Personal care
Before Performing Intimiate Care Routines: It is important that you do not spread your own germs! Illness: If you are ill, do not give personal care. Ask a co-worker to take over Coughing and sneezing: Always cough/sneeze into a tissue and dispose of it appropriately. Do not cough or sneeze in the direction of another person.
Skin Infections: If you have cuts, abrasions or a skin disorder, you must ensure that the entire area is properly protected by gloves or a waterproof dressing before giving care. Intimate care is any care which involves washing, touching or carrying out an invasive procedure that most children carry out for themselves but which some are unable to do due to physical disability, special educational needs associated with learning difficulties, medical needs or needs arising from the child’s stage of development. Care may involve help with drinking, eating, dressing and toileting.
Assisting children to use the toilet Control of the bladder and bowel is always a major achievement on the road to independence. Many children with special needs are likely to be delayed in this area of development. There are no short cuts to being toilet trained so patience, understanding and respect for the dignity of the child is of great importance. Most children will gain control of their body functions in their own time.
Some children will never learn bladder and bowel control because of their particular condition. Children with Spina bifida for example or those who are paralysed from the waist down may be permanently incontinent. Children who are not yet toilet trained and those who wear nappies or incontinence pads will need regular care during the day to keep them fresh, dry and comfortable and to prevent soreness. Children who need assistance with toileting will have their own toileting chart with needs and strategies.
There are, however, general points that need to be taken into consideration. • Determine if the child can carry out toileting procedures independently, under supervision or if manual handling is necessary. • Before assisting a child with their toilet needs ensure you have both washed your hands and put on disposable gloves and apron (ensuring the school is aware of any allergies the child may have to latex). Ensuring that you wipe down the toilet seat.
Be aware of the daily routine: - are they brought to the toilet at a specific time? - do they ask to be brought to the toilet? - can the child determine / indicate if they need to be changed? - are there children who are allowed to go to the toilet unsupervised?
If a child needs to be changed: - maintain the dignity of the child - ensure privacy as much as possible - reassure the child, explain what is being done - follow directions / training regarding toileting issues - follow hygiene regulations
If a child needs supervision / minimal assistance: - ask the child to accompany you to the toilet area - give verbal prompts - encourage privacy and dignity i.e. close the door - when toileting is complete prompt use of toilet paper and flushing - prompt hand washing
When Assisting a Wheelchair User to the Toilet Schools must have as required by law a large toilet to accommodate wheelchair users and children with disabilities. Below are tips of transferring a child from the wheelchair to the toilet. Remember hoists may be available within the school and for this specific training is required prior to the use of this equipment and the child may sufficient strength to safely lift themselves up onto the toilet. Hand rails may be sufficient to assist with balance and they may require not assistance with toileting. Some children may require assistance with adjusting their clothing after using the toilet.
Below is some brief information on assisting the child who is a wheelchair user to and from the toilet and who is unable to do this without assistance. Hoists would often be used to assist in the movement of the child from the wheelchair to the toilet seat. Please note the information below is just for your information and in no way is training material.
The wheelchair user should be sitting in the wheelchair, where it is easy for them to transfer from the chair. Check the child is ready and once ready, you should make sure that the brakes are engaged on both sides of the chair before attempting a transfer. • Next remove any type of components of the chair that are in the way of an easy transfer such as the foot rests (if they are removable) or they may swing out to the sides- ensure they are out of the way prior to moving the child. • You should make sure you are ready to “take” the child’s weight in case you need to assist them during the transfer.
You are now at the edge of the wheelchair seat with some minimal momentum building towards the front of the chair. When they are at the edge of the seat, ask the child to ensure that their legs are level with the ground, and that their feet are positioned straight underneath the seat so that they are ready to stand up. • When the child is in position and ready to stand, make sure that your hands are on their hip area. The child’s arms should be positioned on top of the armrests to provide stability and support. Ask the child to lean towards the front of the chair, this will help you handle the weight of the user when they are assisting the person during a transfer. The child should push themselves upward and out of the chair. Their arms positioned on the armrests, and their feet leveled with the ground, which will help ease the pressure of the transfer for all.
• Once they are in a standing position in front of the chair. The toilet should be directly in front of the child when they are in a standing position after exiting the chair. They should face the front of the toilet, the user’s eyes should be facing the wall where the toilet is facing. • Once they are ready to sit down, assist them by providing limb and hip support, then you will want to instruct them to slowly step back until they are positioned to sit in the center of the toilet seat.
Always make sure you allow the child enough time to complete each step without having to struggle with their body weight. If able, the user should be able to lift some of the weight of their body out of the chair during the transfer, to allow an easy transition. You should always double check the brake mechanisms of the wheelchair before attempting a transfer. Remember that some bathroom surfaces may be slippery when attempting a transfer, some may not provide enough support to enable a wheelchair transfer.
Some children with paralysis as stated previously may have no bowel or bladder control and may wear incontinence pads or nappies. The SNA must ensure that the child is clean, fresh and dry at all times during the school day. SNA’s will be required to change the child with facilities being provided within the school enviorns for changing (in a private and dignified manner).