RUB-A-DUB AND SPLISH-SPLASH: HYGIENE HELPERS

By Janna Barrick, M.S.,OTR/L

Bathing and hair washing can frazzle the nerves of the most organized, calm parents and children. Additionally, children can change on a frequent basis as to fears, sensitivities, negative associations, and level of cooperation. If appropriate, try discussing with your child any difficulties tolerating or participating in the task to see how you can make it a more manageable experience for all. These suggestions, along with adaptations for children who have special needs or sensitivities, may reduce the stress and struggles associated with bathing and washing hair.

Safety and preparation first!
Before bringing your child into the bathroom or before preparing water, organize all supplies needed (towels, shampoo, soap, change of clothes or pajamas) within easy reach. Children who are bathing or showering should not be left unattended even for a few moments since accidents that may lead to drowning or severe injury can occur quickly. When a child is a reluctant participant, having all supplies nearby can also make the difference between completing bathing or shampooing quickly or not at all.

For babies and younger children, check and follow the guidelines for water temperature, and be cautious when adding water or adjusting the temperature. Also, stay in the room with children who are using a smaller tub inside the large one or who are using a bath chair, because falls can occur if the child attempts to get up or out. Make sure you have plenty of time to complete the task in case any unexpected difficulties should arise. Plan ahead for any incentives, and be flexible!

Avoiding bath time battles
The balance between your children developing independence with bathing, while ensuring that they are fully clean is complex, as well as other difficulties associated with bathing. Some easy precautions can reduce the chance of the child developing fears associated with bathing. If your child does not feel secure or becomes too excited in the large space of the bathtub, have her bathe in a small baby tub inside the large one or invest in a small bath chair to ease the transition.

Always wait until he is out of the room before letting the water go down the drain.  If the child already has anxiety regarding the bathtub drain, reinforce that nothing but water and soap bubbles can go down the drain by playing with large (waterproof) dolls or toys in the tub. Refer to the “Public Broadcasting System” kids website for songs or books on this topic. It may be helpful for the him to alternate or take a sponge bath for awhile to reduce apprehension. Since children do not have the same difficulties with oil and sweat as adults, they do not need to bathe every day, so you can choose your battles based on how neat they are.

A child who refuses to cooperate during his or her bath may be motivated by a trip to the store to pick out bath toys, bubble bath, waterproof bath books, and other bath accessories to play with when washing up is finished. Also, he may enjoy singing along with a waterproof radio or CD player to increase the fun. If the association with bedtime is a suspected problem, experiment with moving bath time to follow dinner before some “clean” inside play, and then bedtime, or a morning bath if possible.

Providing your child the choice between you or a puppet washing her may allow some appropriate control over the situation. A child who is sensitive to scents may enjoy selecting his or her own soap or shower gel to alleviate any sensory difficulties.

Washing out hair washing (and styling) wars
While some children love a bath, they may experience anxiety when participating in washing their hair. To make shampooing hair more entertaining, keep a small, unbreakable hand mirror nearby and so he can watch you form funny ears or animals out of the his hair and suds to play a guessing game.

Many children dislike water and/or shampoo in their face or eyes, if so, you can have him use a washcloth to wipe away water or to even cover his face. Invest in a waterproof bath or sun visor, or goggles if that method does not work. If you need to choose between a speedy hairwashing session or none at all, opt for thinner shampoo, mix in water to make shampoo thinner, or use less shampoo to decrease the time needed to rinse hair.

If your child does not like to lean backwards to have her hair rinsed, here are some different options to try. Make hair rinsing a game with different cups, watering cans, and squirt toys that you, your child, or a puppet can use to pour over or squirt the child’s head while he is sitting up with his head tilted back to rinse out shampoo.

Try relating it to swimming lessons if the child enjoyed them—can she do the back float, or bend forward to rinse somewhat? Distract your child by putting stickers, pictures, or some kind of mobile up in the tub for him to examine while you are rinsing hair. Also, you could give your child a hand-held shower sprayer to rinse her hair, that way she has some control. If necessary, you could use the kitchen spray nozzle to rinse your child’s hair while he lays on the kitchen counter with his head over the kitchen sink. This provides support while he is leaning back, and reduces the risk of water and shampoo getting in his eyes. As always, try to reward the child with some playtime with tub toys or a reward system (i.e., a chart to earn something) for a positive session.

To ease the process of styling your child’s hair, try to use conditioner after shampooing, and spray detangler on knotted places. Naturally, shorter styles are easier to wash, style, and maintain. If the child does not like having her hair combed or brushed due to tangles, try to hold hair taut near the base of the head so that pulling with the comb or brush will not hurt as much. Also, to save some time and detangling in the morning, braid or put her hair up the night before.

As a distraction, provide your child with a doll with hair to comb and style, turn on the music or a video, or style hair while he or she is busy eating. To give him some control over his hairstyle and to increase tolerance, allow him to comb or brush it (with you completing the final combing and styling depending on the child’s skill level), along with picking out hair accessories or hats.

Seeking professional assistance
If your child has significant difficulties with the sensory experiences associated with baths, haircuts, standing in line or sitting still, he or she may benefit from a physician’s referral for an occupational therapy evaluation. A pediatric occupational therapist working in an outpatient center can determine if your child could benefit from skilled services and sensory strategies recommended for home use.

While this article offers suggestions that families of children with special needs may find helpful, the child may benefit from occupational therapy services to offer specific exercises to build motor coordination, incorporate sensory strategies, or develop adapted methods for completing bathing and grooming activities.

© 2009 Janna Barrick, M.S.,OTR/L

Janna Barrick is an occupational therapist specializing in Pediatrics for Tx:Team partnered with Frederick Memorial Hospital's outpatient clinics located in Frederick, Maryland. JBarrick@fmh.org.

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