It can be challenging for children with difficulties in sensory processing to tolerate routine grooming tasks, such as hair cutting, bathing, nail trimming, and tooth brushing. This may be caused by tactile hypersensitivity (i.e., aversions to messy/wet textures), auditory over-responsiveness (e.g., aversion to sound of bath water running), and more. Below are strategies developed by occupational therapists that can be implemented at home to aid with the tolerance of grooming tasks.
Before the haircut:
- Provide deep pressure to the scalp or neck prior to the haircut to decrease tactile sensitivity and calm the child
- Cue the child to perform calming techniques, such as deep breathing, hand squeezes, or reciting a calming phrase
- Have the child perform deep pressure/”heavy work” activities, such as animal walks or wheelbarrow walks
During the haircut:
- Bring a weighted object, such as a lap pad or blanket, to provide calming proprioceptive input
- Allow the child to sit in the parent’s lap; the parent can provide squeezes by wrapping their arms around the child’s torso to facilitate calming/regulation
- Provide the child with a fidget toy during the haircut
- Have the child bring a preferred toy or book to the hairdresser to facilitate calming
- If the noise of the scissors/clippers bothers the child, provide a noise-blocking/muffling technique
- Wax earplugs
- Playing soft, soothing tunes (i.e., spa music) through earphones
General tips for haircuts:
- Have the child observe a parent or other family member receiving a haircut
- Schedule the hair appointment at a time of day when the hair salon is not busy, or when the child tends to be the calmest/most happy
- Role-play haircuts with your child by giving each other pretend haircuts with your fingers. Stuffed animals may be included as well. The goal is to increase the child’s comfort with the concept of receiving a haircut
- If possible, plan how long the haircut will take and use a visual timer to show the child how much longer the task will last
- Use a visual schedule such that the child is able to understand what will happen before, during, and after the haircut
- Provide a tangible reward following the haircut (i.e., ice cream, a short trip to a favorite park or museum)
Before bathtime:
- Talk the child through what will happen prior to bathing using a calm voice
- Consider filling the bathtub with water prior to bringing the child into the bathroom, as the noise of the water rushing out of the faucet can hyper-stimulating for some children
- Consider personal preferences
- Allow the child to select a soap product that smells good to them when you are out shopping at the store.
- Allow the child to select the water temperature.
During bathtime:
- Provide dim lighting to create a calming environment
- Utilize a waterproof/laminated “To Do” list with simple photos depicting the steps of bathing
- Use a slow, quiet voice to aid in calming the child
- Incorporate fun toys to keep the child engaged (i.e., wind up toys that will move through the water, favorite action figure and simulate giving him a bath)
- Offer the child the opportunity to wash his/her own hair or complete other bathing tasks independently to increase the sense of control over the situation
- Consider getting into the bath with them and modeling bathing activities on yourself
- Bring measuring cups into the bathtub so that the child can control how much water they pour on themselves. This can also be fun for filling, pouring, and stacking!
- Bring a doll into the tub for the child to wash for fun
General tips for bathtime:
- Use the app “iDo Hygiene,” which visually depicts the steps involved in bathing, as well as other self-care tasks.
- For some kiddos with vestibular processing challenges, filling the water to a lower level can provide an increased sense of confidence
- If tipping the head back during hair rinsing is challenging…
- Have the child wear a foam visor or plastic goggles and pour water over their head
- Encourage the child to operate the showerhead him/herself
- Have the child dip his/her head forward, as this can be preferred to tipping back
Before nail trimming:
- Prior to trimming, provide calming proprioceptive input to the hands with putty, a stress ball, or play-doh to decrease tactile sensitivity
- Consider scheduling bathtime before trimming, as this is when nails will be the softest
- Touch their nails with the clippers without trimming to increase their comfort with the idea of using clippers
- Use the clippers to play “This Little Piggy” or count the nails/fingers
During nail trimming:
- Use kid-friendly clippers (i.e., “Nail Whale” on Amazon designed to look like an animal)
- If the noise of the clippers seems to be the cause of the aversion, provide noise-canceling headphones
- Provide input during cutting to override the sensation from the clippers
- Press on the center of each nail during cutting
- Place a vibrating pad or toy over the hand during cutting
General tips for nail trimming:
- Start slow, trimming 1 nail per day to ease the child in and slowly increase their tolerance of the task
- Make clipping nails a part of the weekly routine rather than an infrequent event
- Trial a nail file to evaluate if this tool is less aversive for the child
Before tooth brushing:
- Prior to tooth brushing, desensitize the face by firmly rubbing a warm washcloth over the cheeks, lips, sides of the nose, and chin
- Allow the child to utilize their finger to brush teeth before upgrading to a toothbrush
- Allow the child to pick his/her own toothbrush
- Also prior to tooth brushing, provide calming deep pressure to the arms and legs, progressing towards the face
During tooth brushing:
- Try using a brush with extremely soft or silicone bristles
- Or, utilize a non-flavored, non-foaming toothpaste such as Oranurse
- Try an electric spinbrush, as the vibration provided can be calming and regulating
- Take turns brushing each other’s teeth
- Increased exposure to the concept and allows the child some control over the task
- Brush in front of the mirror such that the child is able to see what is happening
- Make tooth brushing a game – attack on the cavities!
- Incorporate a visual timer
- Start with just a few seconds and work your way up to 2 minutes
- Can also aid in encouraging children who seek oral sensory input to brush for an appropriate period of time, rather than too long
- Count to a specific number each time the child brushes. When the number is reached, brushing stops
- This can be incrementally increased to facilitate tooth brushing tolerance
General tips for tooth brushing:
- Experiment with different flavors of toothpaste to determine which the child prefers
- Consider using no toothpaste initially to increase the child’s comfort with the idea of having his/her teeth brushed
- Start small to prevent overwhelming the child if brushing is extremely difficult
- Start with 1-2 teeth per day, then increase from there
- Trial different temperatures of water to see which is better tolerated orally
- Consider a toothbrush that sings or lights up
- Try brushing teeth while in the bathtub to combine these grooming tasks
Other General Tips
- Perform “heavy work” proprioceptive activities prior to non-preferred grooming tasks to aid in calming, regulation, and participation
- Wall push-ups or pushes
- Squeezes/big bear hugs
- Wilbarger brushing protocol
- Joint compressions
- Animal walks (i.e., bear walk, wheelbarrow walk)
- Carrying a heavy object across the room
- Yoga poses
- Positively reinforce compliance with grooming tasks (i.e., reward with preferred toy after participation in morning routine tasks or in nightly bathtime routine)
- Ensure that the child knows exactly what they are being rewarded for
- Use “First, then” language (i.e., “First trim 1 nail, then toy”)
- Utilize a visual/picture schedule during grooming routines to prepare the child for what is to come (e.g., “iDo Hygiene” app)
- Model the grooming task on yourself to increase the child’s comfort with the task
- Play soft, calming music or sing in a slow, rhythmic tone for calming (e.g., “Ants Go Marching”)
- Allow a video or preferred toy for distraction if the task is highly aversive
In addition to these suggestions, a pediatric occupational therapist can work with your child and family to address specific concerns related to sensory processing and grooming tasks. Contact Chicago Occupational Therapy or call (773) 980-0300 to learn more about our services and how we can help your child flourish and grow.
