Children with complex medical needs or motor impairments may experience many challenges in bathing, showering, and toileting. In fact, bathing, basic personal hygiene, and toileting can be some of the most complex activities for children and their caregivers.
The challenges can include:
— Moving the child into the best position for bathing, showering, or toileting, depending on the task.
— Providing appropriate postural and positioning supports for safely completing activities and tasks (i.e., functioning).
— Ensuring the child’s pressure and skin integrity management, and comfort needs are met.
— Promoting independence in self-care over time (if this is an appropriate and person-focused goal).
These challenges can change over time – as the child grows and changes, as the caregiver’s capacity to provide assistance changes, or as other things change, like the home environment.
Bathing & Showering: Safety & Convenience Questions
Bathing is an important activity of daily living. For children, bath time may also be an opportunity for play with parents, caregivers, and siblings.
Some children with complex needs are able to safely bathe in a bathtub, using assistive products such as tub-sliders, bath boards, and bath seats. These can provide support that allows for personal hygiene and play.
Often, the biggest initial challenge is safely lifting the child into position for bathing! The caregiver may have more difficulty lifting, twisting, and bending with the child after bathing, when the child’s skin is wet and slippery. Hoists and ceiling lifts can be helpful and provide safety for both the child and caregiver. These will, however, need review and perhaps replacement as the child grows and changes.
An alternative to bathing in a bathtub is to bathe or shower in a roll-in, stepless, or accessible shower stall. With an accessible shower stall, it becomes possible to use static or mobile shower chairs for showering. Static shower chairs do not have wheels and aren’t designed to be moved with the child in place. Although they may be useful for showering, they may present problems in terms of transfers – particularly in the confined space of a bathroom.
A more convenient and practical solution is a multi-use product such as a Mobile Shower Commode Chair (MSCC). MSCCs are similar to wheelchairs and are designed to get fully wet in a showering environment.
MSCCs also include a toileting function (e.g., an aperture or hole in the seat), so the chair can be used as a commode (with a pan placed underneath) or rolled back over a toilet. One big benefit here is that it eliminates the need for separate assistive products for showering and toileting. The MSCC can be used for both.
Being mobile (on wheels), MSCCs can be moved to different areas depending on activities. Transfers on and off the MSCC can be done safely, for example, in the bedroom, and then the MSCC can be propelled or maneuvered to the bathroom, shower, or toilet as needed. Not only is this safer, but it also eliminates multiple transfers in the cramped areas of the bathroom or toilet.
Another big benefit of some MSCCs for children is that they can be configured, adapted, or adjusted to address the child’s unique postural and positioning needs.
The benefits are many for the child and caregiver. First, the child can sit comfortably and safely, and be able to relax and enjoy the showering experience. Second, the right postural setup can support functioning, and potentially independence in some or all tasks in time. Third, MSCCs that are configurable and adjustable can be changed over time and adapt to changing needs and preferences. For example, MSCCs with an add-on self-propelling kit can allow the child to gradually take on independence in propelling or maneuvering. A tilt-in-space feature can be used to enhance the child’s seated position and safety, so the child can sit with less supervision and enjoy some privacy.
Postural Considerations for Toileting
MSCCs are usually designed to wheel over the toilet. Some MSCCs are a fixed height, in which case it’s crucial to check that the chair is high enough to clear the toilet. Most MSCCs offer height adjustment, so the height can be optimized for fit over the toilet (to allow access, but not create splashing) and transfers (for example, to/from a bed).
Postural supports are crucial for positioning the body in a safe, comfortable, and optimal position for going to the toilet, especially for bowel movements. One of the challenges in MSCC seating is that the base frame must be wide enough for the chair to fit over a toilet. The MSCC base usually needs to be at least 18 inches (46 cm) for this. However, a seat back width of 18 inches (46 cm) will be far too wide for most children, and even for adults!
MSCCs will usually need to be configured with either postural supports for the trunk or custom-molded seating to ensure the child’s torso is properly supported. Raz MSCCs offer a unique solution – modular back frames with “reach-over” mounting plates that are bolted onto the base frame. The back frames can be up to 4” narrower than a standard base frame width to accommodate smaller children.
Another crucial component of MSCCs is the seat. The shape and position of the aperture, the seat’s contouring and padding, and the seat’s size all directly affect toileting. These features also impact safety, pressure and skin integrity management, and comfort. It’s important that the seat is reviewed regularly, and adjusted or replaced as the child grows and as their postural, functional, and skin integrity needs change. Assessing comfort (or the absence of discomfort) can be trickier, especially in cases where children are unable to clearly communicate their discomfort.
Adolescence & Additional Hygiene Activities
As children reach adolescence, personal hygiene and self-care activities may change as a result of puberty. Two activities in particular are shaving and managing menstruation.
Both involve different tasks and therefore skills and support. Further, adolescents increasingly want privacy in the bathroom during this developmental stage. MSCCs may need to be reconfigured, adapted, or adjusted to enable these changing needs in activities and personal preferences.
For children with medical issues and/or motor impairments, bathing, showering, and toileting can become very complex activities. Many MSCCs are multi-use assistive products that can be configured, adapted, and adjusted to the needs of the child, both now and in the future. MSCCs can provide postural support and positioning, ensure function and safety, address pressure and skin integrity management concerns, and facilitate comfortable experiences in toileting and showering, both now and in the future.
Editor’s Note:This story is sponsored by Raz Design.