Occupational therapists support children and young people's independence in performing activities of daily living including:
- dressing
- eating
- bathing
- toileting
- grooming
- sleep/wake cycles
- organisation and planning skills
- moving safely and effectively through the environment
- functional mobility.
These tasks can be quite complex for children to learn.
Please access the list below to find guidance on helping your child to gain independence and participation in performing day-to-day activities.
Dressing
Some children can find dressing to be challenging, especially if they have difficulties with movement or learning.
How it presents
The child:
- seeks help with dressing
- ends up with twisted clothing
- puts clothes on backwards or inside out
- resists engaging in dressing themselves
- becomes frustrated that they cannot complete dressing tasks
- does not dress in the correct order, or miss items of clothing when dressing.
How you can help
1) Remember, children learn to undress first, so focus on this initially.
2) Choose loose-fitting clothing without fastenings or buttons initially, such as trousers with an elasticated waist. Shorts and short sleeve tops are easier to start with.
3) Make sure the child is able to use their hands freely for dressing which might mean sitting on a chair to help them to balance.
4) Allow enough time to practice dressing, so the child can start to become involved in the process without feeling rushed. This might mean practising in the evenings or weekends, rather than mornings.
5) Use simple directions when describing what needs to happen.
6) Lay the item of clothing out on the floor first so the child can see where to put in their arms or legs.
7) If the child has a weaker or non-dominant side, learn to dress this side first.
8) Try to do the steps in the same order each time to help the child to learn the routine.
9) Break down the steps for each item of clothing and practice them one at a time. It is usually easier to learn the last step first and work backwards.
10) Using a visual schedule can assist children to learn the order when dressing, these can be found online on websites such as SparkleBox and Twinkle.
11) Remember that learning a new skill can be challenging, try to keep the child motivated by using praise and rewards that are important to the child.
When learning buttoning, start with unbuttoning first as this is easier. Start with large buttons and buttonholes first and work towards smaller ones.
12) When learning to do zippers, start with large easy to manage zippers with an easy-to-grasp tab. Learning to unzip initially is easier.
Feeding
Meal times are an important aspect of family and social life.
Developing the skills to feed yourself is important for both the independence it promotes and for social inclusion.
Learning to use cutlery is a common difficulty for children and it usually takes a child until they are 7 years old to be able to feed themselves with a knife and fork.
How it presents
The child:
- is reluctant to self-feed or ask for help
- is very messy when eating and spills food
- uses their fingers for eating, instead of cutlery
- looks uncoordinated or awkward when trying to use cutlery
- tries to bite off a larger piece instead of cutting their food up.
How you can help
Ensure the child has good positioning to support self-feeding. When seated, ensure that the child has their feet supported and they can comfortably reach the table. They should have the freedom to use both hands.
Ensure that their elbows are tucked in and try not to allow the child to raise them out to the sides of his body.
Try to set out the dishes and cutlery the same way to develop a routine and help the child locate items at each meal.
Spoon
When learning to use a spoon, using spoons with thick and, or textured handles, are easier to hold and a short handle is easier to control. Also, use a bowl or plate with a raised edge so the child has something to scoop against.
When using a spoon, initially start by practicing with foods that stick to the spoon, such as yoghurt or custard, to reduce spills.
You can support the child by helping them to fill the spoon and guide them to bring it to their mouth and reduce how much support you provide over time.
Knife and fork
When learning to use a knife and fork, ensure the knife is in the dominant hand, and the fork is in the non-dominant hand.
Support the child to position his or her index fingers along the shaft of the fork and knife. You may need to use hand-over-hand assistance to achieve this position.
Cutlery with built-up or curved handles, such as Caring cutlery and Kura cutlery, can help with grasp and correctly holding the cutlery. These have thicker handles and indentations to ensure index fingers are correctly positioned on the fork and knife.
The movements - first “stab” the food with the fork to hold it in place, next place the knife next to the fork and “saw” with the knife backward and forwards in a sawing motion.
Use consistent verbal prompting such as “stab” and “saw”
This skill can be practiced outside mealtimes using putty or Play-Doh.
Initially start with soft foods, such as banana, cooked carrot, pieces of melon, cooked potato, fried egg, pasta and pancakes.
