What is required?
- Good enough balance
- Good proprioceptive and tactile (touch) feedback so they are able to know where their hand is when they can't see it. Proprioception is the awareness of where the body is without using vision e.g. hands behind back.
- Good range of movement in the shoulder and arm to be able to reach behind them
- Motivation to want to be independent in bottom wiping
- This is essential for balancing on the toilet.
- Both feet should be placed firmly on the floor, providing the child with a stable base. If this is not possible, provide a step for the child to place his feet on.
- Telephone books bound together can make a step.
- Having a hand rail to hold provides stability.
- The child should be able to reach behind their body and under their legs in order to bottom-wipe.
- The following activities can help improve skills:
- Stick stickers on the child's back and then ask them to reach around and find them.
- Put objects in a bag or behind their back and ask the child to feel and guess what they are without seeing them.
- In front of a mirror ask the child to close their eyes then move one of their arms to a position and ask them to copy it with their other arm without looking. Then ask them to open their eyes and see how close they got to getting the same position.
- Behind the back, unscrew a container to obtain a 'prize'. If necessary practise where the child can see their hands and then move on to behind their back. This will also develop hand skills.
- Bodyball: move a ball/balloon around the body – tummy/back, under legs, over head to someone else etc
- In the bath or shower encourage washing their own bottom and back.
- If your child is not motivated to learn to wipe their bottom then it will be difficult to encourage them but using reward charts may help.
- To learn to wipe their bottoms children need to understand how much toilet paper they need, how to wipe effectively and when to stop wiping. Practice by counting out the sheets with him.
Activities to try
- Pass a ball or balloon around the body passing from one hand to the other.
- Pass a small ball or balloon around the legs in a figure of eight.
- Stick stickers on different places on the child's body, front and back and get the child to find the stickers.
- Practice using toilet paper; tearing off the correct amount, scrunching or folding and the wiping action
HINTS AND TIPS!
- Once the above are in place then there are ways of adapting bottom wiping to make it easier if necessary.
- Wipe from the front between the legs, wipe front to back
- Moist tissue/ wet wipes, try different brands as some are easier to dispense than others
- Wash after wipe, with a disposable cloth
- Toilet paper already torn off in a wad, or make a mark on the roll.
- Make sure there is toilet paper near to the child so he/she can reach out while sitting on the toilet.
- Show the child how to hold the paper without scrunching it up too much
- Hand over hand technique: hold child's hand and help them wipe their bottom
- Buttons and zips on clothing are best kept to a minimum when teaching toileting skills (i.e. use elasticated waist trousers).
- Provide school with a spare set of clothing if accidents are happening.