaluate how well they have done and which areas they missed.
 To start with allow you child to wipe only once with the toilet paper before disposing. Agree on a certain number of sheets to wipe to help the child to organise how much to pull off.

Improving Body Awareness
 The sense of touch plays an important role. Help them develop better awareness of their bottom by encouraging them to use a wash cloth during a bath or shower and “have a go” at washing themselves in a manner mimicking the wiping action with the toilet paper.
 Encourage them to consider the way wiping the rectum feels different to touching the skin of the bottom cheeks.
 Orientate them to the anatomy of the area using pictures from children’s anatomy books.
 For younger children, play games using realistic baby dolls and pretend that they have been to the toilet, encourage your child to wipe the doll’s bottom. Role play the strategies you have been working on.
Skill Building Strategies
Bumbag Games:
Fill a bumbag up with familiar items such as key, coin, peg, cotton wool ball, teaspoon, etc. Put the bumbag on the child and have it loosely positioned around their waist with the bag hanging over their bottom. Sit them sideways on a chair so that their bottom is hanging just off the side and the backrest is not in the way. Call out one item at a time and see if they can search for it behind their back using their “wiping” hand.
Ball Skills:
Play ball games where you vary the way the ball is thrown. Include throws from behind the bottom/through the legs. Pretend to juggle by passing the ball as fast as possible around the waist, upper thighs and through the groin area.
Practise wiping bottom action with clothes on, but with a weighted sock as the pretend “toilet paper”. This may help develop motor memory and hopefully aid the real event.
Practise the actual wiping action by asking your child to wipe down the table after dinner or meal preparations; you may have to demonstrate first. Have them wipe down the sink or mirror or any glass top tables as chores to earn rewards or pocket money.
Make up a “target” with small numbers in the middle and getting higher as you work your way out. Next squirt a bit of moisturiser/mousse/custard on it in the very middle. Play a game to see who can accumulate the least points as they try to wipe up the moisturiser. Start off playing the game on a table and then start making it trickier by moving the target to the side of the body, eventually aiming to play it behind your back.
Similar Suggestions
Positioning on the Toilet:
 Make sure your child is comfortably seated in a stable position on the toilet with feet supported on the floor or on a step stool.
 Adjust the location of the toilet paper to enable your child to reach easily.  Practising the action of reaching around to the bottom:

 During dressing routines practise reaching behind to pull up and pull down underpants, skirts and trousers.
 Place large stickers or rolled up balls of masking tape on the back of your child’s pants to reach and pull off; practise in a sitting position.
 Play games with animal tails or scarves that tuck loosely onto the back of their pants to reach around and pull off; practise in a sitting position.
Managing Toilet Paper:
 Consider alternatives to toilet paper initially, such as tissues or moist towelettes, which can be easier to manage.
 Consider softer toilet paper varieties for children with tactile sensitivities.  For toilet paper located on the wall, use coloured tape or colourful stickers to mark a
short line on the wall about 50cm below the toilet paper roll. This provides a visual guide for how much toilet paper to pull out.  Using a toilet roll holder with a cover can help with tearing off paper using an upward motion. Alternatively, show your child how to use two hands to hold the paper roll with one hand and tear with the other.  Use hand over hand guidance initially to teach your child how to manage the toilet paper. Withdraw this guidance as their independence develops.
Bottom Wiping after Toileting:
Show your child how to use the toilet paper following a consistent sequence:
1. Pull down paper to correct level 2. Tear off paper and roll into hand 3. Reach around to the back of the bottom 4. Wipe once in a front to back motion 5. Check if paper is clean 6. Drop paper into the toilet 7. Repeat sequence until the toilet paper wipes clean
 Consider visual cues, such as a photo, illustration or symbol to prompt the bottom wiping sequence.
 Allow your child to watch other family members using the toilet to reinforce their understanding.
 Use a children’s storybook or video about toileting that reinforces bottom wiping as part of the routine.
Wiping Action and Awareness of Wiping the Bottom Clean:
 Apply shower gel or soap to your child’s bottom at bath time to practise wiping with a hand washer. Also encourage your child to wipe their bottom dry with a towel after bath time.
 Use a large, plastic doll and apply vegemite, shaving cream or hand cream to the doll’s bottom for your child to practise wiping off with toilet paper.
 Practise wiping “clean” other surfaces using toilet paper, such as wiping felt pen off a white board, vegemite off a plate, or chalk off a blackboard.

 Encourage your child to use a new piece of toilet paper after one wipe and to keep wiping until the surface and toilet paper wipes clean.
 Be aware, that all children will continue to need assistance to complete bottom wiping effectively and should always be supervised as they develop these skills.
These are generic suggestions some or all may be of benefit for your child; it is useful to have a range of ideas to suit a range of needs. Key Message: This is often a skill that needs to be taught rather than children acquiring these skills as they develop.
Care & Learning Service, Highland Council, Birnie Centre, Zone 11, Raigmore Hospital, Inverness IV2 3UJ Tel: 01463 704419
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