Gaining independence in completing activities of daily living is something all parents and educators want for the child. Every child has the potential to make gains in these areas whether or not they become fulling independent in the activity. These activities include things like eating, bathing, brushing teeth, toileting, washing hands, dressing and undressing, and grooming. Adults may be tempted to do these activities for the child, especially when they are young. It is so important to the quality of life the child may have as an adult, to be able to participate in these activities as much as possible. Because many of these activities require personal and intimate touch, they can be startling or somewhat stressful for the child. The more opportunities your child has to explore materials used in activities of daily living and to practice individual skills required to complete these routines, the less stressful these activities will become for the child.

General Guidelines

  1. Work on skills related to activities of daily living at times and in settings other than during the actual event. For example, practice skills related to eating at times other than during the actual meal when getting nutrition in becomes the important goal for the child. This also allows the child opportunities to practice without someone watching or attempting to "show" him/her the proper way to do it.
  2. Make activities fun and interesting to the child based on his/her preferences related to sound, textures, shapes and so forth.
  3. Provide many opportunities throughout the day for the child to practice skills related to activities of daily living. This includes things like grasping, kicking legs, putting things on their heads and taking them off, moving arms, and bringing things to their mouths. 
  4. Be mindful of your pace during the actual activities daily living. Give the child lots of time to complete a single piece of the activity before prompting the child. Some children may be able to do more if given plenty of time to try.

Learn more about ways to work on these activities:

Eating

Toothbrushing

Hair Brushing

Hair Drying

Handwashing

Bathing

Undressing and Dressing

 


Eating

For even more information about strategies and issues related to eating, you should also visit Oral Motor Development and Issues.

1 A whistlesLet the child play and explore things with the mouth. Provide whistles, harmonicas, spoons, or favorite objects with food or flavoring on them. You might try apple sauce or yogurt or pudding. Let your child to explore these items in any way that they want to during play activities.

In this video you will see Skye exploring some quack sticks that have been coated with apple sauce. She was just learning to eat from a utensil, and we were having her practice bringing her utensils to her mouth. But you can see during this play activity, she's feeding herself apple sauce from a quack stick, which was one of her favorite toys.

2 Utensils Provide various utensils (made from different materials like wood, metal, rubber, plastic) for your child to play that are coated with different flavorings. Encourage your child to bang them together, bang on pots and pans, smell or taste the ingredients on the utensil, scoop and stir. You can also hang utensils near your child and let them kick, bat or bang them, practice grasping them, and exploring in other ways. This is how they will learn about the utensil and begin to create more robust concepts like "spoon-ness" or "fork-ness". 

Practice scooping or pouring various materials such as dried beans, rice, and noodles. Dump them onto cookie sheets or other noise-making surfaces. If the weather allows, take tubs of water outside to practice scooping and pouring water or include these opportunities during bath time. Provide measuring cups and other containers with handles; this will help the child learn how to pour his own drinks.

In this video you will see with Easton and Jessica McCavit, OTR, near his hand to give him the opportunity to use it, but he currently prefers to use his hands to fill the cups.

PlatesCupsStack plastic or melamine plates and plastic cups with your child. If your child is not at that level yet,  you stack them and let your child practice knocking them over on to noise-making surface (hardwood floor, a tile floor, a resonance board) using arms, hands or legs. This allows the child to become familiar with cups, saucers, bowls and plates before using them during feeding. 

When your child is ready to eat some solid foods, here are some things to remember. In this video you will see Jessica McCavit, OTR, helping Skye eat her lunch. Notice that Jessica holds the spoon steady right by the mouth, and does not chase the child with spoon. Your child may be a little bit hesitant to take food from a utensil, so be patient. After the first bite, the child may be less hesitant to eat.  Then position the utensil near the hand to encourage your child to grasp on to it. The child may want to grab your hand and bring it towards her mouth to help us feed her, so hold it at the very end so the child can grasp the utensil instead.Your child, like the child in this video, may still need a little assistance to load food onto the utensil, but as much as possible allow them to attempt scooping and stabbing food and bringing it independently into the mouth. In the last part of this video, Jessica transitioned to having Skye hold on to her own cup. Prior to this time, she had opportunities play with cups and plates outside of meal times with cups and plates.

