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ADLs and Occupational Self-Care

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ADLs are Activities of Daily Living

In this blog post, we are discussing ADLs (Activities of Daily Living) for kids and teens. These occupational self care tasks are tasks that make up day to day living. Let’s break this down. For additional information on various roles, check out our article on IADLs.

Occupational self care refers to many things. Occupational therapy practitioners support individuals with daily activities that are part of a functional life. One of those important daily tasks is personal self-care, or the ability to care for one’s own being. From dressing oneself to toileting, all of these include daily occupational self care tasks.

In this blog post, you’ll find resources and activities to support children of all abilities in self-care skills.

occupational self care

When exploring the topic of occupational self care, you’ll also want to check out our resource on developmental checklist as a tool for understanding typical development of skill acquisition.

ADLs are self-care skills

Self-care skills, also known as Activities of Daily Living (ADLs), are essential tasks that individuals of all ages perform to take care of their own physical, emotional, and mental well-being.

For children, occupational performance in ADLs is dependent on the child’s age and stage. We can take a look at various stages of development with regard to ADL participation. Those stages include:

  • infancy
  • toddlerhood
  • early childhood
  • elementary childhood
  • adolescense
  • adulthood

Each of these stages will involve different components and abilities when it comes to occupational performance and ADL skills. You will see and expect different occupational roles, adaptive behaviors, self-care skills and abilities, and changes in self-management needs.

Infant Self-Care Skills

Infant self-care involves receiving nurturance of parents and guardians. Self-sufficiency involves primitive reflexes and accepting self-care. ADLs in the infancy stage is mainly regarding family participation which is a vital role.

The infant responds to nurturing, and takes nourishment they receive from their parent or caregiver. They are learning to move and communicate. During the infant stage, babies gain control of their body as they learn to move in daily self-care tasks.

Toddler Self-Care Skills

For toddlers, self-care continues to involve acceptance of the self-care routines provided by parents or guardians. However, at this age, there is more independence beginning as well. You’ll see preference and willingness in toddler ADLs.

Toddlers are refining and mastering some of the skills that they have passively participated in during the first 2 years of their life.

They start to develop self-sufficiency in eating, dressing, washing, and toileting areas.

Childhood Self-Care Skills

During the ages of 6-12, children have continued occupational roles as a daughter or son, friend, and now as a student. These new roles with peers bring on additional self-care tasks as well as adaptive behaviors in childhood ADLs.

The self-care skills of a child include continuing to master ADL skills with more self-sufficiency, routine participation (brushing their teeth each morning and evening with greater independence) and less support.

Children develop preferences in expressing themselves in hairstyles and clothing, which impacts self-care. There are also new learning opportunities which impact occupational performance, including social skills and peer interaction.

Refer to our blog post on occupational therapy for middle school for the end range of this stage.

Adolescence and Self-Care

The years between ages 13 and 19 bring on even more development and self-sufficiency during adolescence. They also have more occupational roles such as an employee, a driver on the road, a teammate, volunteer, and may have a different peer group than before.

Self-care, and ALDs in the teen years include mastery or independence of ADLs and IADLs. There is self-expression, building relationships, and defining occupational roles involved in this stage. The adolescence is preparing for independent living, so self-care supports that transition.

Check out our bog post on occupational therapy for teens for more information.

ADLs, Activities of Daily Living

Occupational therapy practitioners are skilled in analyzing, evaluating, and creating detailed plans of care of ADLs at all stages of life.

What are ADLs?

Activities of Daily Living (ADLs) are daily tasks, or activities, that make up a person’s day. They are tasks that are required for participating (or living) in an environment such as a home or workplace. ADLs involve occupational roles or the various roles one plays throughout their day.

These skills are fundamental for daily life and can vary depending on a person’s age and abilities.

Activities of Daily Living Examples

Self-care skills encompass a wide range of activities and typically include:

  • Personal hygiene
  • Bathing or showering: The ability to clean one’s body, including washing hair, face, and body.
  • Oral care: Brushing teeth, flossing, and mouthwash.
  • Hair care: Brushing hair, combing, and washing hair with shampoo and conditioner
  • Grooming- hair care, shaving, hygiene
  • Makeup application
  • Washing face
  • Caring for hair styles including using a ponytail holder, styling hair, etc.
  • Handwashing: Proper handwashing techniques to maintain hygiene.
  • Dressing and clothing management
  • Dressing: Putting on and taking off clothing, including clothing fasteners like buttons and zippers.
  • Selecting appropriate clothing: Choosing weather-appropriate clothing and outfits suitable for different occasions.
  • Putting on and tying shoes or fastening shoes
  • Nutrition and meal preparation
  • Eating independently: Holding utensils to eat, using utensils, drinking from a cup, and managing food.
  • Meal preparation: Basic cooking skills, such as preparing simple meals or snacks.
  • Toileting and Bathroom Skills
  • Using the toilet: Going to the toilet independently, managing clothing, and proper wiping and perineal hygiene skills
  • Toilet training: Learning to use the toilet for children.
  • Mobility and transfers
  • Safety skills in daily tasks
  • Awareness of danger: Recognizing and responding to potential hazards.
  • Emergency procedures: Knowing what to do in emergencies, such as fire drills or safety protocols.
  • Medication management
  • Taking medications: The ability to take prescribed medications independently and follow dosing instructions.
  • Time management and organization to participate in daily tasks
  • Scheduling: Managing daily routines, appointments, and activities.
  • Staying on task: Using calendars, reminders, or tools to stay organized.
  • Transferring or mobility in daily tasks, like moving from one surface to another, sitting and standing from the toilet, getting into and out of a car, moving in and out of the shower or bathtub, getting into and out of bed, sitting and standing from various surfaces and seats. All of these are considered functional mobility in ADLs.

Self-care skills are crucial for promoting independence, maintaining health, and participating in daily life. These skills are typically learned and developed throughout childhood and adolescence, and they may need to be adapted or supported as individuals age or face physical or cognitive challenges.

Occupational Self-Care

Occupational therapy professionals often work with individuals to enhance or regain occupational self-care skills as part of rehabilitation or therapeutic interventions.

Personal care tasks are part of life.  As children grow, they tend to want to “do it myself!” Sometimes however, children grow and tend to continue to require continued support to perform self-care functional tasks.  Parents, caregivers, and support staff can use varying degrees of verbal and visual cues to encourage independence in personal care tasks, but sometimes it’s just not enough.  
 
Be sure to check out our resource on toddler behavior red flags for more information on participating in daily activities at the toddler age.
 
This month in the Functional Skills for Kids series, 10 Occupational Therapist and Physical Therapist bloggers have come together to analyze and dissect personal care skills.  Take a look through the links below to find tricks, tips, developmental milestones, and creative ways to encourage independence in personal care tasks.  
 
These therapist-approved strategies are perfect for typically developing children and those with special needs.  
 
Tips and tricks for helping kids learn to take care of their own personal care skills. These self care skills are helpful for special needs children and kids who are typically developing, part of the Functional Skills for Kids series from Occupational Therapist and Physical Therapist bloggers.

 

 

How to Help Kids Learn Self Care and Personal Care Skills:

 
 
 
 
 
 
 
 

Adolescent Hygiene Challenges  | Therapy Fun Zone



Tips and tricks for helping kids learn to take care of their own personal care skills. These self care skills are helpful for special needs children and kids who are typically developing, part of the Functional Skills for Kids series from Occupational Therapist and Physical Therapist bloggers.

 

 

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

Teach Kids How to Blow Their Nose

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Teach kids to blow their nose

Want to know how to teach kids to blow their nose so kids can blow their stuffy noses on their own? Many times, we see kiddos with booger-y, runny noses that don’t know how to blow their nose. They might not know how to blow their nose or even how to hold a tissue. Blowing a nose is a functional skill that occupational therapists may see come up in the classroom or at home. Read on for nose blowing tips for kids from an occupational therapist will help kids blow their nose with ease!

Teaching preschoolers to blow their nose is one of the practical life activities for preschool that impact not only functional performance, but learning, too. A stuffed nose effects hearing and auditory processing, which in turn can impact how letter sounds are perceived, verbal directions are heard, and even safety considerations.

How to Blow Your Nose

This time of year, kids get sick.  Sometimes it seems like there are more visits to the pediatrician’s office than there is to the grocery store.  With children back into the routine of school, there are more opportunities for kids to come into contact with germs from friends and teachers.  As parents, one thing we know a lot about is runny noses.  When our babies are born, it is usually not long before a runny nose has us and the sweet little baby up at night with the stuffy, congested breathing.  When kids start to progress in their self care, they can start to become more independent with the task of blowing their own nose.  

Blowing your nose includes steps that can be hard for kids to master:

  • Knowing that their nose is stuffy or full (interoception, or an awareness of the body)
  • Knowing to blow boogers instead of sniffing them up into the nose (interoception)
  • Holding a tissue at the nose without crumbling it (fine motor skills)
  • Blowing air through the nose and not the mouth (oral motor skills)
  • Pressing on one nostril and then the other (fine motor skills, interoception)
  • Knowing that all of the mucus or boogers are gone from the nose (interoception)
  • Handling a messy tissue without spreading germs (fine motor skills and tactile sensory skills)
  • Throwing away a tissue and washing hands (executive functioning skills, problem solving, sensory processing, fine motor skills)

And completing all of these tasks WHILE engaging in learning, social events, or performing other tasks. What a challenge for some of the kids we serve!

How can these steps of nose blowing be mastered by kids who struggle with fine motor skills, sensory processing concerns (including tactile or interoception issues), and executive functioning skills?


Tips to teach kids to blow their nose

Today, I’m sharing tips and tricks to help kids learn how to blow their own nose and to develop their ability to perform this portion of personal hygiene and functional skill ability. These are practical tips to teach kids that blowing the nose, wiping runny noses, washing hands when done, and how to use a tissue to blow a nose are all important aspects to take care of your nose.

For the younger children, you might think it is easier to just wipe a runny nose rather than allowing the young child to attempt nose blowing. You might even have the thought, “does blowing your nose help?” cross your mind. But, yes, it is very important to teach kids to blow their nose. And,

This is a great resource to add to a Montessori nose blowing lesson, because of the practical life skills that are addressed through nose blowing activities.

Teaching kids to blow their own nose can be tricky.  Children who are typically developing find blowing their own nose to be difficult and children with special needs may have an especially troubling time with independent nose blowing.


There are important parts of the development of the child to consider when it comes to nose blowing.  Knowing what a child typically should be able to do in this personal care task can help parents determine if teaching nose blowing is feasible at different ages.  Other kids with sensory, fine motor, cognitive, or other struggles will fit into this developmental breakdown differently.  You can read more on these areas concerns below.

