- Do with the child not to the child - remember all activities are also learning experiences.
- Establish a toilet training routine - unless told otherwise delay in toilet training is not a medical experience, but usually a lack of opportunity / experience.
- Encourage hand / eye co-ordination - ask children to reach for things; don't just give them to them.
- Always give more time to achieve any physical task.
This information focuses on the physical practicalities of everyday life. It highlights how children with cerebral palsy are just like all other children and that simple solutions are often the most effective. Sometimes it is a long-standing approach to a child that has created the limitations. Some people find it tempting to over-protect a disabled child. It is easy to make assumptions about capabilities. Children with cerebral palsy are usually much more robust than we think! The ideas here are only suggestions. Every child is unique, and you - working in partnership with parents and professionals - will find particular ways of dealing with these practicalities that work for that child!
Handling a child with cerebral palsy
This section is about how you lift, carry, hold and position a child and learn to control any muscle stiffness or uncontrolled muscle movements. Obviously the best way to handle a baby or young child depends on age, type of cerebral palsy and how the body is affected. Here are some suggestions, by no means exhaustive:
- Try not to move the child suddenly or jerkily. The muscles may need time to respond to changes in position.
- Some children's muscles tense (spasm). Let muscles tense and relax in their own time - don't force movements.
- Fear can make muscles spasm worse, so give the child as much support as he needs when you are handling him, being careful not to give him more support than he needs.
- Whatever his size or level of impairment, make sure that he spends time in different positions
- Try to position the child so that he can see what is going on around him.
- Many physically disabled children are greatly advantaged by properly fitting and supportive seating.
- As a general rule feet should be flat on the floor, knees bending at right angles, with hips firmly against the back of the seat. Some children benefit from chairs with arms.
- Some children are particularly sensitive to losing their centre of gravity during rapid growth spurts and they can become clumsier and may be more disorganised.
- Physiotherapists and occupational therapists will advise on the appropriateness of any arrangement for an individual child. They may need to show staff how to handle or carry a child in a way that will help him develop the best possible control over his body, and prevent staff back strain or injury.
"People assume that if a child is disabled they want to spend all day in the same place - but disabled children have just the same aspirations - they want to see the changing world around them like everyone else. They just need physical help to get there! Parent
Eating and mealtimes
Some children with cerebral palsy cannot suck and swallow and chew easily, so eating may be messy. It may also take longer but it is important to take time to ensure that the child has a healthy diet. A health visitor can advise, and a speech and language therapist can give specialist help and support if a child has difficulties when eating. Staff may be the first to encourage a child to feed himself or to make choices about food and drinks. There are special cups and pieces of cutlery that may be helpful. They may already be in use at home or parents might have brought them in, but a health visitor or occupational therapist will be able to advise. Brushing teeth is particularly important when children have eating difficulties, since food can easily get stuck in their teeth and gums, and this can lead to tooth decay and gum disease. It may be worth checking the roof of the mouth if food has a tendency to become lodged there. Try to help the child brush his teeth after every meal and cut down on sugary food and drinks. "It is a good idea to focus on low-tech aids that all children can use that don't highlight differences - things like Velcro and rubber suction mats." Parent Scope has general factsheets called Mealtimes and Dental care with more information available. Tel: 0808 800 3333 or visit the Scope website.
Going to the toilet
Toilet training may be more difficult for a child with cerebral palsy. For example, it may be hard for him to relax or use his muscles to empty his bowels. Continence can sometimes be a problem, too. A therapist or health visitor can give him help and support. Scope has a factsheet, Coming out of nappies, which contains more information. For specific advice about continence, you can contact the Continence Foundation Helpline. Tel: 020 7831 9831. You can also call National Action on Incontinence. Tel: 020 7700 7035.
Getting dressed or changing clothes can sometimes be difficult for children with cerebral palsy. It is likely that parents will already have discovered the practicalities of loose, comfortable clothing. Velcro and elastic can be easier to manage than buttons and zips. There are also specialist suppliers who design clothes with the needs of disabled children in mind.
- Always put the clothes on the most affected part of the body first.
- If her legs are bent before putting on socks and shoes it may help ease any stiffness in her ankles and feet and her toes are less likely to curl under.
- Encourage her to do things for herself, even if it takes longer, and give lots of praise for every achievement, however small it is.
See also HemiHelp's information on Dressing, shoes and Scope's website along with information sheets about fatigue management and distraction reduction, which may support all the areas above. A ueful reference to use alongside this is The Dignity of Risk: a practical handbook for professionals working with disabled children and their families, 2004, Council for Disabled Children, ISBN 1904787223, www.ncb.org.uk/cdc/home.aspx This book aims to promote the inclusion of disabled children in community life. HemiHelp's Pre-school information and parts of the primary school information can also be used for practical support.