Deciding when to start toilet training can be a concern for parents. Getting the environment right can help a child be ready for the task. Before you begin, helpful habits to try and form could include:
• Ensure the child has the general ability to remain seated for even a few minutes.
• Aim towards sitting on the toilet without a nappy but make this a gradual change if needed.
• Often children who do not pick up on cues or are socially unaware may not be as curious to follow you into the toilet. You need to deliberately take them (so they can see how you use the toilet).
• Try to keep good eating, drinking and exercise habits as this will make passing fluids and stools easier.
• Have the child sit on the toilet before or after a bath as part of a normal night time routine.
• Introduce sitting on the toilet after meals/snacks.
• Always change the child’s nappy in the bathroom if s/he is mobile and able to stand. If space permits introduce nappy changing in the bathroom.
• Always have the child stand to take off lower garments and nappy then sit him on the toilet if s/he is mobile.
• Always flush stools down the toilet and let the child see where it goes!
• Decide and stick to a set word for stools and urine (e.g., poo and pee).
• Introduce ‘the concept of “wet and dry” in other daily routines so the child knows what each feels like e.g., wet when washing in the bath, dry when towel dried after bath etc.
• For some children the concept of using a potty can confuse them about the skill of going to the toilet. It may be better to sit them on the toilet from the beginning with an insert and footstool.
Families can find that having a child who experiences eating and drinking difficulties can cause mealtimes to become a stressful, difficult time. A child who does not read signals well can struggle to understand when it is time to eat or how long meal times will last. Perhaps they prefer not to sit and eat but be on the go and graze. However, having good family meal times and eating habits can help set the way for the future. Relaxing family meal times are preferable and something for all the family to enjoy.
A few things to try include:
• Lead by example – eating regularly together with a wide and varied range of foods.
• Limit snack food before meals.
• Make sure you prioritise time and plan meal times.
• Introduce new food regularly.
• Try different foods on holidays or special events but have some routines the same.
• Make sure the child is active throughout the day so they are hungry.
• Try being creative with design of disliked food.
• Try a choice between two foods (this is to give the child a level of control).
• Treats are best kept for special occasions so they don’t take over!
• Try involving the child in preparing the meal.
• Try a visual menu plan.
• Try a visual schedule (use a timer to indicate how long to stay at table).
• Don’t ask the child to sit up at the table until it’s time to eat.
• Sit with them so they are not distracted by you being ‘busy’ in the kitchen.
• Is the child too hungry and may be annoyed, angry or irritated to eat?
• Is meal time rushed because of what is happening next?
• Has there been a positive closure to the last activity or is the child still upset at leaving a game, TV. etc?
• As a family, could you have meal times together?
• Set rules e.g., no TV. no mobiles etc during a family meal.
Some ideas to help support your child with this include:
• How the child is sitting has a huge impact on how able they are to self-feed. Make sure their feet are on the floor or a footstool so their legs are not dangling (if feeling wobbly or unstable it can be hard to concentrate).
• Try bigger handled cutlery.
• Try a non-slip mat.
• Let the child choose the cup s/he wants to drink from.
• Try using a straw or cup with straw attached.
• Try a slightly thicker liquid to give a different texture.
• Try making sure the child can see (clear cup) what they are drinking.
• Check what kind of handle may be helpful.
• If a spout is needed check what type is helpful.
• Once a child can drink from a cup try to phase out the use of a bottle.
• Decide when cutlery is appropriate and when it’s not (e.g. ok not to use cutlery for some fast food/not ok to finger feed at gran’s house?)
• Prior to expecting self-feeding – give your child a spoon to play with while you are feeding them.
• Let the child dip the spoon into food and explore tastes even when you are feeding them. Don’t fuss over any mess.
• Load the child’s spoon for them so they only have to get the spoon to their mouth. If this is tricky – let them still try – with your hand over theirs.
• When the child looks ready, let them try at the beginning of the meal (when they are hungry) then you assist or include finger foods and the child will have a feeling of success.
• Where possible don’t make ‘separate food’ for the child or get into that habit.
• Give lots of praise and feedback
If the child is interested in pretend play here are games that can help with feeding:
• Unscrewing lids of jars with a toy inside.
• Stacking cups – putting cups in a specific place.
• Imitation games with dolly/teddy and spoon.
• Using scoops/spades in a sandpit.
• Playing with playdoh – rolling into a snake then cut into baby snakes.
• Using spoon to scoop food from one bowl to another.
• Playing games where the child has to pinpoint his mouth e.g. close your eyes and find your eyes/nose/mouth
• Playing with peg boards.
