Self Care Tips

Teaching basic self care skills can be a bit of a challenge when you don’t know where to start. We have gathered some parent and therapist driven tips to assist your child learn the following skills:

• Feeding/Eating
  • Sucking
  • Swallowing
  • Chewing
  • Tube Feeding
  • Peg Feeding
• Oral Care
• Bathing
• Toileting
• Getting Dressed
• Sleep

For advice, speak to a physiotherapist for positioning, occupational therapist for equipment, routine and practical tips, a speech pathologist for specific feeding and oral care advice and dentist for specialist advice.

To add a tip please contact us.

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Feeding/Eating 

Purchase Food Talks resource from Scope UK £15 ph 01233 840 764, covers all difficulties associated with eating including reflux, swallowing, ng-tubes with practical ideas and games to encourage feeding!

Read mealtime routines and guidelines for assisting eating and drinking and careplan for eating and drinking all by novita, for more tips.

Visit our equipment pages to view equipment that can assist feeding and self-care.

Difficulty Sucking 

• Choose Appropriate Bottle/Teat – ask your OT or Speech Pathologist to recommend one that will suit your child’s needs.
  For babies 0-6 mths try a Haberman Teet Bottle (designed for children with cleft palate by more energy efficient for children with CP and other motor conditions).
• Desensitise Mouth
  If your child has hypersensitivity (tongue thrust, jaw clench when food/drinks are inside their mouth) try and stimulate around the mouth though touch or use of icecube, to desensitise area prior to feeds.
• If your child is unable to breast-feed, they may still have the option of getting your expressed, nutritious breast milk through specialised teats/bottles or via ng tube. Contact Australian Breast Feeding Association, a lactation consultant or midwife for information on expressing and a speech pathologist for advice on feeding.

Lee’s Blog: Asialee could not suckle due to her CP, however I expressed for 6 mths using a Medela Symphomy Pump and she was able to drink first by eyedropper, then haberman teat, then slow flow teat on normal bottle. We would have used an NG tube if these methods weren’t successful. I am sure the breast milk has strengthened her immune system. She is 3 and only ever had 2 colds despite all the hospital appointments!

Difficulty Swallowing 

• Position child in upright as recommended by physiotherapist see Positioning PDF
• Thickened Fluids are easier to swallow– Use guarcol or easy thick to thicken fluids. Get advice from your speech pathologist to determine best consistency for your child.
• Can use routine to prepare your child for mealtime.
• Desensitise mouth as per difficulty sucking section.
• For drinking – Hold the cup in your right hand, Use trigger hold with your left thumb under child’s bottom lip and forefinger gently touching adam apple of child throat. Can encourage jaw to close with left hand to promote good lip seal and reduce dribbling and lost fluids. Can gently press throat to stimulate swallow reflex.
• Try using flexible cut out cups (see equipment section)
• Here are some tips on suctioning to help manage saliva and secretions

Difficulty Chewing 

Chewing involves several steps – opening the mouth, moving the tongue from side to side, moving jaw up and down, pushing food to the back of the mouth by tongue and swallowing.

• Position child in upright as recommended by physiotherapist see Positioning PDF
• Can try using “chewy tube” to encourage chewing between meals
• Desensitise mouth as per difficulty sucking section
• Start with foods that dissolve easily – rice crispbread, (or foods with similar texture to cheezels and burger rings)
• Place food between teeth and cheek to encourage side to side tongue movement.
• Assist massage outside of cheeks to encourage chewing movement.

Tube Feeding 

Some children use tube feeds for 100% of daily calories and nutrition, whilst others use tube feeds to "top up" calories/nutrition/fluids. Discuss your options with your child’s dietician, gastro-enterologist and speech pathologist.

You can administer tube feeds by bolus (injection), gravity feed (bottle/bag feeds into tube), or by timed pump.

Bolus Feeds
Pros: quick and easy for top up feeds. Less prep time.
Cons: risk feeding too quickly, which may cause reflux.

Gravity Feeds
Pros: quick and easy. Some children expend less energy consuming these feeds.
Cons: risk feeding too quickly, which may cause reflux.

Pump:
Pros: Safe timed feeds. Ability today/ night feed whilst child is asleep.
Cons: Feeds can take a lot longer. More set up and pack up than other methods.

Some Tips:

If you are doing frequent (daily) tube feeds, a weighted tube will help prevent reflux or coughing the tube up. Download the Tube Feeding PDF published by Children’s Hospitals and Clinics of Minnesota.