If your child can't maintain a grasp on a utensil (or any object that you are using), , you may want to try using a buncher. Click here to find out more about bunchers or to download directions for making a buncher.  You can also create a make-shift buncher using a hair scrunchy. A buncher allows the child to keep an object in their hand, whether their hand is open or closed. Hook one end of the hair scrunchy around the utensil. Place the remainder of the scrunchy over the top of the child's hand and hook the other end over the grasped utensil.

BuncherPartsIf you use a real buncher, you will see that there are three pieces of elastic. Two of pieces of elastic have button holes and one has three buttons sewn on it. Notice that the buttons are spaced apart to accommodate different sized hands. A real buncher can be used with any object that you are trying to encourage your child to hold. The nice thing about the bunchers is the child can still feel the actual object in the palm of his or her hand as they are practicing grasping and releasing and exploring that object.

Here's is a video of Jack using a buncher at meal times. Notice that he has a loose grasp on the spoon, but because of the buncher, he's able to keep it in his hand and practice bringing that spoon up to his mouth. During times when he's practicing, we will also give him a few bites and then pause our activity so he has an opportunity to practice as well. We always try to make sure that there is food on the spoon. If he does get the spoon up to his mouth, he can tastes. This should motivate him to keep making those movements to bring that utensil up to his mouth. 

8 PizzaWhen you are cooking dinner, let your child explore any items that you are using to make the meal in any way he or she can. So, for example, if you are making pizza, let your child play in the pizza sauce, cheese or other toppings. Give your child their own dough and let them poke, pat and squeeze it. If you have a rolling pin, let them experiment with rolling the dough. If they bring these food items to their mouths, they have the added experience of tasting and even smelling the various topping. Think about foods that are appropriate for your child to explore and remember not to let your child have things that may cause him or her to choke if they are not able to chew their food properly. 

When your child has developed the ability to grasp utensils, you may want to give him opportunities to practice using utensils to skewer food. Use a piece of styrofoam about the size of a cafeteria tray that has been secured to a table top. Stick various forks in the styrofoam with handles up. Let the child practice pulling out the forks. At first the adult might need to put the forks back in the styrofoam for the child, since it is much easier to take the forks out than it is to put them back in the styrofoam. The noise created by the forks going into and out of the foam will help to motivate the child. You can mix other things that have a slim profile like toothbrushes with the forks. The child will have opportunities to identify the similarities and differences between the two objects. 


Toothbrushing

Toothbrushing is often a very stressful activity for the child and the adult helping him or her. There are a number of things you can do utilizing an Active Learning approach to help your child become better able to cope. Just like eating, these activities are taking place throughout the day and not just at toothbrushing time. 

toothbrush strawsJulian toothbrushesTo help the child learn about "toothbrush-ness" and to make a toothbrush less threatening, offer your child a collection of different types of toothbrushes (adult size, child size, vibrating, different bristle types, different grips, etc.). Let the child play with the toothbrushes anyway he or she chooses. You might put a small amount of different flavored toothpaste or food on some. Have some toothbrushes that are wet and some that are dry. Let the child play with the brushes anyway he or she chooses.Hopefully, the child will bring them to her mouth occasionally when she can control how long the toothbrush is there.

Try letting the child play with things that go in the mouth while positioned on a Support Bench or in sitting. You might include things like electric/vibrating and regular toothbrushes, child sized and adult sized toothbrushes, z-vibes with a toothbrush tip, straws, and whistle sippers.

You can also make a mobile using tooth brushes. Below is a video of Katy playing with toothbrushes using a Table Top Mobile.

During toothbrushing or during a play activity, hold the toothbrush in one spot by the child’s mouth and let them move their head back and forth or explore with tongue, lips, or cheeks, however they want. Hold the tooth brush steady, so the child can find it again when they are ready. Don’t chase the child's head or mouth; let them put their mouth, cheeks, and face on it as they choose. Let the child explore how different amounts of pressure make the electric toothbrush sound and feel. Let the child experiment with moving it too far into mouth, so he or she becomes more cautious and moves more slowly, learning about length of objects. The video below shows an example of this strategy.

