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Hygiene Routines and SEND

This post outlines the questions and suggested strategies from the #SENexchange discussion on Life Skills: Health and Hygiene routines. You can download a PDF of the collated discussion below. Please share if you think this will help someone.

What barriers do people with Sensory Processing differences face with common hygiene routines?

Update: check out this visual for discussing the Coronavirus and keeping clean


Coronavirus  Sen  symbol  advice

These suggestions come from a range of sources (all credited at the bottom of this post. People experience different environments through sensory stimuli. Many people have sensitivities to specific stimuli and this can be a huge barrier to accessing specific hygiene related environments. In a previous post, we talked about having a sensory first aid kit. This can be useful for overcoming specific barriers and supporting people to access shared environments where you may not be able to control the stimuli. Eg public toilets. Many of the autistic children and young people I have worked with have developed negative associative memories around bathrooms in general.

washing your hands hygiene and SEND children coronavirus

Our approach to teaching health and hygiene routines is an important life skill. It can set up children for a lifetime of stress. Pressure and demanding compliance are not effective in supporting children to develop effective embedded health and hygiene routines. An issue for some autistic children/adults is a difficulty with understanding the function of personal hygiene. Things that may bother one person may not impact them the same way therefore why should they have the same focus on hygiene? It may not easily motivate children and they may feel that it interrupts a preferred activity or routine (Flow state). It can also be hard for them to perceive how others react and therefore explicit teaching can help, especially if the person enjoys the company of others. 

Common Sensory Issues around Hygiene Routines.

  • The noise of hand dryers
  • Echoes in tiled rooms
  • Temperature of seat 
  • Smell of the toilet
  • Smell of toiletries
  • Toilet flushing
  • Water in the pipes
  • Flavour of toothpaste
  • Foaming of toothpaste
  • Tactile sensitivity to the feel of water, soap.

Some Suggested Strategies.

  • Powdered soap can be good for children who don’t like the wet feel of liquid soap or bar soap.
  • Fill the sink with lots of soap liquid and encourage the child to wash their hands in the water.
  • Headphones to minimise noise.
  • Desensitisation by conducting short visits initially
  • Build familiarity with the products through sensory play.
  • At start reduce the frequency/duration of routines i.e two passes with tangle teaser rather than full hair brushing.
  • Take favoured/own toiletries.
  • Water only teeth brushing to start
  • Small amount of toothpaste smeared into bristles rather than on top.
  • Shampoo on dry hair use water only for rinse
Paw patrol  octonauts autism bath time routine

What strategies can we use to support those who find cleaning their teeth aversive?

For some children, the brush bristles are the issue and a softer toothbrush can help if the bristles are too uncomfortable. This toothbrush is for those able to chew rather than brush their teeth. https://amzn.to/2W4vdXn. Having a toolbox of toothbrushes available may be useful. Suggestions include trying:

  • Electric brushes
  • Three-sided brushes
  • Silicone finger brushes
  • Musical brushes
  • Light up toothbrushes.

The problem with toothpaste

Toothpaste itself is a real barrier. Try finding mild flavoured toothpaste or non-foaming toothpaste I.e. OraNurse. There are now ranges of fruit flavoured toothpaste. Brushing teeth in front of a mirror so the child can see what is happening, spit out more frequently. One contributor used children’s toothpaste (even though the dentist told them not to) because the flavour is not as strong and they even have strawberry. We just made sure the fluoride content was similar to adult toothpaste

Gamification of brushing teeth.

Apps that countdown 2 mins with distractions to take their mind off it and they can see it will be over soon. Before technology, I used to sing the same song to them whilst brushing which had the same purpose. Advice from occupational therapists is to give as much control as poss, use a mirror – for body awareness & to make it a game & relaxed. We had a teeth brushing song & played your turn, my turn. Only short turns to start with & trialled lots of flavoured toothpaste. No quick fix!

What strategies can we use to support those who find washing/brushing/cutting hair aversive?

This is a fantastic idea – A hair washing jug that prevents water on the face!

A child with anxiety around health and hygiene routines may need more frequent trips to the hairdresser for quick trims. This reduces the duration & discomfort is reduced. A fidget resource or deep pressure could help provide calming proprioceptive input. A visual schedule might break down the haircut into small predictable steps. Loads of distraction & a really good protective cape that keeps small hairs off skin as much as possible. Plus, be as quick as you can. My son uses a sunsuit from the beach which keeps the hair off him. He will not tolerate a cape.

Where the haircut happens can be key. Start by cutting hair in a comfortable environment for the child eg sensory room, bedroom. Even try in the garden listening to music. Support child to build a relationship with hairdresser first before going anywhere near their hair.

My daughter had short hair until she was 11 due to hair brushing and styling aversion. It was her choice as she hated having her hair tied back for school. Dry shampoo can be effective to cut down the number of full washes needed. OT interventions for hair washing include deep pressure to the head when their hair is being washed.

To support those reluctant to have a hair cut these strategies may help.

  • 1. Familiar adult cutting hair
  • 2. Scissors rather than noisy clippers
  • 3. Distract with favourite video
  • 4. Timer to outline the duration of hair cut.
  • 5. Start with a quick trim

What strategies can we use to support those who Showers/Baths Aversive?

It’s only when we think about it that there are so many variables around taking a bath that can have such an impact on our children. In my experience from chatting to parents, the challenge more often than not was how to get the child out of the bath!!  I found the water temperature was key and running before the child entered the room (noise).

Experiment with water temperature. Some may need the bath pre-filled if they are sensitive to the sound of the water running. Try unscented soaps or gels and minimise odours in the bathroom. I often see children who cope better with baths rather than showers as they don’t like water running down their face. Mine was utterly terrified of showers, so it was baths for the first 10 years. She has got better with age and will shower now. Still manages to flood the bathroom because she has to open the shower cubicle every 2 minutes to dry her face on a towel! 

Water temperature for many children is often an issue especially if they are sensitive to heat so run the water temperature to child’s preferences

Suggested free health and hygiene resources

Another resource from @CherryGdnSchool site: Washing hands routine

Break it down into sequential steps using visuals or photos. Use a visual timer for showering or shaving, so that they know when it will come to an end. Consider a social story about how hand washing removes germs and how this helps us and others stay healthy

This timetable in the bathroom from @CherryGdnSchool is used to break the process of brushing teeth into small steps to aid understanding. Check out the free resource here.

We found these from @ccsmobility great for children with physical needs

The Middletown Centre for Autism @autismcentre has an excellent online resource devoted to practical strategies for developing life skills. Here’s the page on personal hygiene

Check this website out for waterless shampoo and waterless body wash https://www.dignitylcservices.co.uk/ 

Widgit Health have a great range of free symbol supported health and hygiene resources. https://widgit-health.com/downloads/for-professionals.htm

Thanks to our SEND Specialist Collaborators.

@equals_co_uk @SMSAteaching @EPInsight @penorjen @MapsCherry @Claire_R123 @SusanGriffiths5 @SENexchange

SEND Autism Health routines washing hands virus

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