Pediatric ADLs
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| Chewing | transitioning from liquids to solids: gradually increase the liquid's consistency, add small amounts of chewable food, place two fingers or thumb on the lower jaw directly under the molars and press upward with firm pressure | tongue thrust: involuntary excessive tongue protrusion often seen in children with CP, Down Syndrome, and other muscle control disabilities. Can interfere with eating by pushing food out of mouth | managing tongue thrust: each time the child takes a bite, press the spoon down firmly on the center of the tongue and hold pressure for 3 seconds (this will usually relax and retract tongue), use flat eating utensils |
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| Managing special feeding and eating problems | reasons for biting: to reduce fear or anxiety, unable to perform tactile discrimination, express anger. Intervention: "chewy" toy can be worn as necklace, on belt, or in pocket | Reasons for spitting: excess saliva, ssb synchrony difficulties, experiementing with cause/effect Intervention: to teach acceptable way to handle saliva | Regurgitation: return food to mouth from stomach Pica: eating inedible items Intervention: provide alternative activities, depends on cognitive, social, and visual impairments |
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| Toilet Hygiene | ability to clean oneself after using the potty, mgmt of catheters, colostomies, and suppositories | Interventions: developing a routine, how much to wipe, how much paper to use, hand washing, menstruation mgmt | bears can smell the menstruation |
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| Personal Hygiene and Grooming | Cotas can teach children the skills required to clean themselves. This requires reviewing bedtime and morning routines and developing picture or written checklists. | Adaptions for hair care: baby shampoo, rinse-free shampoo, spray detangler, head massage, warm temperatures, multiple distractions and fun during hair cutting experience | Skin care: children with spinal cord injuries, limited mobility, or limited sensory awareness must be taught to check for bed sores | Oral hygiene: modified toothbrushes can be providing depending on disability. Children with severe impairments need hand-over-hand assistance | Nose blowing: provide reminders, demonstrate how to blow out through nostrils, extra care with children with tactile defensiveness
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| Dressing and Fastening | Activities for dressing: simulation with adding or removing rings from extremities, playing dress-up, costumes, dress-up dolls, fastening boards or vests | Buttoning: requires separation of of the two sides of the hand called "radial-ulnar dissociation", can sing song "pinch the button and pinch the cloth. pull the hole open and push the button through" | Zipping: the child is taught to insert a zipper only after learning to pull it up and down and usually after mastering buttoning and unbuttoning. should practice on own bodies | Shoe tying: forward and backward chaining, use of fading assistance (assistance gradually reduced from max to min and from physical to tactile to verbal to visual cues), wide/ thick laces should be used, laces can be two different colors | Before working on shoe tying: improve sensory discrimination by performing resistive finger activities (squeeze toys, putty, picking up items with tweezers or tongs, playing miniature games, pulling ropes
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| Personal Device Care | hearig aids, glasses, splints, orthotics, braces, prosthetic limbs, artificial eyes, mobility aids | child and caregiver are taught how to apply and remove device, cleaning, storing, replacing parts, and scheduling doctor appointments for a new one | child's performance should be routinely reinforced |
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| Sexual Activity | treatment includes learning how to interact respectfully with the opposite sex and understand appropriate and unappropriate behaviors | "It is okay to touch your private parts in the bathroom or bedroom when no one else is there." |
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| Sleep and Rest | the Cota can be instrumental in helping a family with adaptive equipment for and furniture arrangement in the bedroom | Interventions for better sleep/rest: exercise daily, establish bedtime routine, go to bed at same time each night, baths are more calming than showers, sleep in complete darkness, use relaxation cds or sound machines, eat dinner high in carbs |
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| Safe Mobility | improve body awareness by using simple obstacle courses or relay races, | increase environmental awareness by playing games that require visual cues around the environment | before begining an activity have the child recall safety rules |
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| Suck/Swallow/Breathe | suck-swallow-breathe synchrony (s-s-b) is a skill used throughout life, which allows individuals to breathe while sucking in and swallowing food, drink, and saliva | activities to promote breathing: perform activities in prone, innertube swing or rock on therapy ball (strengthens diaphragm), blowing toys (bubbles, pinwheels, whistles), leaning back in bean bag chair or pile of pillows in partial supine | common indicators of poor ssb: inadequate lip seal while sucking or blowing, gasping for air while sucking or eating, excessive drooling when not being fed |
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| Swallowing/Drinking | techniques to improve swallowing: child's neck should be slightly flexed, slowly stroke upward on lateral muscles of throat, provide sour foods, use a straw | transition from bottle to cup: muscle tone should be adequate (calming of high tone, exciting of low tone), proper lip closure (gentle, firm pressure applied above upper lip and below lower lip), specialized transition cups... | cont: reduce oral defensiveness, jaw tug, deep pressure techniques in and around mouth |
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| Bowel and Bladder Mgmt (AKA: Evacuation and Elimination) | Resistance to toileting: feeling of underwear is unfamiliar, toilet may appear to high, toilet seat is cold, sound of flushing is scary | Interventions for toilet resistance: transition underwear, padded toilet seat, warm seat in advance, "potty chair" close to ground, temporarily omit flushing | Toileting schedule: child is taken to toilet every 30-60 minutes, toileting routine is developed, drink fluids 30 to 60 minutues before toileting, make experience comfortable and successful | Equipment: grab bars, arm rest, step stool, back rest, belts, splashguards Positioning: feet firmly on floor, may sit on toilet backwards |
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| Bathing and Showering | getting supplies as well as soaping, washing, rinsing, drying, and getting into and out of a tub or shower. picture sequences are helpful | Adaptations for severe impairments: roll-in shower, bath chairs with belts and harnesses and pommels, raised tub, hoyer, portable/inflatable tub | Adapted equipment: nonslip mats in and outside of tub, bath chair or tub transfer bench, handheld shower device, grab bars, long-handled sponges |
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