CyndyMatthewToothbrushing

You may also place an vibrating toothbrush in the child's hand using a buncher. Let the child play with the way it feels and the sound it makes as it touches different parts of  his or her body, a Resonance Board or table top, a pan, and other objects or surfaces. 


Hair Brushing

Offer your child opportunities to play with a variety of brushes and combs in anyway he or she chooses.  You can offer brushes that have various purposes such as basting brushes, vegetable brushes, kitchen bottle cleaner brushes brushes, nail brushes, along with hair brushes of different sizes, shapes and materials. Look for a variety of combs and picks to offer such as rattail combs, pocket combs, big combs, little combs, hair picks, decorative hair combs, wooden, metal and plastic combs. 

During indepedent play offer a hairbrush to the child by holding it steady near the hands to let them explore by raking bristles. You may also want to attach the brush to a Velcro Vest or Activity Belt or stick it to the child's shirt with Duck Tape. 

During independent play, allow the child to practice putting two brushes or a brush and comb together by pressing the bristles or teeth and bristles together. Let the child play with pulling them apart of putting them together. The child might also experiment with the different sounds the combs make when raked over a brush, a fingernail, the teeth, or other object. The adult's role is to replenish the materials as they are explored and discarded by the child.


Hair Drying

ToyHairdryerOffer a variety of hairdryers (both real and play) for the child to explore. This is a great way to make use of all the burned-out hairdryers you have. Consider various sizes such as travel-sized, small and large hair dryers. Also try different types such as ones with brushes, defusers, and other add-ons. If you can find an old-fashioned bonnect dryer, the child might find it interesting to set on top of his or her head.

During adult-child play, offer the child things that make noises like a hairdryer or things that produce air. This might include small personal fans, handheld vacumn cleaners, paper fans, blenders, or balloon pumps along with hairdryers. Make sure that the hairdryers are taped or otherwise secured so they do not become too hot. Be prepared to turn the device on and off as the child becomes distressed by the sound. Make sure the child has plenty of time to explore the object before turning it on to produce sound or air. The child might startle to the sound or feel at first, but if they are able regulate their contact or the amount of time they have to hear the device by signaling the adult, they may become more comfortable.  You might also connect some of these devices to a timer switch so the child can practice turning the device on and off.


Handwashing

Soap on panWe all know how important washing hands is for anyone's health and safety. Some children resist handwashing because it is something that is done to them. Here are some ways to let your child learn about handwashing during play. Take a cookie sheet or shallow pan and squirt dishwashing liquid or handsoap in the bottom. Let you child explore by patting, scratching, or rubbing. Add some water to the mix a little at a time to let your child play. Finish by pouring water of his or her hands or rinising under a faucet. 

Another activity that can be fun for the child is to let them play in a mixture of glue and colored rice in a shallow pan. After their hands become coated, place a clean pan with some water in it and let them pat and move their fingers to get the sticky off.


Bathing

Bathing is a great opportunity to allow children to engage in water play.  Remember safety first.  All children must be supervised in the bathtub.  It is important to gather any items you plan to use ahead of time.  Never leave a child alone in a bathtub until he or she has learned all the skills necessary to do so safely. 

Bathtub PlayStart with simple gross motor movements, allowing a child to splash, kick, or move his or her fingers through a hand-held shower.  Progress to introduce simple fine motor skills that encourage opening the fingers, touching, scratching, pushing, grasping and letting go of an object, and grasping and keeping an object.  Break down large tasks into small skills.  Most importantly, adapt bath time so that your child can be active.

BathWashClothMaterialsHere is a unique way of getting a child interested in manipulating a washcloth that you can make at home. You will need a wash cloth, needle and thread, and four plastic rings. Sew the rings onto the washcloth so that the rings can lift away from the washcloth. This will allow you to attach items to the rings. You can position as many rings as you choose on one or both sides of the wash cloth. Using plastic rings will allow you to throw the washcloth in the washing machine and dryer.   Attach items (beads, hair ties, etc.) to additional plastic rings. Using keyrings, attach these items to the rings on the washcloth.  Now, when a child is in the bathtub, the toys on the washcloth may attract the child to either the washcloth or the items on the cloth.  Once the bath is over, simply remove the items to wash the cloth with your laundry.

