After an acquired brain injury, children may need help with dressing and bathing because of problems with balance, changes in sensation and awareness, less control of their hands, or poor planning skills.

During the early stages of recovery, the child may be confused and highly distractable. Activities for daily living should occur in an environment with few distractions and preferably somewhere that is familiar.

Knowledge of the child or young person's self care abilities before the brain injury is necessary so appropriate tasks can be chosen to include in the treatment program.

Who can help?

Occupational therapists assess children with difficulties in this area. Often this assessment is done at home. Occupational therapists identify the cause of the problem and offer appropriate solutions together with the child and family.

What is the treatment?

• Developing routines so the child or young person can complete these activities in a familiar way.
• Often the child or young person needs supervision and help in the early stages of recovery to ensure their safety. For example, they may not be able to safely monitor water temperature in the bath or get in and out of the bath safely.
• As children and young people recover, they are encouraged to take more responsibility for their own self care. The degree of independence expected will depend on the child or young person's level of functioning before the injury, their age and any residual physical and cognitive difficulties.
• Repetition (frequent practise) and use of training strategies (for example, backward chaining, where the child or young person learns an activity by starting with the final step and progressing backward until all the steps are learnt).
• Use of prompt sheets. These may have pictures and words to help the child or young person remember the sequence of actions involved in the task.
• Special equipment may need to be used to accommodate physical changes. This may include equipment such as bath seats, adding hand rails, providing clothing that allows the child to dress and undress more easily (e.g. elastic-waisted pants).
• Often the way the child or young person completes the particular activity needs to be modified, either temporarily or permanently. For example, the child or young person may need to sit on a chair in the shower if they are unable to climb into or out of the bath. The child or young person may need to sit to dress or learn one handed dressing techniques if they have a hemiplegia (where one half of a person's body is weak or paralysed).
• It is important to consider the safety of carers when helping the child or young person do their self care tasks. For example, lifting even small children can cause a back injury to the carer. This can be avoided if carers are shown the best way to help the child/young person.

For more information

• The Royal Children's Hospital
  Paediatric Rehabilitation Service
  T: (03) 9345 9300
  E: rehab.service@rch.org.au
• The Children's Hospital at Westmead Brain injury Service
• Kids Health Info series of fact sheets listed under 'Brain injury'

Developed by The Royal Children's Hospital Paediatric Rehabilitation Service based on information from the Brain Injury Service at Westmead Children’s Hospital. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.