Tips to teach kids how to blow their own nose. This is great for typically developing kids and special needs kids.

Nose Blowing Development

While the runny noses that impact newborns seem to happen right away, as children age, you may wonder “When Can Kids Blow Their Nose?” There is much to think about in the nose blowing process…considerations such as body awareness, social awareness, grasping the tissue, and the actual nose blowing process.

Blowing a nose doesn’t come naturally. It’s a skill that needs to be taught. Parents that watch their little ones struggle with boogery, wet, runny noses often wonder when their child is old enough to blow their own nose. In fact, there are milestones that go along with this functional skill.

These are typical age ranges for the breakdown of skills needed for independence in nose care:


Age 1 –  The child allows his or her nose to be wiped.
Age 1.5– Attempts to wipe nose without actually completing the task
Age 2- Wipes nose when asked
Age 2.5-3.5- Wipes nose without request
Age 2.5-3.5- Blows nose with request



It’s important to note that kids don’t always follow these developmental milestones and that every child is different.  They typically developing child may not blow his or her own nose until age 5.  

Just like any skill that a child completes, there are various ranges of development.  In this post, you will find tricks and tips to help kids develop this skill.


For the child with special needs, independent nose blowing may develop more slowly as a result of concerns in other areas.  

How to blow your nose: Fine motor skills needed 

When blowing one’s own nose, there are fine motor components that are necessary.  Eye-hand coordination, bringing the hands to midline, vision-obstructed motor control, pincer grasp, and pinch grip strength are necessary for managing a tissue. To address these needs, try building the skills needed for each area.

Here are strategies to build fine motor skills.

How to blow your nose: Sensory Skills needed

For a child, the process of blowing his or her own nose can be quite distressing.  

Children with olfactory sensitivities may breathe primarily through their mouth, making the act of nose blowing difficult.  A sensitivity to scents can cause an overreaction to the tissue that needs to be held near the nose.  

To accommodate for these sensitivities, try using unscented tissues.  Attempting the nose-breathing activities listed below can help.

There are tactile and olfactory sensory skills involved with nose blowing and managing a tissue, but also interoceptive skills.

Interoception is a sensory processing ability that tells us how our body feels and impacts functioning skills. This skills allows kids to understand and feel what’s going on inside their body. When a child struggles with the interoceptive sense, they may have trouble knowing when their nose is full, running, or stuffed. They may not realize they have a booger on their face or when they need to blow their nose. Interoception allows us to know when we are finished blowing our nose and when a child’s  nose is empty or they’ve finished blowing.

Here is more information on sensory processing.


How to blow your nose: Cognitive skills needed

For young children, the process of completing each step of nose blowing can be a difficult process. Children need to maintain lip closure while breathing through their nose, one nostril at a time.  

This multi-process task can be difficult for older children who demonstrate difficulty with cognition.  To address these problem areas, try using a social story for the steps of nose blowing.  A social story can also help children identify the appropriate time for attempting to blow their nose.

Executive functioning skills play a part in teaching kids to blow their own nose. The problem solving needed to identify when a stuffy nose impacts functioning is just one concern. Here are more ways that executive functioning impacts nose blowing:

  • Initiation
  • Planning
  • Prioritization
  • Attention
  • Impulse Control
  • Working Memory
  • Cognitive Flexibility
  • Foresight

If a child has a runny nose when in the classroom, they need to plan out how to get a tissue.

They need the foresight to know that if they don’t blow their nose, they will have a messy nose, runny boogers, or get an ear infection from sniffing too much.

They need to prioritize how to stop writing or reading and how to blow their nose in the middle of the classroom, and then what to do with the used tissue.

They need the impulse control to not sniffle or to throw their tissue in the garbage as opposed to the floor.

They need the working memory and cognitive flexibility to return to the task at hand once they blow their nose.

They need the ability to pay attention to the teacher or their assignment while they blow their nose.

What a lot of executive functioning skills are involved with nose blowing!

How to Blow your nose: Oral motor skills needed

In order to blow the nose, a child needs to maintain lip closure.  This can be a very difficult task for children who exhibit oral motor problems.  Oral motor skills impact feeding and breathing through the nose (as opposed to mouth breathing), but blowing the nose is impacted by oral motor skill development as well.

Here is more information on oral motor skills.

Use these fun tips to teach kids how to blow their nose.


Strategies for helping kids learn to blow their own nose: 



1. First practice nose blowing with the mouth.  

Teach kids bring a tissue to their nose and practice blowing air out of their mouth.  In this way, kids understand that blowing out air can move the tissue.  They can then progress to closing their mouth and blowing air out through their nose. 


2. Teach nose blowing when not sick.

This is an important factor in teaching kids to blow their nose.  Parents typically do not consider nose blowing until there is congestion that interferes with breathing.  

When kids are trying to learn to blow their nose and they are dealing with a runny or blocked nose, it can be overwhelming and frustrating for kids to breathe while holding their mouth shut.  Try practicing nose blowing when the child is feeling well.


3. Teach kids to blow their nose by practicing to blow water.

Teach kids that they can use their nose to blow air through one or both nostrils at a time in order to blow ripples across the surface of water.  Ask them to practice pinching their nose. 


4. Blow a tissue ball to practice blowing a nose.

Tear a small piece of facial tissue and crumble it into a very small ball. Place it on the table surface and ask your child to blow the tissue on the table using their nose.


5. Blow on a mirror to see the fog to practice blowing a nose.  

Ask your child to pinch one nostril closed and to blow air through their nose onto a mirror.


6. Teach the child about the spread of germs.  

Try this children’s book and craft to get started.

7. Teach the child to hold one nostril with a tissue. 

Use your hand to push down on one nostril. Kids can try this skill too, by trying to making the tissue dance with just one side of their nose. Call it a “tissue boogie” and get that tissue dancing by blowing it with the air from one nostril at a time.

8. Teach kids to blow their nose by over-exaggerating.

Over-exaggerate the breathing, closing mouth, and blowing through the nose without a tissue. Sit across from the child and play a game of “Simon Says” to copy the movements to take a deep breath, hold it in, close the mouth, and blow through the nose. You can find functional and practical Simon Says commands on our site.

9. Nose Blowing Social Story.

Try this nose blowing social story to teach kids to blow their own nose.

Tips from an Occupational Therapist to teach kids how to blow their nose.

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

Tips For Potty Training -Occupational Therapy & Physical Therapy

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occupational therapy potty training tips

There are many tips on potty training out there, including many toileting methods, training strategies, and potty training charts. But, what if you could have the occupational therapy potty training strategy? Toileting is an ADL and potty training is part of that. What if you could get the low down on potty training from an occupational therapy or physical therapy professional, that is guided by development, focuses on underlying skills needed to use the bathroom, and addresses the whole child perspective? What if you could ask every developmental question under the sun and get tips for toileting straight from the pediatric OT and PT?

occupational therapy potty training tips

This blog post covers just that! I’ve joined forces with some of the best occupational therapy and physical therapy bloggers to to bring you the best potty training tips.

Occupational therapy Potty Training

When occupational therapists work with children, they focus on the whole perspective. We look at development, environment, and every aspect that contributes to the entire process of toileting:

  • Awareness (sensory, cognition) to know when to go to the bathroom
  • Clothing management (fine motor skills, gross motor skills, visual motor skills, bilateral coordination, crossing midline, coordination skills, executive functioning skills, cognition, sequencing)
  • Motor skills to sit, balance, stand, grasp, wipe, clean
  • Bowel movements and urination (sensory processing including interoception aspect, contributing factors such as sleep, nutrition, sensory integration) Related, read our resource on not sleeping through the night.
  • Pericare
  • Hygiene– washing and drying hands (fine motor skills, gross motor skills, visual motor skills, sensory processing, executive functioning skills, attention and behavior)
  • Parent education
  • Physical adaptations and modifications– adaptive equipment, specialty toilet seats, environmental changes, visual schedule use, etc.
  • Play-based activities to support development of underlying areas that impact each of the above areas

As you can see, occupational therapy professionals focus on the overall development and whole view of the child, the environment, and many other perspectives. This is a wider focus than your typical 3 day potty training method, or a sticker chart!

Potty Training Tips

Toilet training tips can look like a checklist of tasks to complete. But, when you consider all of the aspects of development that play into the process of toileting, there is much more than just a list of potty training tips to accomplish.

Potty training is an important rite of passage for children. For most individuals, they use the toilet each day without a single thought. And it is possible for the toddler or preschooler to get to that stage. Children of all ages, including older kids can struggle with the process, which is all very typical.

1) ROUTINES- The most valuable potty training tip for parents, no matter the age of the child and the physical or cognitive ability is consistent routine.

Routine, whether it is practiced with a visual schedule, a potty training sticker chart, toileting adaptations, special nutrition, timers, physical exercises like yoga…all should be consistent and replicated on an ongoing basis.

There are so many aspects of development that contribute to underlying skills and the process of toileting. Whether these factors are addressed in occupational therapy sessions or in a home program, that consistent practice and routine trial is needed to support development.

2) PATIENCE- A second and worthy toileting tip is to focus on the patience.

Toileting is a complex process. Add in environmental considerations such as public toilets, loud hand dryers, noisy flushing toilets, and other sensory-based distractions.

  • Consider rushed schedules to get out the door in the morning.
  • Consider typical behaviors and attention spans of toddlers and preschoolers.
  • Consider day to day stressors.
  • Consider the distraction of screens and social media (“My infant is using the toilet all by themselves!”…yeah right!)

This is just the tip of the iceberg when it comes to all the factors that play into potty training. The fact is that kids are kids! They are just learning this complex skill, and toileting is a huge developmental process! The key to this whole process is patience and persistence.

3. BIGGER PICTURE- A third potty training tip occupational therapy professionals focus on is looking at the whole child.

This is more on what we covered above. When you take a step back and think about ALL of the developmental areas that play into toileting, self-care, hygiene, there are SO MANY areas at play here!

Let’s look at all of the areas that have a factor in the toileting process:

  • Balance
  • Coordination
  • Dexterity
  • Motor planning
  • Sequencing
  • Impulse control
  • Attention/focus
  • Safety awareness
  • Body awareness
  • Grasping strength and mobility
  • Postural control
  • Fine motor coordination
  • Gross motor coordination
  • Visual perceptual skills
  • Sensory processing- tactile sensitivities, proprioception, vestibular, interoception, auditory, olfactory (smell)
  • Interoception- This is worthy of a second mention- The ability to know when to go, to feel the pressure in the belly area, the sensation of having to pee or poop, the feel of pushing a bowel movement, the sensation of knowing when the process is complete, feeling hunger or thirst, sensing an upset stomach
  • Cognition
  • Communication and language
  • Social and emotional skills
  • Family perspective

This list essentially covers all areas of development! You can see that simply potty training can take longer for some individuals, and that is completely ok!