When learning to sure cutlery, make it more manageable by practicing with a few cuts at each mealtime and increase this over time.
Remember that learning to use cutlery can be messy and takes a lot of practice.
Toileting
Learning to use the toilet is a complex task with many steps.
A child needs to:
- know when they need to go
- communicate with you
- manage their clothing
- control their bladder and bowels
- learn to wipe themselves
- and remember all the steps to the task in order.
Due to the complexity of toileting, it can take some children a long time to become independent with toileting.
How it presents
The child:
- uses nappies or diapers
- refuses to sit on the toilet
- is unable to wipe themselves
- has many toileting accidents throughout the day.
How you can help
Support the child to feel safe and comfortable on the toilet using a toilet insert and ensuring their feet are supported by using a sturdy step can help your child feel more secure.
Break down the task and practice skills one at a time, such as learning to manage their clothing and washing their hands.
Ensure the child has a way of communicating their needs with you, speak with the child’s speech and language therapist for more support with this.
Make toileting a fun and positive experience – use books, singing, bubbles, or toys specifically for the toilet. Remember to use a lot of praise and encouragement.
Help the child understand the toileting process using books or videos about toilet training.
Removing the nappy as soon as possible when starting toilet training will assist your child to feel when they are wet or dirty.
Take the child to the toilet at regular intervals and keep the routine consistent.
Using a visual schedule can help the child understand the steps.
Bottom wiping
Ensure the child is well supported so they can balance. They may benefit from a handrail to hold onto when leaning to the side to wipe.
Sometimes children prefer to use wet wipes instead of toilet paper, as these can help with cleansing and are often easier to wipe (put them into the bin instead of the toilet).
Practice one step at a time such as:
- getting toilet paper off the roll
- folding the paper
- reaching around to their bottom
- checking if it is dirty
- and putting it into the toilet.
A social story can help to teach the sequence for bottom wiping.
Consider visual cues, such as a photo, illustration, or symbol to prompt the bottom wiping sequence.
Organisation and planning
Difficulties with organising and planning can make it difficult for a child or young person to develop independence from others.
How it presents
The child
- does not know how to begin a task
- fidgets with items rather than beginning a task
- does not collect the correct equipment for the task
- misses steps throughout a task
- waits for help with tasks or asking for help regularly.
How you can help
1) Remember that they may require a lot of adult support initially and this support can be reduced over time.
2) Start with practicing short or simple tasks to support them to feel successful.
3) At the beginning of a task, talk through the steps and talk through the equipment needed.
4) Break down tasks into smaller steps, it could also be helpful to write this down for them to refer to.
5) Break the steps down visually so they benefit from visual support.
6) Initially prompt them one step at a time and wait for them to complete this step before giving them the next step.
7) Encourage problems solving when possible, asking them what they could do rather than giving them the answer.
8) Ensure they feel comfortable asking for repeated instructions.
9) For older children, using checklists and planners can be useful. They may initially need support to use these and this can be reduced over time.
10) Make belongings easier to manage e.g. using a clear pencil case can assist with finding items, using labels for items within draws and having a specific place for all belongings.
Transitioning between tasks
Transitioning is moving from one task to another or from one place to another. Some children can find it particularly difficult to cope with transitions.
How it presents
The child:
- has difficulty focusing during a new task
- resists ending a task or negotiates with adults
- has meltdowns due to a task ending
- may have difficulty finishing a task and starting a new task
- shows signs of frustration or behaviours that appear during transitions.
How you can help
1) Use a timetable of activities for the day to support the child to be aware of what is coming up. This could be visual or written timetable, depending on the needs of the child.
2) Use warnings before a transition occurs, for example, “5 minutes until we pack away” or “2 more turns and then the game is finished”.
3) Ensure you have the attention of the child before giving warnings or instructions.
4) Use a timer, such as a sand timer or digital timer, to support the child to know how long a task will last.
5) Having a fidget toy for movement between areas can be helpful.
6) Engaging in calming strategies prior to transitions, such as pushing and pulling activities.
7) Using a transition song can support with transitions such as a pack away song.
8) Praise and reward positive transitions.