Self Care Skills

What are self care skills?

Self care skills are the everyday tasks undertaken so children are ready to participate in life activities (including dressing, eating, cleaning teeth). They are often referred to as the activities of daily living (ADL’s). While these are typically supported by adults in young children, it is expected that children develop independence in these as they mature.

Why are self care skills important?

Self care skills are one of the first ways that children develop the ability to plan and sequence task performance, to organise the necessary materials and to develop the refined physical control required to carry out daily tasks (e.g. opening lunch boxes, drawing or standing to pull up pants). Self care skills act as precursors for many school related tasks as well as life skills. The term ‘self care’ would suggest that these skills are expected to be done independently and in many cases it becomes inappropriate for others to assist for such tasks (age dependent of course). More specifically, many preschools and schools will have a requirement for children to be toilet trained prior to starting at their centre.

When self care skills are difficult, this also becomes a limiting factor for many other life experiences. It makes it difficult to have sleep overs at friend’s or family’s houses, to go on school/preschool excursions, children may standout at birthday parties if they are not comfortable eating and toileting independently, they may experience bullying or miss out on other social experiences as a result.

What are the building blocks necessary to develop self care skills?

Hand and finger strength: An ability to exert force against resistance using the hands and fingers for utensil use.
Hand control: The ability to move and use the hands in a controlled manner such as cutlery use for eating.
Sensory processing: Accurate registration, interpretation and response to sensory stimulation in the environment and one’s own body.
Object manipulation: The ability to skilfully manipulate tools, including the ability to hold and move pencils and scissors with control, controlled use of everyday tools such as a toothbrush, hairbrush, and cutlery.

Expressive language (using language): The use of language through speech, sign or alternative forms of communication to communicate wants, needs, thoughts and ideas.
Planning and sequencing: The sequential multi-step task/activity performance to achieve a well-defined result (e.g. dressing and teeth cleaning).
Receptive language (understanding): Comprehension of language.
Compliance: Ability to follow simple adult-directed routines (i.e. doesn’t demonstrate avoidance behaviours where the child simply doesn’t want to do it because an adult is telling them to do it and interrupting what they were doing).

How can you tell if my child has problems with self care skills?

If a child has self care difficulties, they might:

Be unable to feed themselves independently.
Require more help than others of their age to get dressed or undressed.
Find it difficult to tolerate wearing certain clothes.
Struggle to use cutlery.
Need adults to open food packaging in their lunch box.
Refuse to eat certain foods.
Be unable to coordinate movements to brush teeth.
Require extensive help to fall asleep.
Choose to toilet only at home where there is adult support.
Be late to develop independent day time toileting.
Show limited motivation for independence in self care, sot hey wait for adults to do it for them instead.

What other problems can occur when you see difficulties with self care skills?

When a child has self care difficulties, they might also have difficulties with:

Following instructions: The ability to understand and be able to initiate the tasks to be done as per requested by others.
Receptive language (understanding): Comprehension of language.
Eating: The physical skill of using cutlery in an age appropriate manner as well as eating a good range of food.
Sleeping: Being able to independently settle and resettle to get to sleep.
Dressing and undressing or assisting with dressing to an age appropriate level and recognising what articles of clothing go where and in what order.
Social skills: Determined by the ability to engage in reciprocal interaction with others (either verbally or non-verbally), to compromise with others, and be able to recognize and follow social norms.
Fine motor skills: Finger and hand skills such as opening lunch boxes, tying shoelaces, doing up buttons.
Gross motor skills: Whole body physical skills using the ‘core’ strength muscles of the trunk, arms, legs such as getting on and off the toilet and standing to dress.
Organisation: The ability to know what a task involves, the materials required, how to collate them such as packing the bag for preschool or even getting dressed.
Learning new tasks and retaining that information for the next time the task is done again.
Executive functioning: Higher order reasoning and thinking skills.

What can be done to improve self care skills?

Visual schedule of the steps involved.
Reward chart for independent completion of tasks (or attempt at, in the early stages).
Small steps: Breaking down self-care skills into smaller steps and supporting the child through each step so that, in time, they can do more for themselves.
Routine: Use the same routine or strategy each time you complete the same task to help them learn it faster.
Consistency: Be consistent with the words and signs used to assist the child, and keep instructions short and simple.
Allow enough time: Ensure that there is enough time available for the child to participate in self care activities without feeling rushed (e.g. practice dressing on the weekend to start with before then doing it before rushing to preschool or school).

What activities can help improve self care skills?

Small parts of activities: Practice doing a small part of a task each day as it is easier to learn new skills in smaller sections.
Observation: Have your child to observe other family members performing everyday self care skills.
Role play self care tasks such as eating, dressing or brushing teeth with teddy bears. Doing it on others can help learning it before then doing it on yourself.
Take care of others: Allow the child to brush your hair or teeth first, before brushing their own.
Timers to indicate how long they must tolerate an activity they may not enjoy, such as teeth cleaning.

Why should I seek therapy if I notice difficulties with self care skills in my child?

Therapeutic intervention to help a child with self care difficulties is important as:

Self care skills are the every day practice of the foundations skills for academic performance not just life skills.
The more these tasks are performed incorrectly (i.e. often daily) the more the bad habits are reinforced.
To support age appropriate independence before these skills become a problem such as at school camps for older children or much desired sleep overs for kind aged children.

If left untreated what can difficulties with self care skills lead to?

When children have self care difficulties, they might also have difficulties with:

Reluctance to attempt not only self care skills, but many other skills that require planning and sequencing. This is then likely to impact on academic tasks and potentially a child’s transition into preschool or school.
More difficulty resolving the difficulties as it becomes harder to change.
Reliance upon an adult helper: A child may become accustomed to having a parent or carer assisting with self care skills to the point it becomes an expectation, so when a helper is not there, they might display behavioural challenges.
As the child gets older and the gap between them and their peers increases, they are more likely to become aware of this gap, resulting in lowered self esteem and possible reluctance to attempt activities for fear of failure. This is a difficult cycle to break so the earlier it is resolved the easier it is to make forward progress.