Occupational Therapy Toileting Strategies

The occupational therapy professional working with families on the functional task of toileting considers all of the areas listed above. They break down the process and use skilled assessment to analyze areas contributing to challenges with toileting.

OT professionals offer strategies and supports to develop contributing areas that impact the challenges that come up with toilet training. They offer suggestions, motivators, fun play activities, schedules, and consultancy that promotes development in the areas that will lead to success.

Occupational therapy practitioners can support families with potty training troubles in so many ways:

  • Development of underlying areas through play
  • Adaptations and modifications to the environment
  • Establishing a routine
  • Creating a sensory diet
  • Writing appropriate toileting social stories
  • Educating parents and guardians on readiness factors
  • Supporting carryover of skills across environments
  • Medical review and ruling out considerations that should be addressed with a physician
  • Focusing on reducing anxiety
  • Supporting with schedules, motivators, and play-based games and activities
  • Creating visual cue cards or tools to support communication skills
  • Address mobility and motor skill issues
  • Supports to address dressing skills
  • Backward chaining or forward chaining methods for potty training process
  • Education on various potty training methods that work best for the individual
  • Data methods
  • Functional skill assessment
  • Address sensory sensitivities
  • Address clothing considerations
  • Educate on sensory and perceptual concepts such as wet/dry, clean/dirty, front/back
  • Body awareness considerations
  • Address physical considerations
  • Address concurrent considerations such as diagnoses and their impact on toileting: physical or cognitive considerations, sensory processing differences, mobility, balance, muscle tone, etc.

The whole process of potty training is complex and aspects can be a challenging and difficult time for parents.  There can even be frustration at times.

All children need to learn and finding out the best potty training tips and ways to help with teaching kids to potty train that works for their individual needs.

To support kids in these areas, I’ve joined a team of pediatric occupational therapy professionals and physical therapists in creating the ultimate resource based on development and the whole child.

The Toilet Training Book: A Developmental Look at Potty Training for Kids of all Abilities was created as a comprehensive resource covering every aspect of toilet training including:

  • Potty training readiness (based on development)
  • The developmental progression of toileting, perineal hygiene, self-care, and handwashing
  • Toileting for special populations including Autistic individuals, those with diagnoses such as Down Syndrome, Cerebral Palsy, Traumatic Brain Injuries, Spina Bifida, Spinal Cord Injuries, and other physical disabilities, etc.
  • Strategies and supports for those with fine motor, gross motor, visual motor, behavioral, trauma, sensory, or cognitive considerations
  • Tips and suggestions when there is trouble with toilet training
  • Equipment suggestions for toileting

The book also includes toilet training matrix for readiness and functioning, readiness skill activities, interoception information, social stories, visual schedules, sticker charts, and other tools.

ackling potty training is a challenge for all kids! What if you had the inside scoop on development in your back pocket? 

What if you had the know-how of occupational therapists and physical therapists with DECADES of experience to guide you?  

The Toilet Training Book offers a developmental look at potty training for kids of ALL needs.

toilet training book

More Potty Training Tips from OT and PT

The authors of the Toilet Training Book have decades of experience working with individuals of all skills and abilities. Check out some of the potty training tips they have, coming from the OT/PT perspective:  

Fine Motor and Toileting- Looking for fine motor considerations when it comes to toileting and potty training? There are many fine motor skill areas that impact potty training:

  • tearing toilet paper
  • wiping with enough grip and strength
  • managing clothing fasteners such as buttons, zippers, snaps, etc.
  • managing the faucet and soap
  • Motor skills to grasp and use towels
  • and even using the sticker chart!
  • Opening locks on public restroom doors
  • Flushing the toilet

We as occupational therapists might focus on the fine motor aspect all of these areas that impact toileting. Still other contributions grasp, coordination, pinch strength, crossing midline, bilateral coordination, eye-hand coordination.

For tips and suggestions to support development of all of theses areas, check out Potty Training, Toileting and Fine Motor Considerations by The Inspired Treehouse.

Gross Motor and Toileting- Toileting has a considerable gross motor skill component. Consider that areas that impact potty training skills:

  • Mobility to the bathroom
  • Managing a small space
  • Getting on and off the toilet
  • For boys, standing and maintaining balance at the urinal or toilet
  • Managing clothing while sitting, standing, squatting
  • Balance
  • Coordination
  • Postural control
  • Weight shift
  • Trunk control

Pediatric OTs and PTs can use task analysis to break down these areas into smaller steps that can be addressed through play, modifications, and activities. Check out Gross Motor Skills and Toilet Training by Your Therapy Source for more information.

Potty Training and Sensory Processing- The potty training process has a huge sensory component. Think about these areas:

  • Tactile components to manage toilet paper, water, soap, etc.
  • Auditory consideration- sound of flushing, echo in the bathroom, sounds of others in a public restroom, hand dryers
  • Olfactory consideration- The smell of bowel movements and urination can be an issue for some, the scent of soap
  • Proprioception- understanding where the body is in space in order to squat, stand, and move with enough force
  • Vestibular- movement into different planes including an inverted head (kids will do this), standing, sitting
  • Interoception- knowing when to go, when bowel movements are completed, the feeling of a full bladder and empty bladder, huger, thirst, and even sweat
  • Sensory defensiveness, sensory seeking, sensory hypersensitivities, poor registration of sensory input all contribute to toileting
  • Body awareness
  • Fecal smearing

For more information on the sensory aspect of potty training, check out Toileting and Sensory Processing by Miss Jaime OT.

Adaptations and Modifications for Potty Training- Modifications to potty training can include many things:

  • adaptive equipment
  • adjustments for fine motor or gross motor
  • seating modifications
  • adaptations for fear
  • social stories
  • visual schedules
  • wiping modifications
  • sensory modifications
  • behavior modifications

For more information on the modifications, check out Modifications For Potty Training from Therapy Fun Zone

Developmental and Environmental Readiness for Potty Training- Readiness is more than development in some cases. Therapy can address these areas that impact successful toileting:

  • Readiness activities such as books, stories, and social stories
  • Following the lead of the child
  • Practicing hand washing
  • Practicing clothing management- removing clothing, dressing skills, buttons, zippers, snaps, buckles, etc.
  • Visual cue cards

For more information on readiness, check out Preparing Your Child & Environment for Potty Training from Growing Hands-On Kids.

Play-based potty training- Occupational therapy professionals use play as a tool to support development, because play is the primary occupation of children. Through play we can develop many skills. Play can be used to address activities in toileting such as:

  • Teaching wet and dry through sensory play
  • Teaching dirty and clean through sensory play
  • Teaching front/back and directional concepts through obstacle courses and doll play or other toys
  • Addressing body awareness through sensory play, obstacle courses, and toys
  • Addressing interoception, proprioception, body awareness, and sensory integration through yoga and heavy work activities
  • Addressing hand strength, gross motor skills, crossing midline, and physical considerations through pretend play, gross motor games, etc.

For more information on using play to support potty training, check out Teaching Concepts for Potty Training Through Play from Your Kids OT.

All of these areas are covered in detail, along with much, much more information in The Toilet Training Book, a Developmental Look at Potty Training for Kids of All Abilities.  

Potty Training tips and ideas to help kids learn to potty train from Occupational Therapists and Physical Therapists
Potty Training tips and ideas to help kids learn to potty train from Occupational Therapists and Physical Therapists

  Looking for more functional ideas for kids?  

Potty Training Seats for Special Needs

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Potty training seats for potty training special needs kids

Occupational therapy professionals work with clients of all ages and abilities on toileting and hygiene. That’s why this resource on special needs toilet training seats is so important. In therapy sessions, a skilled assessment of the whole individual can indicate a need for postural modifications to support motor skill needs. When it comes to potty training and toileting in general, there is a LOT of information out there. And, if you ask around for suggestions for the best potty training seats, you will probably get a variety of answers.

Some of these seats will help with independent perineal care, too because of the positioning and stability added for balance. Potty training supports like handrails, grab bars, and guards can help with the hygiene aspect of toileting.

Special Needs Toilet Training Seats

It can be overwhelming to weed through all of the potty seats out there on the market and in the local box store toddler aisle. The difficulty compounds when you consider potty training with special needs children.

Today, I wanted to pull together a list of kids toilet seats out there on the market that are perfect for special needs kids, as well as typically developing kids. Why? Because so often, a few simple changes with positioning, balance, and stability can be the tool to help kids feel more comfortable, confident during the toileting process.

Adding a stable support at the feet, back, or bottom can help a child to relax so they can toilet.

These potty training chairs help address the underlying needs that kids might struggle with when it comes to potty training. These potty training seats and supports can be the tools needed to address a variety of underlying needs when it comes to getting started with potty training.

Here’s the thing: it can be difficult to make suggestions or come up with a comprehensive list that covers ALL of the special needs out there. (That’s where your occupational therapy evaluation or equipment analysis will come into play!)

BUT, I can definitely address some of the more common potty training seats out on the market and address the underlying areas that they can address and hopefully target a best fit.

These recommendations for potty training seats are guided by development and great for kids of all needs. Use these potty training seats as suggestions when starting potty training for toddlers or preschoolers.

Potty Training Seats are Not One-Size Fits All!

Let’s face it. There is no one-size-fits-all approach when it comes to potty training. Because of the vast differences in in kids development, interests, motivation, physical or special needs, potty training can be a challenge to know where to start.

This list is hopefully a start for addressing some of the areas kids need for successful potty training.

Amazon affiliate links are included below.

Portable Seat– (affiliate link) This type of seat is great for kids who need a smaller opening on the toilet. Kids of all needs benefit from a larger seat area when first potty training. This one is nice because it can be carried from place to place when on the go outside of the home. Just fold it up and place in it’s carrying bag. Using a portable seat can make it easy to add interests when beginning potty training. Add interests such as special toys and items to make sitting motivating.

Squatty Potty– (affiliate link) The squatty potty is a helpful way to provide a more stable base of support while sitting on the toilet seat. Kids can place their feet on the support that curves around the toilet base and improve balance while sitting. This base of support can help kids who need extra support or have balance needs.

The Step and Go stool (affiliate link) is another, more inexpensive option. Adding a supportive base can help calm nerves of unsupported sitting. Children can use a wider base of support with this type of stool.