• Using a small jug in the bath – pouring slowly into another jug.
• Picking up and placing raisins/Cheerios/Sugar Puffs on a plate.
• Using tongs to pick up and place big soft blocks
Giving your child opportunities to be around other children can support them to learn various skills such as early turn taking and sharing, as well as supporting communication.
Ideas to support with this include:
• Introduce a familiar child into your child’s safe space e.g., your home, garden etc.
• Use the local offer to find SEND sessions in the local area. https://www.trafforddirectory.co.uk/kb5/trafford/fsd/localoffer.page?newlocalofferchannel=1
• Do a familiar walk with another child
• Go to a local park for a short period of time, perhaps choosing a quieter period e.g., early evening or early morning.
Walking – Supporting your child to walk early on is important for their independence and their health. Walking around with a child is often a stress. Buggies for very young children can be very helpful but it is important to remember that the aim is ultimately to enable the child to walk with you independently, to learn to walk and not be in a buggy. Children need positive experiences of walking. Ideas to try if your child struggles to walk:
• Try providing deep pressure on the bottom of the feet, before a big walk. Seat the child firmly on your lap facing a wall. Place the child’s feet flat against the wall and put pressure directly through the knees into the feet. Have the child help push (this helps them to know where their feet are and may make walking easier).
• Have clear times when you go for a walk, create a routine.
• Try a specific length of time, finish with a liked activity i.e., see ducks in pond.
• Try to gradually build up the length of time you walk.
• You will have set routes for certain activities but try and change these to show other routes/possibilities.
• If you can walk rather than take the car, try to do this with the child.
• Walk the child as often as you can in quiet times when you are not in a hurry.
• Set times for a walk when you have no need to buy anything.
• When using the buggy get the child to push the buggy.
• Give a clear purpose for the trip.
• Use pictures to draw out what is happening and when (sequence the trip).
• Get the child to walk the first part then use the buggy when they are tired.
• Try not to get into the habit of carrying the child if they are tired. Try motivating them with a small positive experience when you arrive.
• Think about when you can withdraw the buggy, rather than relying on it indefinitely.
• Plan a time to stop using the buggy (e.g., starting school, new term etc)
Modern living means we travel frequently and go to lots of different places away from the family home. Home is familiar. Travelling to an activity is as important as the activity itself. Sometimes children will read the journey wrongly if they go a certain way or pass a familiar place they usually stop at (but don’t on one occasion). This can cause alarm for some children and may then lead to behaviour that can be difficult to manage while travelling. Ultimately, we want to build skills that eventually allow children to travel independently or without parental support. To achieve this, try to let the child to experience as many forms of transport as possible as part of normal family life. Children can struggle with many aspects of being in a car e.g., restrictions of the seatbelt or car seat, not knowing where they are going, expecting to go somewhere just because the car turned a certain way. Providing lots of information can help reduce anxiety. Giving some information in a visual form (pictures or objects) can help. Use visual cues more than verbal cues as they give the child a reference.
Ideas to try in a car:
• Make a list of things to look out for.
• Use DVD, CD etc.
• Use a small reward fidget toy attached to car seat when playing counting games (e.g. count 10 trucks).
• Long journeys need frequent breaks (mark the stops on a journey planner, let the child tick off stops).
• Choose a bag of toys for the car. Have a small car-toy box that stays in the car.
• Have a clear map of places to visit.
• Always be consistent in car safety.
• Stop the car if the child takes the seatbelt off and build up clear guidelines (visual rules might help). • Always tell the child where s/he is going.
• Use visual pictures of the journey if necessary.
• Change the route to the same destination, if possible, to show there are other routes to the same place (so the child does not think by going a set route s/he is always going to the same place).
• Have clear objects for set places i.e., get a swim bag for swimming or a specific bag to take to grans.
• If you have a sat-nav and know where you are going – have it near the child for them to watch and know where they are.
Ideas for Public Transport – Many children are not exposed to bus journeys. Ultimately, independent travel is an issue that might not always be considered but should not be forgotten. Skills are only acquired through exposure and practice. Before a child learns to use public transport independently, they need to experience safely using a variety of different types of transport.
• Make sure the child has the opportunity to use the bus.
• Allow the child the opportunity to pay the driver and collect the ticket.
• Prompt the child before correct stop – allow him to press the bell.
• Practise negotiating getting on/off the bus and walking up/down moving bus if appropriate.
• Count the stops on a regular bus journey.
• Explore your local area so you know which buses go to the routes important to your family.