Tube Feeding PDF.pdf

PEG Feeding 

Some children use peg feeds for 100% of daily calories and nutrition, whilst others use peg feeds to “top up” calories/nutrition/fluids. Others have a peg inserted and use it rarely on days where they’ve had multiple seizures, severe reflux or difficulty swallowing. Discuss your options with your child’s dietician, gastro-enterologist and speech pathologist.

Pros: Food is directly pumped to stomach. Reduced risk of aspiration.
Cons: Child needs to undergo surgery to insert peg and anaesthetic which has its risks. Saliva and digestive enzymes do not predigest food as they do in oral feeds. Bowel motions may be affected due to limited fibre intake. Limited oral stimulation or practice if all feeds administered by peg.

PEG feeds can be administered 3 ways:

• Bolus Feeds
  Pros: quick and easy for top up feeds. Less prep time.
  Cons: risk feeding too quickly, which may cause reflux.
• Gravity Feeds
  Pros: quick and easy. Some children expend less energy consuming these feeds.
  Cons: risk feeding too quickly, which may cause reflux.
• Pump:
  Pros: Safe timed feeds. Ability today/ night feed whilst child is asleep.
  Cons: Feeds can take a lot longer. More set up and pack up than other methods.

For more information download the PEG Feeding information document below.

PEG Feeding.pdf

Oral Care 

Oral care can sometimes be tricky especially if your child has difficulty opening their mouth or has challenging behaviour. If your child is still learning to communicate, it is more tricky for them to let you know if they are in pain or discomfort… by practicing good oral care the risks are reduced!

Here are our top tips:

• Desensitise mouth area before trying to rinse or clean inside mouth/teeth
• You can play with doll to show your child what you are going to do together. Ie. Let’s brush the dolls teeth like we brush yours!
• Make it fun – use rhythm rhyme and repetition to make this a fun time Ie: SING Lets brush your teeth BRUSH BRUSH BRUSH and keep repeating.
• For children who have difficulty opening or tend to clamp jaw shut, you can use a soft cork towards the back of their jaw to enable tooth brushing
• Use a colus curve toothbrush to reach front and back of teeth with ease.
• Some kids struggle to manage toothpaste, so you can try using Neways mouthwash on the toothbrush to help fight plaque and protect tooth enamel.
• Try and rinse mouth with water several times a day.
• Avoid sugary foods and drinks and always flush mouth with water after these.
• If your child is prone to reflux or vomiting, rinse mouth often and brush teeth at least 2 x a day.
• Try an electric toothbrush for children with learning challenges, as well as some types of CP.

Visit our equipment pages to view equipment that may assist your child’s oral care and ability to self-care, including hand grips and other devices.
Visit the dentist regularly for specialist advice. Children with high needs will need a referral to visit Children’s Hospital Dentist.

Bathing 

Visit our equipment section for equipment that can offer children postural support and independence in the bathroom!

Join us on Facebook to read and share parent posted tips

For heavier children with high postural needs, consider installing a hoist to lift child from postural seat to shower commode or bath chair.

Watch this space for behaviour management tips.

Toileting 

Visit our equipment section for equipment that can offer children postural support and independence in the bathroom!

Join us on Facebook to read and share parent posted tips

For heavier children with high postural needs, consider installing a hoist to lift child from postural seat to shower commode or bath chair.

Watch this space for behaviour management tips.

Buy Are You Ready/Tom’s Toilet Triumph DVD from TCCP WA for comprehensive advice for carers of kids with physical challenges

Getting Dressed 

Join us on Facebook to read and share parent posted tips

Children who are unable to reach, or dress themselves, often enjoy being given a choice. This can begin as soon as 6 mths of age by offering a choice “do you want to wear the pink one or the yellow one” or blind children you may offer a texture difference – the silky one or the wool one. Ask your child to tell you with their voice if able or nod or eye gaze.

Buttons & zips may be difficult for children with fine motor challenges so try pull on/over tops and pants, slip on or Velcro shoes instead of laceups. To teach these skills try using oversize dolls with zips, laces and buttons.

Sleep 

Read the Sleep Fact Sheet by Scope UK, for information on developing optimal sleep through diet, behaviour, routine, positioning and other useful management tips!

Sleep Fact Sheet.pdf

For children who need postural positioning or are at risk of reflux or aspiration, we suggest visiting our equipment pages to view Positioning and Sleep Equipment.