Potty Training Chart– (affiliate link) While this isn’t a potty training seat, a training chart can be used to promote extended sitting on a potty chair, and to allow kids the ability to build up patience to sit and wait on a potty chair.

Starting out by using a potty training chart to encourage kids just to go to and sit on the potty seat is a great start for younger kids or those who need to accommodate for sensory needs.

A visual tool such as a potty training chart can be a practical way to reinforce individual skills that make up the process of toilet training. The nice thing about toilet training charts is that they can be individualized, based on the child’s needs.

Some kids with special needs or sensory needs may be afraid of walking into the bathroom. A sticker chart can be one strategy to address that aspect given various modifications or activities that can help address needs.

Step Stool with Handles– (affiliate link) Having a handle can help little ones who struggle with balance or feeling unstable when sitting on a regular sized toilet seat. This one has a step stool that provides a base of support through the feet.

Toilet Seat with Pee Guard– (affiliate link) This seat insert has handles and slight curvature to the sides of the toilet seat ring, providing support and a sense of stability when seated on a regular size toilet. The urine guard is helpful for both boys and girls.

Three-in-one Potty Training Seat– (affiliate link) As a mom of four, this 3-in-one potty training seat is a favorite. It goes with kids from the toddler stage when a smaller, floor potty chair is helpful in training. The ring insert can then be used when transitioning to a regular sized toilet. Finally, the seat forms a step stool for using either on the toilet or when washing hands. This is a convenient toilet training seat for families!

A lower toilet position is closer to the ground and fits a smaller bottom. This helps with transition to a regular size toilet and allows for comfort and confidence in young children. This potty training system is great for the child who appreciates consistency.

 Ring Reducer– (affiliate link) There are many styles of toilet seat ring reducers out there and they serve a great purpose; to reduce the size of the opening on the toilet seat, allowing for small kids to feel more safe and secure when sitting on the toilet. This is a good transition seat to a regular sized toilet. For kids who struggle with coordination and balance, this ring reducer can be just the ticket to potty training success.

Disposable Seat Covers– (affiliate link) These seat covers are convenient for kids who tend to grab the toilet seat when sitting on a regular-sized toilet. When out and about in the community, it can be helpful for some kids to use a seat cover that is more effective than just using toilet paper. Some of our kiddos can’t tolerate sitting without holding onto the seat or just can’t follow the directions to “not hold onto the seat”.

These special needs potty training seats can be a guide to getting started with potty training for special needs kids.

Physical Limitations and Special Needs Toilet Training

While these potty training seat options just cover the surface of potty training, it’s important to remember to consider the underlying and developmental aspects of potty training.

The therapist’s perspective can play an important part in identifying any developmental or transitioning needs when it comes to potty training. While there are many more specific tools that can be used with special needs toilet training as well as typically developing kids, these are just some of the basics.

Remember that there truly is not a one-size-fits-all aspect for toileting. Some of our kids with more physical special needs or developmental considerations may benefit from a more extensive and supportive seating system.

That’s where the occupational therapist comes into play with identifying needs and tools that will promote independence and function.

There are many considerations that should be addressed when it comes to seating and toilet seats. First and foremost is the safe positioning of the individual on the toilet. Other considerations, depending on the special diagnosis may include:

  • reflex development and maturation
  • muscle tone
  • range of motion
  • balance
  • motor skills
  • attention span
  • motor planning
  • visual perceptual skills
  • postural reactions
  • joint tightness
  • eye mobility
  • cognitive considerations
  • weakness
  • sensory processing challenges
  • self-concept
  • body awareness

In the book, The Toilet Training Book: A Developmental Take on Potty Training for Kids of all Abilities, we cover more on special diagnoses and potty training, including strategies and tips for individuals with cerebral palsy, Spina Bifida, trauma, Traumatic Brain Injury, ADHD, Autism, and other general considerations.

Use these potty training seats for special needs kids when beginning the potty training process with kids of all needs.

Potty Training Seats for Physical Needs

Toileting Seat System- There are many toileting systems on the market that address physical needs. Seating systems are intended to  promote positioning, safety, mobility, transfers, function, and quality of life of the individual. Look for a system that meets the budget and can efficiently accommodate various needs such as toileting, showering/bathing, hygiene, etc.   

Systems can come with a variety of adjustments and supports. Consider the need or use of the following supports:  

  • Headrest
  • Backrest
  • Armrests
  • Lateral back supports
  • Harness
  • Seat belt
  • Tray
  • Anterior support
  • Hip guides
  • Abductor
  • Urine deflector or guard
  • Calf supports
  • Lower extremity lateral supports
  • Ankle straps
  • Footrest
  • Tilt in space (backward/forward)
  • Recline
  • Height adjustments
  • Push handles (for caregiver support)
  • Wheeled base
  • Molded and Foam cushions
  • Pan/adaptability for use over a toilet or as a stand-alone toilet chair  

Support Station for Toileting- A standing support station can be used in assisted hygiene or assisted toileting. The standing station can be a support to transfers and can be beneficial to clothing management, self-care, skin care, and undergarment changing.   

The support station is a helpful tool for improving function and dignity of clients as can perform aspects of toileting, as well as participate in self-care. This is a means for reducing diaper use as well, further improving dignity.

Additionally, support stations are a tool for improved safety of caregivers. When clients stand at a standing support frame, they are truly building strength, endurance and self-care skills in a natural manner within the occupation of toileting. 

Wiping after toileting and special Potty seating

When it comes to pericare, there are things to consider with the various special needs toileting systems.

  • Can the child maintain their balance while reaching for toilet paper?
  • Can the child weight bear or shift their weight from side to side or forward in order to wipe?
  • Can the child reach around their body to wipe?

For More information on Potty Training 

Watch for information coming soon to this space on the new Toilet Training Book! It’s about to be released and is your go-to resource on potty training based on development and individualized needs.

This book was created by occupational therapists and physical therapists who are experts in the field of child development, sensory processing, motor skills, and function.    Need more information and real strategies to improve potty training success? Want insider tips and tools from the occupational therapist’s and physical therapist’s perspectives? The Toilet Training Book is here!

Potty Training Help

Tackling potty training is a challenge for all kids! What if you had the inside scoop on development in your back pocket? 

What if you had the know-how of occupational therapists and physical therapists with DECADES of experience to guide you?  

The Toilet Training Book offers a developmental look at potty training for kids of ALL needs.

  • This digital e-book is a deal of a resource at $19.99

The Toileting Book is a comprehensive resource covering every aspect of toilet training.  

Details about The Toileting Book:  

  • Written by a team of experienced pediatric occupational therapists and physical therapists with decades of experience  
  • Packed with information on toilet training readiness and achievement of toileting success
  • Includes Toilet Training Guides for special populations (children with fine or gross motor needs, behavioral or cognitive challenges, physical disabilities, etc.) including Sensory Processing Disorder, Trauma-Informed Needs, Autism Spectrum Disorder, Cerebral Palsy, Spina Bifida, Spinal Cord Injuries
  • Provides information on interoception and the role this sensory system plays in potty training
  • Discusses common toileting equipment and special needs toileting tools
  • Includes tips and suggestions for individualized toilet training 

This book is available in digital, e-book format AND in a physical, soft-cover book format.

The Toilet Training Book- the potty training resource you need!

Perineal Hygiene

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perineal hygiene and pericare tips

Here, we are covering an aspect of potty training that comes up for every parent: pericare, or perineal hygiene, and teaching kids how to wipe when toilet training. So often, a young child learns to use the toilet and other aspects of potty training, but then struggle for a long period of time with the wiping aspect. Teaching children to wipe thoroughly is a hygiene task that can be limited by many underlying areas. Here, you’ll find strategies to help wiping bottoms and interventions for perineal hygiene. Also check out ADLs for more information on daily tasks.

How to teach pericare, or perineal hygiene needed to wipe completely during toileting.

What is pericare?

For the uninitiated, pericare (or peri-care) is short for perineal care. Perineal care refers to the hygiene and self-care of the perineal area following toileting, cleaning, and wiping of the perineal area of the body is the “private parts” area. Pericare is a term for the hygienic tasks involved in this part of the body, such as wiping one’s bottom.

Anyone of any age may need help wiping their bottom with their perineal care, but it is especially important to teach our little ones the proper way to manage their bottoms as they become more independent. 

This component of toileting is one that impacts overall independence and self-care with the toileting process. So often, we cheer and celebrate making it to the toilet on time, but the perineal hygiene aspect is equally as important.

Related: Potty Training Seats for Special Needs

You may be thinking, “Why do I need to teach my child how to wipe!?!”. For something that is such a natural task for many, it can feel odd to teach somehow how to do it.

However, learning how to maintain a clean bottom is important for one’s health and confidence. Wiping properly, washing gently, and wearing appropriate clothing decreases the risk of yeast infections, urinary tract infections, and odors. Plus, discussing peri-care can open the door to many other conversations about the body, health, and safety – if that’s something you are interested in exploring with your child.   

A great time to educate your child about peri-cares is while potty training. It is easier to teach the correct way first than to re-learn how to do it later. If you are stuck on potty training, we feel you there! Check out this Toliet Training Book that can help you help your children of varying needs.

Don’t be discouraged if your child is already potty trained and they have yet to learn how to take care of their bottoms independently – it can take time and practice! 

Development of Pericare

An important area to cover first is the development of pericare skills. It is so important to remember that we are talking about young children who are learning a whole new skill with toileting. There are many considerations: autonomy, body awareness, interoception, self-awareness, the sensory processing and interoception aspect, family perspectives…potty training can be very overwhelming for kids.

Then, to break it down even further, the hygiene aspect of toileting is another ball game!

In our book, The Toilet Training Book, we cover the development of potty training and really cover what underlying skills play into potty training and independence with toileting.

But, one important thing to remember is that a three year old child may be able to make it to the toilet in time to go, flush, and wash their hands, but the wiping aspect can developmentally, come with time.

Developmentally, perineal hygiene, or wiping completely after toileting, may be a skill achieved during a range of 4-6 years. This range is so wide due to the underlying skills, sensory considerations, motor skills, and cognitive growth needed for perineal hygiene including knowing when and where to wipe after a bowel movement or urination, using enough pressure on the toilet paper to clean completely, wiping enough times to clean completely, and maturity to complete the task.

The emergence of these skills takes time, but there are ways to support development of perineal hygiene.

GET COMFORTABLE with perineal hygiene

Everyone wants a clean bottom, let’s start there. It can be smelly and embarrassing to talk about, but it is an important step to understanding personal healthcare.