• Find out which bus/train takes you where you need to go.
• Get to the bus stop 5 minutes early.
• Check you are standing at the correct bus stop.
• When the bus is approaching – let the driver know you want the bus to stop – signal by stretching out arm. Ensure the child stays on the pavement to “hail and ride”.
• If the child is anxious, give him something to chew when on the bus (bagel, chewy sweets, chewy tubes)
• Try a visual schedule of a specific bus journey.
• Have pictures of places to look for when on the bus.
• Look for bus stops when you are out and about.
• Notice different types of buses (try picture spotting).
Places to visit. Noisy, busy places can be challenging. Ideas to try:
• Whenever possible, consider additional planning for special events such as firework displays, birthday parties, football matches- – Is there a quick exit route if the child becomes stressed? – Is there a special toy/routine that can be used to calm the child?
• Consider when to carry out everyday activities. Is there a less busy supermarket, or off-peak time? Is there a quiet space available e.g., dining booth?
• Consider having the child wear earplugs.
• Consider using a music player with headphones, allowing the child to listen to favourite songs/music. This may help to drown out environmental noises and help the child stay focused on an activity.
• Consider giving the child something to chew/suck on – it may help calm them down.
Going to shops is part of modern life. Often children do not like or enjoy it. To reduce stress, many parents do not take the child shopping if they do not like it. Planning shopping, preparing for the activity and limiting the amount of time at shops might help the child prepare to build skills in this area. Think “Where”, “Why”, “How”, “When”. Always think how long, what time it will take and what experience the child will be exposed to and what is realistic.
• When walking round shops, introduce it at a quiet time. Have set things to get (to give the child a purpose).
• In the supermarket have one item per aisle to collect. If it is one you go to regularly, let the child find the item and put it in the basket/trolley. Have a clear routine that can be described, or use pictures of your route.
• Have a clear timescale – e.g., we are going on a 10-minute walk round the pond.
•Consider taking a toy along in your/their pocket.
• Think about where you initially park the car – park as close to where you are going as you can so the child does not have as far to walk.
• Using a limited specific shopping list the child can tick off or use visual cards for.
• Having a set plan of shops with a final shop which the child likes.
• Having one item the child has a picture of to collect on each aisle.
• Limiting shopping trips to quieter times.
• Having a clear plan of what is happening and when it will end.
Going to the park is a common trip for most families. It can be very challenging if the child struggles to understand the setting and what it is for.
• Try and use play parks with boundary fences.
• Try showing a picture of a park before you leave the house to clarify where you are going.
• In wide open spaces (when child can run away) have a plan ready.
Swimming pools can be both an enjoyable and a stressful family activity. Planning for a calmer experience can be worthwhile. Ideas to try:
• Think about the noise, glare, smell, texture, temperature – often sensations in a pool can be off putting (Will this distress the child? What do they find calming – take that with you?).
• Consider dressing routine needed.
• Don’t let the child take off their swimwear in a common area (keep rules to take into adulthood)
• Have set routine e.g., getting undressed, swim, shower, dress, then café. Build up confidence at quieter times first.
• Use a visual timetable.
Making choices is vital to helping your child communicate. Giving choices allows them the opportunity to communicate their preferences. Ideas to try:
• Place items out of reach to encourage reaching/pointing
• Put treats out of reach so they need to take you to the cupboard then you can offer 2 choices for them to choose
• Ensure that items are not always readily accessible
• Offer a choice of 2 jumpers or t-shirts for them to choose their favourite.
• Offer a choice of 2 places to go e.g. walk or park
Being able to dress independently is an important milestone but it takes lots of practice/experience/play to get there.
Ideas to try:
• Break dressing down into smaller steps.
• Try doing most of the task and letting the child get the success of the final part. When children finish something, they can feel they did it all.
• Try getting them to put on loose pyjamas first to feel sense of achievement.
• Try laying clothes out and always stick to a specific order.
• Try checking if specific textures are worth avoiding or if labels are annoying the child (if socks seams are annoying – wear inside out).
• Practise putting on/taking off dressing up clothes.
• Practise pulling clothes over their head.
• If the child likes clothes off in the house try tighter fitting undergarments.
• If the child prefers clothes off in the house limit it to their own bedroom with clothes on in all other areas.
• Give short, simple instructions. Give a cue for one garment of clothing at a time.
• Think about the time you want to practise (bed time/bath time are good times to practise – when you are not rushing out to school/work).
• It’s easier to get undressed than dressed.
• It’s easier to put PJs/nightdress on than clothes.