In this video, Patty Obrzut, OTR, is using a large tub to demonstrate what a child might do in the bathtub. For children who are sitting in a bath chair, you may place the washcloth across the stomach or chest.  This may help to keep the child warm in the tub.  A child can scratch the surface of the cloth, move his or her fingers across the cloth, or manipulate the objects.  She also attached a buncher between two of the rings.  This allows an adult to place the washcloth on the hand of a child if desired.  Remember, children develop fine motor skills by first scratching, pushing, then grasping and letting go, and grasping and keeping.

During independent play, offer the child a variety of different types, sizes and shapes of sponges to play with in the water. This could happen in the bathtub, outside in a kiddie pool, at a water table or on a tray with some water. Let the child have opportunities to explore by patting, scratching, poking, grasping or squeezing the sponges. Another activity using sponges can be done by giving the child wet and dry sponges to compare. If the child likes to throw, give her a bucket of wet sponges to throw at an outside wall. 

In this video, a buncher is added to a sponge, again for children who want to hold onto a toy, but who cannot maintain grasp. Children with limited movement may just scratch on the surface, while other children may push to hear the water rushing out of the sponge, or grasp and squeeze on the sponge.  The wash cloth remains in the tub, to build on previously used skills. The child is learning about size, shape, texture, and matter, but above all the child is active.

Some children may need to use a shower sprayer in their bath routine. A buncher can be placed over the hand-held shower head. (A buncher can be altered to attach to object of varying size.)  Let the child independently bringing the shower head up to his mouth to take a drink or get his or her face wet.  Eventually he or she can be encouraged to move the spray to other parts of his body in play.  In the long term, he is learning to rinse himself off during bathing. 

Bathtub and outdoor water play is always a good idea, and you get the additional benefit of helping the child learn skills needed for washing and bathing.  Here are some eay ideas for this type of water play:

    • If you have an older tub made from cast iron, you may be able to use magnetic toys during bath time. These toys can be pulled off and put back on very easily. If you don't have a cast iron tub, you can use suction cups to stick to the sides of tubs or bath walls. Items like suction cup soap savers or soap dishes, or toys like sqigz (available on-line, Kohls or Target) are great for learning to push and pull.  You can also use suction cups with plastic hooks or suction cup grab bars to hang objects from the side of the tub.  You can make a mobile from a dowel rod or yard stick.  Attach toys to hang from the mobile, so that children can kick their legs or move their hands to touch the objects. 
    • Provide suction cup toys, water toys such as balls that soak up water and brushes of varying sizes and shape for water play.
    • If a child scratches the surface of a brush, this is a great way to introduce nail brushes to help keep fingernails clean. 
    • Once a child knows how to grasp and can hold on and keep objects, he or she can begin to engage in more complex ways of water play. Simple cups, bowls and pitchers are great ways of learning to fill or pour. Let the child practice pouring from various size cups and containers.
    • Allow a child to explore and bang. Don’t forget to add simple objects like golf balls or ping pong balls to the child's bathtub or water play. Children will learn that things float and sink. 
    • Provide bowls and containers along with objects to allow the child to learn to put things in and take things out. 
    • Save your empty shampoo bottles or soap dispensers and add them to your bath tub toys. Fill the bottles up with water and allow your child to practice squeezing and pumping the dispensers. You may also want to include ketchup and mustard squeeze bottles to this collection.
    • You can use a hair tie in place of a buncher to allow the child to hold a corrugated straw. If the child taps or rubs the straw along various surfaces it makes an interesting sound.


Undressing and Dressing

Every child can participate in some way during dressing and undressing. It is important to break down dressing tasks into simple skills that a child can do.  Start with gross motor movements like moving an arm or leg, and then begin to introduce easy fine motor skills.  These motor skills should be practiced in daily activities and not just at dressing times. This process can take weeks, months, or in some cases, years to accomplish. Always let your child be successful in many, many attempts before moving to a more difficult task. 

Undressing

Before children learn to put clothes on, they learn to take clothes off. Taking off is always easier than putting on. Let you child have the opportunity to be active during dressing in anyway they can. If you have a shirt pulled mostly off the child's head, can he pull it the remainder of the way off? Can she bend the leg or pull the foot to remove the shoe or sock while you hold on to it? Any little bit of action on their part is the goal.