We want to give you the confidence to discuss this in any way that you and your family feel comfortable with because it is a “touchy” subject for some. The more comfortable you are with peri cares, the more comfortable the child will be. 

Let’s start off the potty training wiping techniques by talking about good hygiene.

Here are some ideas to talk about perineal hygiene with kids:

  • Make it silly: Some people respond best to humor but watch out for demeaning jokes. 
  • Make the conversation about pericare hygiene scientifically accurate: It becomes less embarrassing when you hardly know what is being said! 
  • Make pericare sound similar to washing hands: We have to clean away the germs; they can make us sick! 
  • Make discussions about perineal hygiene your own: You know your family best. Think about terminology that works for the individual. In what ways can you increase trust and comfort for all? 

GENERAL GUIDELINES for teaching perineal hygiene

Here are some general tips for a healthy bottom that should be shared for children and adults alike. Please speak to your family physician if you have any questions or concerns related to your child’s unique needs. 

  • Wear breathable (preferably cotton) underwear that is not too tight. Change daily or when soiled. 
  • Don’t hold it in. While it is good to wait to “go” until you reach the toilet, holding in pee or poop for too long can result in a variety of issues. 
  • If it is comfortable, sit on the toilet with elevated feet. You may have heard of the (Amazon affiliate link) Squatty Potty – placing the legs in more of a squatting position helps bowel movements pass. More importantly, children should have access to a either a smaller potty or a footstool (or a box,etc.) near the toilet so that their feet do not dangle. 
  • Wipe from front to back to reduce bacteria entering the urethra. Talk about anatomy and why wiping front to back is effective and safe.
  • Wipe gently with 3-4 squares of folded toilet paper (each household can determine the amount – some kiddos use way too much!) until clean. I always recommend to look at what you are wiping away so that you learn about how much you need to wipe. 
  • Consider use of warm or cool wipes over toilet paper.
  • When bathing, wash the genital area gently with mild soap and rinse with clean water. No soap should be entering the body through the anus or the vagina. 
  • For bathing a uncircumsized child, refer to this article for great information and consult your family doctor for personalized advice.   

Pericare INTERVENTION IDEAS

Children will not know unless we lead them, so here are some fun ways to teach pericare! 

Areas that can be broken down to increase overall self-care include:

  • Address balance
  • Pulling up and down undergarments
  • Wiping front to back
  • Wiping thoroughly
  • Wiping with enough pressure
  • Gripping the toilet paper
  • Washing hands after wiping
  • Reaching around to the back

Each of these areas can include aspects of balance, gross motor skills, fine motor skills, strength, coordination, sensory processing, executive functioning skills, and visual motor skills. It’s important to look at each individual’s area of difficulty and then break it down into the underlying areas that are impacting success with pericare.

First look at the area of difficulty. Then, consider how underlying areas are impacting that particular area. Come up with intervention strategies that support that need and create a “just right” challenge to build independence and pericare functioning.

Let’s look at each of these areas of perineal hygiene…

Pulling up and down undergarments:

  • Fine motor strength and coordination fine motor activities to the rescue! There are so many fantastically fun ways to increase this skill, but here are some that are more directly associated with potty training.
    • Lei Obstacle Course: Grab some Hawaiian-inspired leis, hula skirts, or long necklaces and create a long pathway. As a child walks through the pathway (hopefully to another fun activity in the course), they must step inside the lei and pull it up as high as it will go. If it fits over their arms/head, they can wear it as a necklace. Pulling up the lei and wiggling their body through will strengthen the same skill as in pulling up pants. Reverse the challenge to mimic pulling pants down.
    • Silly Socks: Grab a variety of socks in fun colors and different sizes and see how many you can put on in one minute! Layering socks up the arms and legs (and removing them, too!) mimics the skill of pulling up and down undergarments. 
    • Stickers: Challenge them to peel off stickers all along the waistband of their pants. Don’t forget the backside! 

Pericare: Wiping Activities

Balance and reach are huge parts of perineal hygiene. Staying balanced on the potty while wiping is a big challenge for our core strength, flexibility, and range of motion. To practice this skill through play-based activities, see the ideas below! 

Play-pretend: Place peanut butter on the back of a disposable or washable diaper and have your child wipe it off. Any familiar paste will do – sun butter, nutella, cookie butter…anything to wipe! When they think they are done wiping, show them the diaper to see if they actually cleaned it. 

Art-based: Wipe a plastic plate with toilet paper to create an art project – the toilet paper acts as the paintbrush. They must wipe clean the whole plate! For an extra challenge, place the plate behind their backs, and the work of art in front of them. 

Play activity: Using static electricity, tape, or velcro, have your child squat to “pick up” pom-poms or other sticky and lightweight items on their bottoms (think: window stickers, damp tissues, etc.). They carry them carefully to a container and remove them one by one. You can really make this game your own!

Wiping Front to Back

There are so many ways to work on perineal hygiene to cover other aspects besides the balance consideration. Consider these strategies to teach kids to wipe front to back:

  • Use toys, books, clothing, and other items to work on teaching front and back directional concepts.
  • Teach children to count to help with wiping a certain number of times.

Reaching Back to Wipe During Perineal Hygiene

  • Clip and unclip clothes pins on the back of clothing to work on reaching back and around..
  • Use a pool noodle to reach around and through the legs to work on reach, visual attention, scanning, and eye-hand coordination. You can tap the pool noodle on a target and create a game.
  • Practice wiping the backside in the bathtub.
  • Put a handkerchief or scarf in their back pocket for the child to reach for and pull out.
  • Put stickers on the child’s back or pants for them to reach for and grab.

Wiping with enough pressure

  • Work on tearing paper for hand strength and eye-hand coordination to pull off appropriate sizes of toilet paper.
  • Use play dough, LEGO, tong activities to develop hand strength.
  • Wipe dry erase marker off a dry erase board. Then, position the dry erase board on the ground between the feet to bend and wipe. Then, position it behind the back to reach and wipe.
  • Wipe peanut butter or washable paint from a plastic baby doll.
  • Help kids to wipe thoroughly by painting with toilet paper with having them try to wipe a blob of paint off a plastic plate and remind them to keep going until the plate was empty.

More perineal care and potty training tips

Looking for more information on underlying considerations that impact toileting? Need strategies, supports, and tools to facilitate independence with toileting skills? Need support strategies for potty training an older child, but not know where to begin?

Looking for ways to help individuals with toileting skills when cognitive, behavioral, motor skills impact participation in independent toileting? Trying to initiate or progress with potty training when a diagnosis of Down Syndrome, Autism, or a motor skills challenge is at hand? Check out the Toilet Training Book: A Developmental Take on Potty Training for Kids of All Abilities.

Resources for toilet training kids of all abilities
The Toilet Training Book: A Developmental Look at Potty Training for Kids of all Abilities

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Behavoral Issues with Potty Training

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Potty Training problems and tips

Here we are covering behavioral issues with potty training and potty training problems that impact toilet training in kids. Teaching a child to potty train is a complex task. You’ve probably tried some of the common tips for potty training. But what happens when there are real problems? There are many components that can affect a child’s progression and retention of toileting independence. Let’s go deeper.

Behavioral issues with potty training

Parents often times seek out potty training help when they are working on building independence in this functional skill of childhood.  

While there are many considerations that go into the developmental progression of independence, attention and behavior are key skills in function.

Behavioral issues with potty training can look like many different things:

  • Intentionally urinating on the floor
  • Impulsive actions in the bathroom
  • Hyperactivity during toilet training
  • Playing in the toilet
  • Using too much toilet paper in anger or frustration
  • Hitting
  • Aggression during toileting





Full disclosure: This post contains affiliate links.

Potty Training Tips and Help for kids with attention or behavior problems

Behavior and Potty Training

It is important to note that many times, behaviors that are seen with potty training are a result of potty training starting too soon.  

When a child demonstrates behaviors, there is often times, a communication point that the child is trying to get across: Behaviors are many times just information.

Other times, behaviors are normal development of a child’s cognitive and imagination.  Children who are potty training might refuse to take time to toilet, make urine or fecal messes on the floor intentionally, throw objects into the toilet, or refuse to use certain bathrooms, among many other behaviors.


It is important to take the behavior objectively and think about the behaviors as information. Information should be viewed objectively and without bias.  

A behavior can be viewed as good or bad but in order to address the behavior, it is necessary to figure out the reason behind the behavior.  

A child who has tantrums and hits an adult is considered to have bad behavior while a child who attends to a task is considered to have good behavior.  This bias is a perception of behavior.


There are many reasons behind behaviors related to potty training and the act of toileting.

Problems with potty training and behaviors during toileting may be a result of:

  • Sensory concerns with steps of toileting
  • Fear of going into the bathroom
  • Anxiety as a result loud hand dryers or other sources of over-stimulation
  • Fear of self-flushing toilets
  • Consider a need for a special toilet training seat, especially for kids with special needs.
  • Uncertainty of the steps of toileting
  • Difficulty with fine motor or gross motor/positioning needs related to toileting
  • Constipation due to holding output or other physical discomfort
  • Cognitive delays limiting understanding of portions of the toileting process
  • Unfamiliarity with surroundings when using different bathrooms
  • Difficulty with the breakdown of a multiple step task such as clothing management, toileting, and hygiene
  • Inability to communicate effectively
  • Typical development of boundary pushing and expression of language and cognition

For a more comprehensive look at all areas that can impact successful toilet training, be sure to dive into The Toilet Training Book: A Comprehensive Take on Potty Training for Kids of all Needs and abilities.

These types of difficulties can result in reactions that lead to frustration and tension between the child and adult.    

It is important to remember the causes of behaviors throughout the potty training process.  

Once there is a potential reason identified for the cause of behaviors related to toileting, examine the behaviors and consider the following questions:

  • What is the child getting or not getting from the behavior?
  • What makes the behavior stop?
  • What makes the behavior continue?
  • What are precursors to changes in the behavior?
  • Does the child withhold toileting breaks to avoid going into the bathroom?
  • Does the child demonstrate cognitive, communication, sensory, fine motor, or gross motor difficulties that might interfere with steps of the potty training process?

 

How to support Children with potty training problems    

Let’s talk tips to help with behaviors related to potty training.

Aggressive behaviors might include shouting or physically hitting and might occur suddenly as a result of frustrations perceived by the child.  Other children might become upset in certain bathroom environments like public restrooms.  Still others might overly focus on certain details.  It is important to try and understand what is causing the child to become angry, upset, anxious, or agitated.  

Some of these strategies can work to support children that struggle with potty training problems.

Modify the Task– One tip to adjust the precursors to behaviors in toileting is to modify the task or simplify the steps that you are asking the child to complete.    

