Safety is vital at bath time for all involved. Whether the child has disabilities for not, no young child should be left in the bath unattended. The safety of the caregiver at bath time is also very important. Care and thought should be given to how the caregiver is getting the child into the bath. Simply lifting and holding the child may work when they are 2, but as the child grows, more and more strain will be put on the back, which is not safe for either party. Whenever possible, the child should be lifted or helped into the tub in a standing position; then he can sit down from the standing position. This is much easier for the caregiver. Also, if the caregiver sits on the edge of the bathtub with one foot in the tub before lifting the child, this reduces the stress on the caregivers back.
Just as in all other activities, for children with CP it is best to find a body position that will minimize the severity of spasms during their baths. For bath time to be a success, you need to position your child in a way that normalizes his muscle tone as much as possible Children with CP each have different abilities when it comes to sitting balance. Some may have very weak trunks or may have a tendency to arch their backs while in a sitting position. You should also try to give your child a sense of security, rather than challenge his sense of balance. Many popularly marketed bath seats that have straps or belts to aid in trunk support can provide your child the security he needs while giving you an extra pair of hands in the tub. You may also find a semi-inflated inner tube (from a compact car, or a swimming tube) helpful as a positioning device. If your child cannot maintain a sitting position, he may be more comfortable in a semi-reclined bath seat that is held in place with suction cups. If sitting balance is pretty good, a small towel underneath them will also reduce the risk of slipping while in the tub and provide added security. If the child has difficulty sitting with her legs straight at a 90 degree angle from their trunk, a plastic chair with supporting straps placed in the bath or shower can be an option.
A hand-held shower can make the process of rinsing and bathing much less difficult.
For an older child who can stand, the addition of hand rails in the shower or bath can give them more security and stability while in the shower. For those who are more seriously impaired, the family may want to consider renting or investing in one of the variety of bath chairs and hydraulic lifts available from special equipment suppliers to aid in transfers to the tub, both for the safety of the child and the caregiver. There is far more opportunity for an accident that could hurt either of them if the caregiver is straining or struggling to affect the move.
Some older children enjoy showering in a kneeling or sitting position. Again, use the principles of good positioning for your child. You may also want to add grab bars or nonskid strips to the shower stall or tub to make it safer for your child.
Bath time can also be turned into a fun learning experience. Think first about the process of undressing. If you child has the movement skills, bathtime is a natural time for him to begin independent undressing. It is also a great opportunity to quickly run through those range-of-motion exercises your physical or occupational therapist has suggested turning them into a game if possible. As you do these routines, think about all the words and concepts it is natural to introduce to your child for example, arm in, out, through: tub full, empty, slippery; water wet, warm, cold. If your child is around the developmental age of 12 18 months, this would also be a wonderful time to work on the names of body parts.
In the bath, your child has many opportunities to learn cause-and-effect relationships, spatial relationships, wrist rotation, and tolerance of different sensations. Young children impaired or otherwise often do some of their best learning while playing and discovering the world around them. And while your child is busy learning to float the duck, grab the soap, squirt the squeeze toy, dump and fill the cups, or paint the tiles with bathtub fingerpaint, he may not even notice that he is also getting clean.
Special situations Children with Cerebral Palsy may require surgery at some point that will result in being in bed or having a cast for a period of time. Special care should be given so that the cast does not become wet and that no soap gets under the edges of the cast where it can cause irritation.
If its necessary to bathe the child in bed, first gather all of the supplies that you will need: water basin, soap, sponge or clothe, towels, etc. It is best to begin with the head, face and neck; followed by the chest, arms, back and legs; finally the buttocks and genitals. Make sure that you dry and cover the completed areas as you go to avoid chills and discomfort.
When it comes to washing hair with a cast on the body, if the child can comfortably get to the sink or kneel at the side of the tub, you can wash or help them wash their hair in that way. Again, the hand held shower is very helpful in these situations.
If the child must be confined to bed for a bath and hair washing, you may want to invest in special equipment that is commercially available to allow water from hair washing to drain off the bed. Check with local stores or home care companies for a listing of the products they carry to make it easier to wash hair in bed. It may be possible to wash your childs hair in bed by funneling a plastic drape from around his neck into a plastic container (a trash can or bucket), allowing the shampoo water to run from the head, to the plastic, to the container.
By the time a child reaches the age of 2 or so, parents are often looking forward to the beginning of toilet training and to the end of changing diapers. There is a relatively large window of time in which either daytime bladder control (18-40 mo., with an average of 32mo.) or bowel control (16-48 mo., with an average of 29) is achieved. A child must be temperamentally and physically ready to accept toilet training as well as be able to understand the process in order to have any success.
Most parents and caregivers get to know a childs habits well enough to be aware of the behaviors that signals that a child is urinating or having a bowel movement. This indicates that the child has an awareness of what is going on with their body. For young children, elimination is more of a reflexive act than a cognitive one. When they have the ability to communicate to the caregiver, in some fashion, that they are wet or soiled, it is a good time to think about toilet training.
Most experts and parents agree that a positive attitude by the caregiver and a fairly casual, nonconfrontational introduction to the process will help get toilet training off to a good start. Whether in the early going the child has success or not in producing a bowel movement or urinating, praising them is crucial. Either praise them for their success or praise them for sitting patiently on the toilet and trying.
For children with Cerebral Palsy who have poor sitting balance, trying to sit on a toilet seat or training potty can be very frightening. Not only are they trying a new thing, but they may also be worried that they will fall over or off the seat and hurt themselves in the process. Just as with bathing, the child has to feel safe and secure. There are many different types of potty seats available for children with the need for special support. Your GP or occupational therapist can no doubt help with some suggestions.
For a child with Cerebral Palsy who is also mentally retarded there can be added concerns. Sometimes the child is confused and frightened by bowel movements , thinking that a part of their body is being flushed down the toilet. It is important to reassure them that all is fine and that there is nothing to fear.
Bowel training can be especially challenging for children with Cerebral Palsy for a number of reasons. They frequently suffer from constipation due to any number of factors: lack of exercise, insufficient fiber and liquid in their diet or as a side effect of medications to name a few. Making sure that there is sufficient bulk in their diet such as fruits (especially plums and prunes), green leafy vegetable, bran, olive oil and perhaps ground flaxseeds or sesame seeds and plenty of liquid in their diet can be one of the best ways to combat constipation. Cows milk products can be binding so care should be taken to be avoid over consumption of milk.
Laxatives, suppositories, enemas and pharmaceuticals may also be used, but they can lead to their own difficulties. Using a more natural diet based approach is safer if it can be used to alleviate the problem.
For all of us, eating a meal will often act as a signal to the body to have a bowel movement, usually at breakfast or dinnertime, For this reason, when initiating a bowel training program, it is a good idea to try to have meals at regular times so the body is able to establish a rhythm. Thirty minutes or so after eating put the child on the toilet or training potty so that they are sitting comfortably and securely with their feet on the ground or on a stool. Sit with them for 15 -30 minutes so that they have an opportunity to have a bowel movement. (You dont want move than two days to pass without their having had a bowel movement or you run the risk of an impaction due to constipation.) Use simple descriptive common words to describe the desired activity. Again, be positive by praising the desired results, and praise the child for sitting on the toilet as you wished, even if there is no bowel movement. Be sure there are no distractions during the time.
After a while, in most cases the, the child is able to successfully learn bowel control.