• Its best to practise in the bathroom/bedroom.
• If the child has not got great balance, you may find sitting on the floor or leaning against the wall will help.
• If you are helping your child, verbally tell them what you are doing, “OK, put one leg in your trousers, other leg in now.”
• If your child likes to watch themselves, it can be fun for them to see themselves in the mirror being a “big boy or girl”.
• Think about the clothes you practise with (start with elastic waists, v-necks, stretchy cotton, raglan sleeves).
• If there is no label, mark the back of the garments with a sticker/ribbon so that the child can pick out the front and back.
• With tops, get your child to put it on the ground FACE DOWN before putting on.
• With pants/trousers get your child to put them on the ground FACE UP. If buttons are tricky think about replacing the thread with elastic thread so it can be stretched if the child needs to pull the button to see it.
• Try not to let the child get into the habit of undressing and staying undressed when at home. This can be difficult to break later (sometimes the child has a sensitivity to clothes and prefers them off but it’s not a good habit to get into).
• Learning to dress independently has lots of stages. Being encouraged to actively join in dressing/undressing can be introduced a long time before you expect the child to be independent.
If the child is interested in pretend play here are games that help the skills needed to progress dressing:
• Start with easy pull on/pull off capes. Introduce hats/scarves/BIG BOOTS. Think about Velcro fastening (first at front then at back). Use oversized buttons Finally, try zips/buttons/poppers.
• Play with a hula hoop – step in – step out – pull up/pull down. Add fabric to hula hoop so the child feels cloth against skin when he lifts it up/down and over/off his head.
• Play “find your tail” – tuck a toy into the child’s waistband – let them find and pull it out.
• Practise posting games (similar skills needed for buttons)-coins into bank, letters into post box – Make a “post box” out of an old shoe box – let the child “post” a coin then find it at the other side (like buttons).
• Don’t always buy Velcro shoes or trainers. Consider teaching the child to tie laces before they have to (when feet too big for Velcro shoes).
• Play with magnetic toys – put together then pull apart.
• Pull-apart toys – pop beads, lego, duplo.
• Practise undoing fastenings first on a dressing doll only and give lots of praise.
• Don’t try “dressing” until the child managed undressing.
• Play games that “name” part of the body so that the child knows where you mean e.g. Simon Says. • Do this also in bath when washing
• Grab as you go – “… here are your trousers…..where do they go…..on your legs….where are your legs. That’s it.” Tap the child’s legs to make them aware where they are before they start.
• Play Peek-a-Boo – let the child lift up towel/sheet to hide behind/under – let them pull it off.
• Jack-in-the-box toy where the child holds with one hand and turns handle with the other.
• Songs that encourage specific movements e.g. “Wheels On The Bus”: “Doors go Open And Shut “Wipers go Swash/Swish” “Children go Up/Down”” “Wheels go Round And Round”
My child has been given the opportunity to bath or shower
Questions to think about:
• Does the child prefer a bath or a shower?
• Are they better with a morning or evening bath routine?
• Do they have a preference of types of cloth, soap, towels?
• Is dressing/undressing a factor if they are distressed while bathing?
Suggestions
• Make it clear if the bath is to include hair washing or not (some children dislike hair washing). It’s useful for them to know when their hair is not being washed. Have a regular day for hair washing.
• Let the child wear swim goggles if they are scared of getting shampoo in their eyes or give them a soft cloth to hold against their eyes/face.
• Use a jug to rinse shampoo out of hair if the child is fearful of lying back/tipping their head.
• Always have a bathing routine and stick to it.
• Give choices of toys in the bath to help choice-making be part of the experience.
• Let the child help to wash her/himself.
• Sing a bathing song e.g. “This is the way we wash our arms” (e.g., to tune of Mulberry Bush).
• Have a set time in the bath routine when you will do the “cleaning bit” i.e., washing hair at the beginning or middle or before a liked game.
• Count a less-liked activity e.g., shampoo on hair will take a count to 10 so that it’s time limited.
• Try to give a wide experience of using the bath and shower- in different places such as on holiday, at the swimming pool or at grans. However, try to stick to the same routine to give familiarity e.g., favourite game, count while washing hair.
• Use soap/foam that covers the body part as you wash it e.g., shower foam then the child can see what is washed.
• Use a washing “mitt” so that holding a cloth isn’t a problem.
• Try different types of shower head.
• Try different temperatures of water.
• Try a seat in the shower if they seem unstable.
• Try a favourite item before and after the bath as part of the routine.
• Try different smells in the bath i.e., lavender, bath salts with a preferred smell.
