|Bathing a child with Cerebral Palsy|
The passages below note the importance of bathtime in several areas: hygiene, intimacy, an opportunity to learn new things and practice what has been established, the exercise of play and creativity and simply an opportunity to feel safe and relaxed. Material aids are also noted below. Specific recommendations are detailed on how to make bathtime a profoundly important part of the day.
“Bathing is an activity that can involve a great deal of lifting and bending over in positions that can be very stressful to the caregiver’s back. Before bathing a young child on a changing table, the caregiver should adjust the level of the table to the level of the caregiver’s mid-abdomen. Children from age 2 to age 10 especially enjoy being bathed in warm water and are usually bathed in a bathtub. There are several different kinds of bathing chairs that provide trunk support for the child who has poor trunk control: an occupational therapist can help you select one that is appropriate for your child.
The main problem in tub bathing for caregivers, however, is lifting the child into the bathtub. Before he reaches about age 10 this may be difficult but can still be managed. After age 10, it becomes more difficult. 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 caregiver’s back. For the child who can stand, use a shower with a hand rail for his to hold on to. This is an excellent way to bathe an older child who can stand.
As the chld approaches puberty and adult height, it is no longer wise to continue to lift her into a bathtub. This is hard on the caregiver’s back and usually is unsafe for the child, because there is an increased risk that the caregiver will slip and droop the child when she is heavier.” (Cerebral Palsy: A Complete Guide for Caregiving: p. 281)
“Above all else, the skin under the cast must not get wet. If your child can walk in the cast and get himself to the bathroom for a sponge bath, let him do it. When you bathe your child, gather all the needed supplies before you begin. Then, if you will be bathing your child in bed: 1. Gather towels, a washcloth, a basin with water, soap, a soap dish, and protective towels or flannel-covered plastic bed protectors for the bed and the cast. Use a bath sheet (a larger towel) to keep your child warm during the bath. 2. Wash the head, ears, and face first, then all exposed skin beginning with the chest and moving to arms, trunk, back, and legs. Wash the genitals and buttocks last. Cover exposed areas with a bath blanket or dry towels. 3. Make sure along the way that you have removed all soap residue and have dried the skin. Be careful not to get soap under the cast, since this may cause itching. Do not sue lotions or creams under the cast or near the edges of the cast.” (Cerebral Palsy: A Complete Guide for Caregiving: p. 321)
“If your child can get to the sink, help him wash his hair over the sink or tub. Protect the cast with plastic to keep it from getting wet. A plastic barber’s or hairdresser’s cape might serve the purpose. If the child must be confined to bed for a bath and hairwashing, you may want to invest in special equipment that is commercially available to allow water from hairwashing to drain off the bed. Check with local department stores of 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 child’s 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. (Cerebral Palsy: A Complete Guide for Caregiving: 322)
“Bathing your child can and should be fun, a special time for both of you. Because bathtime is time-consuming, it is an ideal opportunity to do more than just get your child clean. It is a natural time to work on many of your child’s self-help, motor, language, and cognitive goals in an interesting, different kind of setting.
Just as in bathing any child, the first item on the agenda is safety. For bathtime to be a success, you need to position your child in a way that normalizes his muscle tone as much as possible (see the previous discussion on positioning). You should also try to give your child a sense of security, rather than challenge his sense of balance. Many popularly marketed bath seats 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….Finally, a bath sponge wedge can be used to bathe an infant in both sitting and lying positions. When using most of these positioning devices, you will need to keep the water level low and to pour or swish the water over your child to rinse him.
As your child gets bigger and heavier, you may need to rent or purchase one of the variety of bath chairs and hydraulic lifts available from special equipment suppliers. Some older children enjoy showering in a kneeling or sitting position. A shower sprayer on a long hose is handy for this purpose. 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. Remember that no child, with or without disabilities, should ever be left unattended in a bathtub or shower.
In devising ways to make a bathtime a 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. 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. 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 crazy foam, he may not even notice that he is also getting clean.
The time following a bath can also be very productive. For example, a brisk run with a terry towel can help your child learn to process sensations and can lead to better body awareness. And if your child is ready, pajamas are ideal for beginning to learn self-dressing skills. In any event, the period following bathtime is an excellent time to focus on calming activities such as a back rub, massage, or use of powder or lotion, and on using and understanding language.
For most children with cerebral palsy, bathing in a secure, warm tub is calming, relaxing, and conducive to a successful bedtime. But for some children, bathtime has the opposite effect, stimulating and exciting them. If your child reacts this way, you probably will not want to bathe him immediately before bed- or nap-time. Instead, you may want to schedule baths just before times when you want your child to be awake and alert. (Children with Cerebral Palsy: p. 132 – 134)
“Most children enjoy the experience of being bathed. This is true, however, only if they feel safe. When the child is fairly small and if he has some sitting balance, he will feel safe in a bath-tub as long as someone is close by. If he is the kind of child who sits back on his sacrum and whose upper back is rounded, he will be helped by sitting up on a semi-inflated swimming ring. If one does not help him enough, try two tied together.
Until a child has a good sitting balance, it is helpful for him to have a towel to sit on. This gives him a less slippery surface to balance on.
The child whose sitting balance is not so good will need some support while being bathed. If the mother is doing this alone, she must either hold on to the child with one hand and wash him with the other, or use a special support in which she can place him and know he will be safe
It is important to help the family member who bathes the child to find a good position to be in, so that they can hold the child safely but not damage their own backs. Kneeling on a soft cushion is usually better than stooping over. If kneeling is difficult, sitting on a low stool may be an alternative.” (Children with Cerebral Palsy: p. 156)
*Cleanliness for the Child with Cerebral Palsy: This is an informative booklet on bathing, cleaning and grooming. Available in English Hindi Bengali.
“Self-grooming is often difficult for people with cerebral palsy. The following suggestions may help your child learn to accomplish these everyday tasks…”