This is the first in a series of four posts in response to your questions about parenting and caring for Autistic children. (All of the ‘You Asked’ series of posts can be found here).
Our Respectfully Connected authors respond here based on our own experiences and knowledge. All of our families are different, but you will see common threads through our responses: honouring our children’s autonomy, respecting their differences, parenting peacefully, and with a dash of creativity.
Q1. How do you encourage autistic children to perform self-care activities such as teeth brushing and bathing?
Meg Murry: I take the pressure off to lower the stress level surrounding that activity for both my child and for myself. If it’s been an especially distressing experience, I may not bring it up for a while. My experience is that there is usually very little harm to temporarily suspending some self care activities compared to the harm in forcing them.
I may ask what it is that bothers him about the activity, and if he can’t explain it I try to figure out what it might be so that I can offer alternatives. Usually there is a compromise that works, though it may not be ideal, for both of us. For example, brushing teeth less than once a day, or cleaning up with washcloths rather than a bath.
Cas Faulds: Different self-care activities involve different challenges depending on a child’s individual characteristics, so I’m going to focus on brushing teeth because this is something that we’ve needed to work on in our home.
I think it’s important to actually understand what that can feel like for a child. So, to experience that, ask your partner or another adult to brush your teeth. It’s invasive and there’s very little sense of control. But, brushing teeth is important so it’s worthwhile explaining why it is important before suggesting different strategies to your child as to how you can brush their teeth without creating too much discomfort. You could suggest that your child brushes your teeth while you brush theirs, or you could agree on a system of counting to a certain number before moving to a different area of their mouth.
If your child is older, you might want to encourage them to start brushing their own teeth. To do this, you can show them yourself, or they might be more open to watching other people on YouTube brush their teeth – there is a wealth of YouTube videos out there that show teeth brushing.
It’s also important to consider whether sensory issues are contributing towards their aversion to teeth brushing as well. Try different flavours of toothpaste, and different styles and shapes of toothbrushes in order to see what works best for your child.
Leia Solo: We’ve realized that there are a lot of self care activities that can be scaled right back to the bare minimum and not impact on the health of your child. For example, it’s not really necessary to bathe daily or wash your hair weekly. Teeth cleaning is more of a challenge because we fear the impact of not brushing twice daily. With our son, backing right off was the only option. Anything else escalated the battle and made it worse. This requires that we manage our own adult fears around hygiene and that can be hard. Sometimes though, there is no alternative but to step
back, let them see you showering, teeth cleaning and caring for yourself and see what happens.
Michelle Sutton: At our house we don’t enforce our expectations of what self care activities should look like on our kids. We discuss hygiene, health and self care, but we do not enforce. If there is an issue that is causing us concern for our child’s well being we talk privately to the child and let them know our concerns and offer them a few alternatives or strategies to consider.
Example: for a child who does not like their head touched you can avoid the need to wash and brush hair by encouraging them to lie in the warm bath or stand under the running shower every couple of days to maintain hair cleanliness and prevent with knotting.
On the broader topic of self care, I have this blog post: http://amazingadventuresautism.blogspot.com.au/2015/05/amazing-adventures-acceptance-love-and.html
Briannon Lee: My children have a right to bodily autonomy and are able to say no to self care activities such as hair washing, tooth brushing and baths. We never pressure, nag, bribe or induce our children to undertake self cares, as this seems to increase their anxiety about the task. Instead we try to explore what is underneath the dislike of the activity (e.g. sensory challenges, switching tasks, or change) and this helps us work
together on different strategies. We provide factual information about why people bathe, brush teeth and wash hair, and explain the possible natural
consequences of not doing so; offer at different times of the day when timing ‘feels right’ eg teeth brushing while watching TV mid-morning; we change clothes while they are sleeping; we swim and play with water as much as we can. Letting go of ingrained habits and beliefs has greatly reduced unnecessary worry and anxiety for all of us and supports our children to develop planning, self advocacy, and problem-solving skills and to learn about bodily integrity.
Naomi Callaghan: We go with what is tolerated. If bathing isn’t currently being tolerated, we take a sponge bath-style approach. Showers are a no-go, so we avoid them. When the weather is warm, we have a lot of water-play set up outside (it’s a favourite), and we will fill the outside bathtub up with bubbles and leave the kids to it. Hair brushing and washing is a sensory trigger, so we do it only when we must, and only for as long as it will be tolerated. Sometimes that means messy hair, or hair that hasn’t been washed for a little while. It the past it has meant dreads. We model a lot of self care behaviours – by that I mean we talk about how and why we brush our teeth, for instance, while we do it. We don’t force it, because
that does more overall hurt than not cleaning teeth every day. Sometimes toothpaste is acceptable, sometimes it’s not. We try to find ways of supporting as much self care as we can while still respecting sensory needs. Our basic approach is that bodily autonomy trumps everything (including social expectations) with the exception of medical needs.
* All of the ‘You Asked’ series of posts can be found here *