Begin where the child is consistently successful. A child who’s anxiety of entering a bathroom prevents further progression of independence may begin with the child walking into the bathroom, and staying in the bathroom for a count of five.    

Continue practicing this portion of potty training until there is success.  Then the child will be capable of moving on to other steps of toileting.  

Gradual progression of potty training coincides with waiting to begin potty training until the child has shown readiness cues.  

Take time to respond– Before responding or reacting, take a moment before you respond as the parent. Before reacting to potty training behaviors, consider:

  • Think about the cause of the aggression or anxiety.
  • Focus on the child’s emotions.
  • Be positive and reassuring.
  • Provide reassurance through calm a voice and phrases.
  • Reduce noise and distractions to help the child relax.
  • Follow the child’s lead.
  • Realize that some behaviors can indicate that the child isn’t ready and they are communicating a lack of readiness through their behaviors.
  • Keep it simple: reduce verbal cues.
  • Boys can sit to pee at first until they get the hang of the physical act of awareness of the urge to urinate and clothing management.
  • Use the same gender roles to make learning easier.
  • Begin potty training when it works for your family time-wise: don’t start potty training during a vacation or when other changes are happening in the household.
  • Also accept that there will never be perfect timing to start potty training.

Support perineal hygiene with specific strategies.

Attention Considerations in Potty Training

Like the reasonings behind behaviors seen in potty training, children often times have a reason for inattention leading to poor carryover of skills or steps of toileting.  

There are certain attention areas that should be achieved by children before attempting to begin potty training. 

A child should have an attention span that allows them to respond appropriately to verbal instructions when they are given one step verbal cues:

  • Sit down in a chair.
  • Stand up.
  • Walk to another room.
  • Imitate a parent in a simple motor task.
  • Point to body parts when asked.

If a child is not able to attend to these tasks, they may not be ready to begin attention.

Strategies for Helping with Challenging Behaviors and Attention Difficulties during Potty Training 

Tips and help for potty training with behaviors and attention problems like this key chain schedule.

Potty Training Schedule

Visual Supports– These might include visual schedules, or visual supports are schedules, dry erase boards, and timers.  

Start with this information on how to use visual reward charts for the most success.

A schedule can be as basic as a “first-then” cue or complex and including each step of the potty training process. I have created a customized schedule card that can be attached to a key chain and taken to various bathrooms during outings as well as used in the home.

Use the steps printable to customize the schedule card to meet the needs of your child.  

Another quick tip can include using an Alexa skill to create a timer or schedule for time to try the bathroom routine.

How to make a customized potty training schedule for kids:

  • Print the schedule images. Cut out the pictures that work best for your child’s needs.  You can adjust the length or steps of the schedule based on your child.  Changes to potty training schedules should be practiced for at least two weeks before giving up on a specific technique or schedule.
  • Using card stock, cut a 2 1/2″ by 9″ length.  
  • Create  2 1/4″ x 2″ card stock squares for covers.  
  • Fold and tape the covers to the back of a 2″ square card stock.  This will hold the different steps of potty training.  
  • Create a small slit and attach a badge clip. Use this clip-on schedule by attaching to clothing or hang it in a bathroom.



Choices– Incorporate choices into the potty training process.  Choices might include:

  • Do you want to use this restroom or that one?  
  • Do you want to use the paper towel or the hand drier?
  • Do you want to walk or hop into the bathroom?  

Choices like these allow the child to feel in control of a situation that has to happen.  Toileting is a task that must occur and the choice that a child makes can sometimes be withholding toileting or purposefully urinating on the floor instead of in the toilet.  

Positive Reinforcement– Positive behaviors can be rewarded to provide feedback to the child with behaviors.  Feedback is the information about the outcome of a response.

  1. Internal feedback is the response of the sensory systems in respond to a task.  A child feels better after toileting.  

2. External feedback comes from a source.  In potty training, external feedback might be visual cues or praise from a parent in response to completed tasks.  A reward system is another type of external feedback.  

Feedback can be provided after every completed step of potty training, or it can be varied to transition to the end of tasks.  Feedback (like a small food reward) that is given after every step of potty training becomes a crutch.  

Positive reinforcement should be transitioned to the end result of toileting, including hygiene, washing hands, and leaving the bathroom in order to help with skill retention.


Initially, a positive reinforcement such as a food or sticker reward should be given immediately after the child does the expected behavior. They can be given the reward every time they complete that part of potty training. Gradually you will increase the steps the child needs to accomplish before earning a reward. Parents should be specific with the behavior that is being reinforced. Say,“I like the way you are sitting on the toilet,” as they are given a tangible reinforcement. 

This potty training incentive resource covers more on positive reinforcements for toileting.

Reinforcer Chart– A child who is working on multiple steps of potty training or who has moved on from single step positive reinforcement can use a reinforcer chart to earn a small prize after multiple successful attempts at toileting.  

The child might earn a toy from a prize bin or a small treat at a store. Even a picking a sticker out of a basket and allowing the child to place the sticker onto a potty training chart is a great tool that offers positive reinforcement.

This type of reinforcement builds delayed gratification.


Positive Communication– When behaviors arise during potty training, it is important to use effective communication and not respond with criticism to behaviors or inattention.  

Also important is avoiding the term “good job” as a reward to accomplishing desired behaviors.  A child might not be successful but tried hard.  Other more appropriate terms include words or gestures for encouragement or suggestions for “next time”.

Tips and help for potty training with behaviors and attention problems like this key chain schedule.

Potty Training Tips to Help with Behavior and Attention Concerns:

  • Simplify when teaching new skills.  Break down tasks into smaller, obtainable steps to allow success.  Provide positive reinforcement to each step.  
  • Use stronger reinforcers for more difficult tasks.  This might include holding urine overnight for several nights or continuing potty training skills at different settings outside the home.  
  • Verbal cues are more difficult to fade than physical cues.  Limit the amount of verbal cues once a child has shown success with steps of potty training.  

Potty Training Resources:
Warwick, T. (2013, February). Effective Strategies for Decreasing Challenging Behavior in Individuals with Autism Spectrum Disorders. OccupationalTherapy.com, Article 2174. 

Tips and help for potty training with behaviors and attention problems like this key chain schedule.

Potty Training Book

The Toilet Training Book is a comprehensive resource for all aspects of toilet training.

The Toilet Training Book is a developmental resource on potty training children of all abilities and skills. Created by occupational therapists and physical therapists, and guided by child development, this toilet training resource is like no other.

Resources for toilet training kids of all abilities
THE TOILET TRAINING BOOK: A DEVELOPMENTAL TAKE ON POTTY TRAINING KIDS OF ALL NEEDS

Tackling potty training is a challenge for all kids! What if you had the inside scoop on development in your back pocket?

In the book, you’ll find guidance, tips, and actionable strategies to support all aspects of toilet training, including tools and supports for kids with physicals needs, neurotypical individuals, and children of all needs and levels.

  • Written by a team of experienced pediatric occupational therapists and physical therapists with decades of experience
  • Packed with information on toilet training readiness and achievement of toileting success
  • Includes Toilet Training Guides for special populations (children with fine or gross motor needs, behavioral or cognitive challenges, physical disabilities, etc.) including Sensory Processing Disorder, Trauma-Informed Needs, Autism Spectrum Disorder, Cerebral Palsy, Spina Bifida, Spinal Cord Injuries
  • Provides information on interoception and the role this sensory system plays in potty training
  • Discusses common toileting equipment and special needs toileting tools
  • Includes tips and suggestions for individualized toilet training

Click here to read more about The Toilet Training Book: A Developmental Take at Potty Training for Kids of all Needs.

Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

Handwashing Activities

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handwashing activities for kids

Today, we’re talking handwashing activities. These self-hygiene activities can be used as a hand washing activity for preschoolers, when teaching kindergarteners to wash their hands, and even older kids that struggle with completely washing their hands. Add these multisensory ideas to add to a hand washing lesson plan.

handwashing activities for kids

We all know that handwashing is so important. Per the Centers for Disease Control, it is the most effective method to prevent the spreading of germs. Of course, we all want children to be healthy for participation in school, daycare, and other daily life events so that their growth continues undisturbed. We want them remaining healthy to enjoy their days of play and learning while essentially building their bodies and brains!

We also know that handwashing is the last thing that a child feels like they need to do.  Younger children do not understand what purpose it serves as they do not see a direct impact on themselves (unless they can see the dirt literally wash off their hands and down the drain).  Older kiddos think that a simple handwashing is all it takes as they went through all of the steps and think, “That’s good” when really their routine didn’t wash away all those icky germs and some are still on the hands ready to move onto others. Yuck!!

how to wash hands for kids

In this post, we will look at handwashing tips, tricks, and activities that can help children of all ages, and even some adults, manage their handwashing hygiene and help to keep themselves and others healthy and well.  Essentially, getting the true ‘ick’ off of the hands and down the drain where they belong!

Handwashing Tips and Tricks:

  • Allow the child to pick their own hand soap scent and give them the opportunity to decorate the container with their own touch of stickers, glitter, marker drawings, etc.  Some children enjoy placing small plastic toys inside the dispenser as well. Take a look at these fun Lego and Halloween soap ideas. 
  • Give the child a variety of options to choose from when picking a hand soap, such as bar vs. pump, foam vs. gel, etc.  Maybe a bar of soap in a mesh baggie would help. 
  • Allow the child to choose their favorite hand drying towel or buy a special towel just for this purpose. Maybe it’s a fun themed towel or simply a fluffy towel that feels good to the hands. Think positive experience, so no scratchy towel fabric here.
  • Incorporate a fun handwashing song into their handwashing routine.   There are so many fun songs out there with some being designed to help the child wash better and longer to cleanse those germs away. Take a look at these fun Handwashing Songs!  Songs can be super helpful for younger kiddos.
  • Bring a few of their favorite toys to the handwashing routine to encourage their engagement. They can play with them after they wash their hands thoroughly.
  • Consider using a visual timer to help them wash their hands for the appropriate length of time to cleanse those germs away. This is helpful for older kiddos. Think about a visual gel timer that lasts 20-30ish seconds. 
  • Make sure the sink is comfortably accessible to the child. Can they reach the faucet? Can they place hands directly under the faucet and above the basin comfortably? Consider using foot stools, faucet handle extenders or grippers, and faucet extenders. You can purchase these in fun themes or if you are creative, make your own! Take a look at this DIY faucet extender and fun faucet set. If you prefer to have something more adult-like in theme, take a look at this simple faucet extender. 
  • Sometimes if a child is able to see themselves in the mirror behind the sink, they are ready to wash their hands while watching themselves. You’ll see them make funny faces, showing different facial expressions, etc.  Make sure the child is able to multi-task to do this. 
  • Consider adding a few fun window clings to the mirror that can watch the child as they work on handwashing hygiene. Let the child pick them out, maybe you can change them with every holiday.
  • Consider joining the child for the handwashing routine. This shows that that everyone must take the time to wash their hands throughout the day.
  • Create a sticker reward chart as an incentive to have the child work on handwashing skills. Maybe a reward that they would really want could be the handwashing motivator.
  • Use these free Hand Washing Posters and step by step visual schedule by Your Therapy Source to assist with teaching children proper handwashing techniques. The fun posters have a visual reminder and when it’s important to perform handwashing.  Also, they have a fun Hand Washing Activities Packet that has a variety of hand hygiene activities. 
  • Consider the water temperature as some children do not like certain water temperatures. Help them set the water temperature they like to motivate them to complete thorough handwashing.
  • If the child does not yet know how to set the water temperature, help them learn to do so. Use visual supports for water temp clarification by wrapping each handle with tape that is the color for hot (red) and the color for cold (blue).  If you have one central handle, place arrows on the sink backsplash surface with these same colors and the words ‘hot’ and ‘cold’ written on the arrows. You can also purchase some colored indicators from a hardware store, if that is your preference.