In this video you can see that Patty Obrzut, OTR, has placed a Velcro strap of bells on Rylan’s feet. This encourages Rylan to kick his legs and feet. 

The same motion of kicking the legs and feet can be used to remove pants or socks. For a child to participate, the adult needs to pull the pants all they way down until they are almost off the feet, then allow the child to kick the pants off the feet. For socks, pull most of the sock off the feet, so that minimal movement is needed to remove the socks. Remember that a child will only learn to help if he or she is given the opportunity and the time needed to do so.

During undressing, allow your child to try and pull a shirt from the face area. If your child is lying down, remove the shirt so that it is lying loosely across a child’s face.  Then wait and give the child enough time to attempt to pull the shirt away.  This task may be a little easier to perform in sitting.  Position the shirt in the same fashion and allow the child to pull the shirt from his face.  Over time, slowly lower the shirt further down the head so the child has to pull a little harder.  With continued success, eventually the shirt placement can be down around the neck.

You may have necklaces or neck ties in your home of varying sizes. Allow your child to play games of taking them off or putting them parts of the body.  This will help a child develop the skills necessary for taking off or putting on a shirt. 

Drape lightweight scarves or cloth over the child's head, making sure part of it is near where the child can try to grasp. Let them pull the scarf off. This might grow into an adult child turn-taking game similar to peek-a-boo.

Put various hats or caps on the child's head, and let him or her get it off.  In this video, you will see how a child might first learn to take off or put on a hat.  Instead of using a hat, a child may pull something else off his head.  Here tissue paper, pots and pans are used. Introduce large sized hats. Most importantly, allow your child to problem solve getting clothes off and on during play.

Dressing

25 dressing shoesWhen children are first learning to dress, it is good to give them practice putting on articles of clothing that are over-sized. This is why dress-up centers are so great for all kids, no matter their age. You can include things in this area like hats, wigs, shoes, shirts, tutu skirts, scarves, neckties, sunglasses, earbobs, flower leis, shawls, necklaces, socks....the list goes on  and on. Just like so many Grandma's know, an old trunk or suitcase full of clothing is a great place to while away the hours.

During play, allow your child to interact and manipulate dressing items. Give your child shoes of many types and sizes.  It is much easier to put on an adult’s shoes than it is for a child to put on his or her own shoes. You may put items inside the shoes for removal. You can use tissue paper, balls, or socks, anything to encourage your child to take apart and put together.

26 dressing slot toysFasteners used in dressing require very complex fine motor skills. These skills are learned in play. Once your child can grasp and let go, start to introduce toys or objects that encourage taking apart and putting together.  These simple toys have slots in them.  A child who masters these toys will eventually be able to put a button through a button hole. You might also use interesting coin banks that will allow for large coins or metal washers to fit inside. 

Here is toy you can make for your child. Button holes are sewn into material, and the material is mounted on a frame.  This frame can be placed inside or over a container. As you can see in this video, the button holes are very large to make it easier for the child to practice putting items through the holes. Attaching some of the buttons on elastic, keeps the buttons accessible.  Remember a child needs to repeat and practice putting a button or other small objects inside slots many times before he or she masters this skill. 

For a child to work any fastener, he or she must first be able to take apart and put together. Use simple toys like pop beads and bristle blocks to help your child get that practice.  Then get more complex like items like snapping toys or legos.  Find or make toys that have snaps, zippers, buttons or clasps.  Use containers of all shapes and sizes that open and close.  Old glass cases, wallets, and purses are wonderful toys to explore.  Place objects inside the containers for your child to discover once opened.  Initially leave some of the compartments open, then start to close them partially or completely.  Containers that have lids to snap on and off, tops or panels to open, and lids to screw on and off, also help to develop the fine motor skills necessary to work fasteners.

Finally, to encourage your child to develop dressing skills, introduce activities at your child’s developmental level that support putting together and taking apart. After all, that is what a fastener does.  In this video, you will see Patty Obrzut, OTR, manipulating various objects that are related in some way to fasteners.