• If dressing/undressing is an issue try wrapping the child in a towel when removing clothes and wrapping them quickly again after their bath.
Lack of sleep does not help any member of the family. Learning to go to (and stay) asleep is often something to work towards. Your child may settle better beside you, however this isn’t a long-term solution. The longer you have this routine the harder it may be to change. Children may not pick up what is expected at bed time and through the night. They may have less need for sleep or may have difficulty sleeping (this could be part of their other difficulties and may be a great challenge). Children (and their parents) need sleep to function!
Strategies –
• Always have a bed time routine which finishes with a quick final quiet activity.
• Build up the child’s ability to self-occupy quietly as part of the night routine i.e., looking at a book or listening to a CD story.
• Screens and lots of visual information are stimulating. If you want the child to sleep, limit this before bed.
• In particular, limit interactive screens – this is even more stimulating and can actually affect the child’s ability to go into a deeper sleep.
Sleep can be quite abstract and going to sleep may be difficult to understand. Start early with good habits. A night time routine helps good sleep habits. A typical routine can be:
• Eat a light snack
• Take a bath
• Put on pyjamas
• Brush teeth
• Read a story
• Check room for temperature, light and sound
• Put child in bed
• Say good night, hug and leave child.
• Make bedtime the same time every night.
• Make routine a positive experience but do not include TV or video (this can make falling asleep more difficult).
• Keep the same environmental setting e.g. subdued lighting, just the right temperature.
• Dim the lights as part of story reading time.
• Consider heavy blankets, favourite textures in bedding.
• Encourage the child to fall asleep on his own from as young an age as possible. (This ability to self soothe may be helpful if the child wakes in the night).
• Don’t miss out day time naps if needed as it may make the child over-tired at night.
• Give the child plenty of exercise during the day.
• Check the amount of sleep the child should have for his age and try to stick to it.
• Don’t have a TV in the bedroom at night.
• Make a sleep chart to look at the child’s sleeping pattern and suggest possible solutions.
• If the child gets up at night, give minimal contact, settle her/him then leave as soon as possible. Reassure quietly in a low-key manner.
• Use visual charts to reinforce routine.
• Try not to change child’s nappy during the night unless absolutely necessary (nappies are very absorbent and can last 5 hours +).
• Have a set time before you feel it’s “morning” for your family and continually put the child to bed until that time. Have a clock which indicates when that time has arrived for the child to see visually.
• Use black-out blinds at night in the summer.
• Try a heavy, king size quilt (gives a lot of pressure which can be quite comforting).
• Tuck the child in at night so the blanket is quite tight.
• Consider letting the child use a sleeping bag instead of a quilt.
• Consider where the bed is in the room and where the child is facing when in bed (in case the light from door/window distracts).
• Consider having the bed up against 2 walls like a little den.
• Consider the use of a bed-tent to limit visual distractions in the child’s bedroom.
• Consider ‘swaddling’ the older child with a fleece blanket if they like very firm hugs.
Technology is part of our lives. Computers, TV, phones, games consoles, hand held games are a world more familiar to children than their parents. Early life skills can be affected by unhelpful technology routines. Each family is different but technology can have an impact on behaviour/skills that is not helpful e.g., if the child is engrossed in morning TV, and dressing, eating, toileting routines are affected, then this needs your attention. Regarding technology, setting up good habits can help a child be motivated by the rewards of what needs to happen next. Think about your family’s technology habits: –
• When is the TV on?
• What rooms are computers in?
• Who has a phone, are they put away/on silent at mealtimes – texting etc?
• Are the demands from computer time or games consoles taking over other components needed in family life?
• Are headphones interfering with general family communication?
• Is the child just moving from the TV to the computer and still isolated in individual activities?
Ideas to try :
• Have times when the TV is off (especially when you want the child to focus on something else).
• Have phone-free meals.
• Set times for computer and type of computer activity.
• Look at what technology is in the bedroom and if this is helpful or needs to be timed.
• “Set” liked DVD etc to reward after completing other activities.
• Have a 5-minute countdown to finish off games console, computer time etc. (use kitchen timer, let the child switch off rather than parent if possible)
• Check that routines, if they include TV or computer etc. are timed.
• Use hand held games/phones for waiting time in queues etc.
• Use computer/phone calendars for events and time of events.
• Use alerts on phones to count down to event.
• Use visual timetable for what is happening.
• Use times for stopping or countdown to stop activity. • Decide what is helpful, use “screen” timer for you and your family. Actively build up other activities which the child likes so that there are alternatives to screen time