Using fun activities can help children to learn the importance of appropriate handwashing hygiene.  The activities not only serve the purpose of being fun, but they serve a more important purpose of demonstrating the need and the value of proper handwashing.  Sometimes teaching kids to wash their hands properly requires some creativity and FUN! 

Handwashing Activities

Below are some handwashing activities that help engage children in the hand hygiene process while also providing valuable learning experiences to clarify why this foundational skill is necessary in their daily lives. 

  • This sensory ‘bin’ activity involves the use of a water bin and latex gloves – Wash Your Hands – a playful exploration using latex gloves, ice, and water making it the perfectly blended sensory, science, and health activity. 
  • This Clean Hands sensory ‘bag’ activity involves the use of hands drawn on a gel-filled, pom-pom baggie and the use of bottle brush. It helps children to learn to get the hands squeaky clean by scrubbing away those pom-pom germs. 
  • This fun self-care activity – Germy Hand – is an OT activity that adds a fine motor and functional component to learning the importance of proper handwashing as the child learns a handwashing song and works on germ buttoning to dirty the hand and then follows with germ unbuttoning to cleanse the hand.
  • Read a germ book or two to help children learn about why handwashing is important. Review this 20 Germ Books for Kids post by Fun with Mama to see all of the options you could use with a variety of children.
  • Ice Cube Handwash is an OT activity that promotes tactile tolerance through extended engagement with water and ice in order to encourage a child to work on thoroughness and find enjoyment in hand hygiene. 
  • Use this Glitter Germs Activity to help children understand visually what exactly they working on washing away with proper handwashing. It involves the use of lotion and glitter and creates a fun germ-spreading game!
  • Use this fun OT Fuzzy Germ Craft activity to teach about germs. You can easily add it to your reading of a germ-themed book and you’ll have a whole lesson plan for germs! This is a great activity for older kids!
  • This bread science experiment is a disgustingly real way to teach about the importance of proper handwashing and why hand hygiene is so important. This will really convince children to wash their hands and will probably help them do it without you even reminding them!
  • This pepper science experiment is a unique way to teach younger children about why it’s so important to wash their hand and use soap to do so. 
  • Use this free Handwashing Social Story to work with individual children or even a small group of children. It is highly detailed and uses full color photos instead of more abstract clipart. Check out our tips for how to write a social story to get started.
  • Use the free step by step visual schedule printable from Your Therapy Source and cut apart the individual steps to hide around the room and have the child do a handwashing scavenger hunt. Once they find all of the steps, they place them into the correct sequence. This is a great OT activity!
  • This Icky Germs Craft makes for another fun activity that incorporates hand tracing, coloring, and cutting skills.  It also allows for some creativity with germ creations.  
  • This germy hand craft is similar to the one above, but it adds a fun little paper soap element that helps children relate to the need to use soap to cleanse away those icky germs!
use these washing hands rhymes to teach handwashing skills

Washing Hands Rhymes

Individuals that learn best through multisensory input may appreciate a hand washing rhyme. When kids are exposed to the rhythm and rhyme of a saying that teaches handwashing, the individual steps may be more likely to stick.

These washing hands rhymes ideas are great to use in teaching handwashing to preschoolers, kindergarteners…and older kids!

Each of these rhyme ideas have several goals: to get kids to learn to wash their hands, to use each step of handwashing, and to scrub with soap for a longer period of time.

This is the way we Wash Our Hands Washing Hands Rhyme

(Sung to the tune of All Around the Mulberry Bush)

This washing hands rhyme teaches kids about the hygiene concept of washing hands before eating.

This is the way we wash our hands
Wash our hands
Wash our hands
This is the way we wash our hands
Before we eat our food.

Tops and Bottoms Hand Washing Rhyme

(Sung to the tune of Frere Jacques)

This hand washing rhyme teaches kids each step of the hand washing process, including where to scrub with soap.

Tops and Bottoms, Tops and Bottoms, (Rub top and bottom of hands)
In between, In between, (Rub fingers inside on both hands)
All around our hands, All around our hands, (Wash all over)
Then we rinse. Then we dry.

Use this hand washing lesson plan to teach kids to wash their hands effectively

hand washing lesson plan

If you are teaching handwashing, using a hand washing lesson plan is one way to stay on track with teaching the correct concepts of hand hygiene, and making sure the steps of handwashing sticks with kids. Those with cognitive deficits, attention challenges, executive functioning needs, and others may struggle with each step. This is where a handwashing lesson plan comes into play.

Pick and choose the handwashing activities listed above to incorporate into a lesson plan. This could be included in an overall life skills class, a self-hygiene course, or even daily functional task lessons.

A specific handwashing lesson plan may include:

Handwashing Lesson Plan

  • Title of Lesson: Handwashing
  • Time: 1 day-1 week
  • Subject Areas: Self-Help Skills; Life Skills
  • Media: Books, Play activities, Online videos, manipulatives, handwashing station or sink, soap, water, towel, isolated sink in classroom, public bathroom
  • Objective: Student will learn to wash their hands.
  • Procedures for Lesson:
    • Read a handwashing book or germ book (see above)
    • Complete a germ experiment or multisensory activity related to germs (see above)
    • Write the list of steps for handwashing. Student can copy onto paper.
    • Discuss each step of handwashing.
    • Sing washing hands rhymes (see above)
    • Complete a how-to writing task. Student can write independently the steps of handwriting.
    • Manipulate needed materials: soap, water, towel, paper towel, sink, water handles, water temperature, air dryer.
    • Interactive activity with peers: Sort handwashing visual cards into steps.
  • Key Vocabulary:
    • Germs
    • Water
    • Temperature
    • Soap (types: liquid soap, bar soap, antibacterial, soap dispenser, etc.)
    • Dry/wet
    • Towel, paper towel, napkin, air dryer
    • Scrub
    • Rinse
  • Practice and Application:
    • Student describes steps of handwashing.
    • Practice handwashing at a sink using dry materials on the hand such as a light dusting of flour or cornmeal.
    • Practice handwashing at a sink, using all of the steps.
    • Handwashing in public space such as school bathroom where there may be other bathroom users, loud noises, and distractions.
  • Scaffolding:
    • Modeling
    • Guided practice
    • Independent practice
  • Grouping Options:
    • Individual
    • Small groups
    • Large groups
    • Peer activity
    • Partners

In this post are ample tips and tricks to try with kiddos to help them learn the importance of this foundational skill and build the motivation to do so. There are links to engaging activities to help a child learn when and why to do proper handwashing. 

However, if you should have other concerns about your child that these tips or tricks do not address, please contact an occupational therapy provider to discuss. Your child may have other underlying issues, such as sensory processing, motor planning, bilateral coordination, strength, and executive functioning needs. 

Regina Allen

Regina Parsons-Allen is a school-based certified occupational therapy assistant. She has a pediatrics practice area of emphasis from the NBCOT. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. She has been practicing occupational therapy in the same school district for 20 years. She loves her children, husband, OT, working with children and teaching Sunday school. She is passionate about engaging, empowering, and enabling children to reach their maximum potential in ALL of their occupations as well assuring them that God loves them!

Adaptive Equipment For Eating

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Adaptive equipment for eating

This article covers adaptive equipment for eating, including adaptive feeding equipment, assistive feeding devices, adaptive utensils, plates, bowls, and other tools to support functional feeding skills.

One of the main paths that occupational therapists help people achieve success in their daily occupations is through adaptive equipment and technology. There are so many great feeding products and eating tools available to increase independence, and today we will start off the conversation by introducing adaptive equipment specifically for feeding. 

Adaptive equipment for eating

A great place to start with learning more about adaptive equipment for eating and the possible need for reaching out to occupational therapy for adaptive eating tools or support is this resource on Pediatric Feeding: Is it Sensory, Oral Motor, or Both?

Adaptive Equipment for Eating

When it comes to helping individuals become more independent with daily occupations, feeding and eating skills have a big role. Occupational therapy, being the holistic profession that it is, recognizes the overall piece of eating has on wellness and wellbeing, nutrition, and day to day functioning. OTs focus on both the feeding aspect for nutritional intake as well as functional eating skills in use of utensils, cups, and bowls for independence.

Let’s take a look at various adaptive equipment tools for feeding and eating:

Adaptive utensils for feeding needs

Adaptive Utensils

Adaptive dinnerware includes adjusting handles on eating utensils, adding width to the utensil handle, adding weight or length, and addressing the ability to hold a fork and spoon, or knife. Other adaptive feeding needs cover difficulty bringing food to the mouth or the ability to remove food from the utensil as a result of oral motor issues.

Let’s take a look at various adaptive utensils.

Amazon affiliate links are included below.

EazyHold Silicone Silicone Aide-Basically a silicone universal cuff, this adaptive utensil tool is perfect for feeding! The silicone texture makes it easy to clean, and it comes in sizes for newborns through adults. This piece of equipment can be placed around the hand and hold common objects like forks, spoons, markers, and paintbrushes making it a one-stop device for turning household spoons, knives, and forks into adaptive eating utensils. It can remarkably increase independence for individuals that demonstrate deficits in grip strength. 

Maroon Spoon– This adaptive feeding utensil is a classic! The maroon spoon has a shallow spoon depth that can assist in feeding for users with poor lip closure, oral hypersensitivity, or tongue thrust. 

Weighted, Thick Handled Utensils– These weighted utensils have thick handles that are great for those who can grasp a wide handle but have a harder time holding on to something smaller that requires more grip strength. If this is the case, built-up handles are a lifesaver!

You can also use Viva Foam Tubing to make any household spoon, fork, or knife handles thicker and easier to grasp. The added weight of these utensils is also great for individuals who have tremors – the extra weight helps to combat the motion of the tremor, leading to a more successful meal time. 

Textured Spoons– The texture on the spoon provides oral-motor stimulation to the mouth, increasing wanted oral movement patterns and decreasing hypersensitivity. The texture can also cue the user to engage with the tastes and textures while feeding. This spoon comes with extra-long handles to make hand over hand assist a bit easier, too! 

These bendable textured spoons are great for self-feeding and oral motor stimulation as they have a smaller, hand-held size and can offer different textures for gum and tongue sensory input.

Off- Set Spoon– This tool, and many other utensils like it, allow for easier self-feeding for individuals who have limited mobility. The angle of the spoon is turned toward the person, instead of being straight, so that they can bring their spoonful of food directly to their mouth without having to change the orientation of the spoon or their bodies. 

Adaptive plates and adapted bowls for feeding issues

Adaptive Eating Plates and Bowls

When it comes to a container to hold food, plates and bowls can look like many things. Here, you’ll find recommendations for lipped plates, suction cup

Scooper Plate– A lipped plate is just one way to help individuals scoop food from the plate surface, and not onto the table. This scooper plate is a dinner plate with a lip, or a higher edge. Here is another must-have item for individuals that have trouble scooping or stabilizing their plate or bowl.

This “scooper plate” is a plate with high walls like a bowl that have been specifically designed to make it easier to scoop and pick up food items with a utensil. Even better, there is a suction cup feature at the bottom to secure it to the tabletop for more stability while scooping. You can also get the scooper bowl here.

Plate Guard– Similar to the scooper plate, these plate guards can be added to any of your existing plates to add a wall to scoop against. This reduces spills, food waste, and time spent chasing food around with a utensil. That being said, there is much to learn from messy food play.

4-Square Meal Plate– Some feeding therapy involves increasing food repertoire for picky eating. This plate can be a great tool to help make mealtime fun and engaging for kids.

Adaptive cups and adaptive spoons for feeding needs

Adaptive Cups

Adaptive cups can help with drinking without lifting the head or chin or can help address other motor control and strength challenges. For individuals that struggle to hold a cup or sip from the edge of a cup, there are straw options as well. Below, you’ll find adapted cups that are designed for those with dysphasia or aspiration precautions. Those requiring thickness needs or safety concerns with swallowing liquids should consult a professional. Read this resource on oral motor issues and feeding needs to get started.

Flexi Nosey Cup– This is a flexible drinking cup that also has a space cut out of it to fit a person’s nose. This is a simple and effective way to improve the independence of those who are limited in their ability to tilt their head back while drinking. With the space cut out for the nose, there is no need to tilt their head back while using this cup. The flexibility of the cup can control the flow of the fluid as well, to promote safe swallowing. 

Bear Straw Cup– This kit can help teach a child how to drink out of a straw. The design keeps the liquid near the top of the straw so that less effort is required to take a sip. This can be great for those with oral motor deficits or those just learning how to suck. The kit comes with a lip block to prevent biting on the straw or having the straw enter the throat, and encourages oral motor exercise as well! 

Recessed Lid Cup– This drinking cup is designed with two handles and a recessed lid that can improve lip closure while avoiding sippy cup use. Why do we want to avoid sippy cups? Short answer: if they are used to exclusively, for too long, they can cause dental issues and speech problems. The recessed lid cup mimics drinking from an open cup without all the spillage. Plus, it improves lip closure and tongue retraction for improved oral motor function. This kind even comes with two lid options, one that is suitable for straw use, and the other for typical drinking. 

Flow Control Cup– This cup helps with oral motor control, lip closure, and tongue mobility that impacts sucking from a straw and managing the flow of liquids when drinking from a cup.

Extra-Long Drinking Straw– This flexible drinking straw is extra long, addressing mobility needs that limits an individual’s ability to move closer to a cup and straw that are positioned on the table surface.

If you are a therapist or another professional looking for brands to support during feeding therapy, take a look at Ark’s products. They make tons of oral motor tools for desensitizing and strengthening a child’s mouth to encourage the development of food repertoire and safer, more independent feeding and swallowing. 

Finally, if adaptive feeding equipment is something that needs to be further adapted to meet the specific needs of an individual, don’t forget the many uses that Dycem will have in addressing specific needs.

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Messy Eating

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Benefits of Messy eating for babies and toddlers

Have you ever noticed that small children eat meals with recklessness? Bits of food covers the face, cheeks, hands, lap, floor, belly, and even hair. Part of it is learning to use utensils and manage food on the fork or spoon. But there’s more to messy eating too! Messy eating for a baby or toddler is actually a good thing, and completely normal part of child development. And, letting a small child get messy when they eat, and even playing with their food as they eat is OK!

Messy eating in babies and toddlers has benefits to developing tactile sensory challenges and fine motor skills in young children.

Messy eating

I’m sure that your mother never told you it was okay to play with your food at the dinner table, but I’m here to tell you otherwise. Playing with food is not only okay, it is vital to development of self feeding skills and positive engagement with food. When young children play with their food they are engaging in a rich, exploratory sensory experience that helps them develop knowledge of texture, taste, smell, changing visual presentation of foods and oral motor development.

When play with food is discouraged it can lead to food texture issues, picky eating, oral motor delays and increased hesitancy with trying new foods later on.

Eating with hands- Messy benefits

When solid foods are introduced to baby, it is often a VERY messy ordeal. There is food on the chair, the bib, the floor, you…everywhere but the baby’s mouth. Often times, parents may feel discouraged or don’t like the mess that is the result, but it is OK. In fact, the messier the better.

Exploring food textures with the hands provides tactile experience to the hands, palm, and individual fingers. Are foods sticky, chunky, goopy, or gooey? All of that exposure to the hands is filed away as exposure to textures.

Picking up and manipulating foods offers fine motor benefits, too. Picking up and manipulating bits of food offers repetition in pincer grasp, graded precision, grasp and release, eye-hand coordination, bilateral coordination, crossing midline, and proprioceptive feedback. All of this is likely presented in a baby seat or high chair that offers support and stability through the trunk and core. When that support is offered to babies and toddlers, they can then work on the distal coordination and dexterity. At first, manipulation of food is very messy as those refined skills are developed, but it’s all “on-the-job training” with tasty benefits!

Research shows that a child moves through a series of exploratory steps before successfully eating new foods. This process involves messy play from the hands, up the arms, onto the head and then into the mouth. The steps of this process cannot happen unless the child is encouraged to touch, examine and play with their food. In today’s culture of sterilization and cleanliness, this often counterintuitive to parents and a hard pattern to break.

Promoting Play with Food

Mealtimes can be rushed affairs, making it hard to play with food, but they are not the only times we engage with food throughout the day.

Cooking and meal prep are two of the most common opportunities for play and engagement with food. These activities present perfect opportunities for parents to talk about color, size, shape, texture, smell and taste of the foods that are being prepared. Use of descriptive words,
over exaggeration when talking about and tasting foods, along exploration opportunities develop a positive interest in foods.

Babies can be involved in kitchen prep as they play with appropriate utensils and kitchen items like baby-safe bowls or pots. Toddlers enjoy being involved in the food preparations and can wash, prep, and even chop soft foods with toddler-safe kitchen tools.

Explore these cooking with kids recipes to get small children involved in all the benefits of the kitchen.

Here are more baby play ideas that promote development.

Food Art

Free play with foods like yogurt, jello and applesauce are also great opportunities to promote messy play and creativity. Utilize these foods for finger painting, or painting with other foods as the brushes. This activity challenges tactile and smell regulation, along with constant changes in
the visual presentation of the food.

Creativity with Food

When presented with food for free play, or at the dinner table encourage their creativity–carrot sticks become cars or paint brushes, and raisins become ants on a log.

The sillier the presentation, and more engaged the child becomes, the more likely they are to eat the foods you have presented to them. Especially, if these foods are new, or are non-preferred foods. High levels of over exaggeration also leads to increased positive experiences with foods, which in turn leads to happier eaters, and less stressful mealtimes
down the road.

Ideas like these flower snacks promote healthy eating and can prompt a child to explore new textures or tastes in a fun, themed creative food set-up.

Messy Eating and Oral Motor Development

Not only does play promote increased sensory regulation and positive engagement with foods, it also promotes oral motor skill development.
Oral motor skill development is promoted when a variety of foods are presented and the mastered skills are challenged.

Here is more information on oral motor problems and feeding issues that are often concerns for parents. The question of feeding concerns and picky eating being a sensory issue or oral motor motor concern comes up frequently.

Foods that are long and stick like such as carrots, celery and bell peppers, promote integration of the gag reflex, along with development of the transverse tongue reflex that later supports tongue lateralization for bolus management.

Foods such as peas, or grapes promote oral awareness and regulation for foods that “pop” when bitten, and abilities to manage multiple textures at one time.

Messy Eating and Positive Mealtimes

Whether you have a picky eater, or are just trying to make mealtimes fun, play is the way to go!

Play with food is critical to development of oral motor skills and sensory regulation needed to support positive meal times. Through the use of creative play, exposure, and over exaggeration these milestones can be achieved.

Although the goal is for your child to eat new foods there are many steps we need to conquer before getting there. Don’t worry, these can be fun and stress free! 

Let me ask you a question. If you were presented with a new food, something so new and anxiety provoking that you don’t want it near you and you definitely don’t want to touch it; do you think you would want it anywhere near your mouth? About in your mouth? Even more, how about swallowing it? The answer for most would be NO WAY! 

Well, we can’t expect the same from our kids. If they don’t want to look at or touch a food, they most definitely will not want to eat it! So before getting kids to put new foods near or in their mouth, we need to take several steps back and learn how to interact with it. This is where the fun can come in! 

This week we are going to experiment with various ways of play or interacting with foods. Remember, the goal in not to eat it. The goal is simply to interact with it and hopefully to start getting messy with it! Let’s kid you child comfortable with touching food and have fun doing it. This will not only get them a few steps closer to eating it, but it will also build positive associations with the food and also make them more comfortable with various aspects of it. This can include the color, texture, shape, smell, etc. The more foods we play with, the more of these they are feeling comfortable with. So in short, let’s start our food journey with our hands and our eyes by getting messy! 

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