Personal Hygiene and Toileting
Personal hygiene includes washing hands, covering your mouth when you cough as well as keeping clean. It is also about dealing with things like body odour and bad breath which have personal social implications.
Children and young people learn best from parents/carers at home as role models demonstrating good hygiene habits. Children learn that habits such as having regular baths or showering, cleaning teeth and washing hands regularly are important. Teachers will reinforce this when explaining that keeping your body clean, especially your hands, is part of staying healthy.
Good hygiene habits in childhood provide a foundation for good hygiene as a young person grows. If children are given more responsibility when younger and taught to wash themselves and learn from an early age when clothing is changed, it is easier to build on this later.
Adolescence is a time when body changes means that personal hygiene will need to change too. Young men and women need to take extra care with hygiene. If they are prepared in advance for the changes that will happen they can also be introduced to items they will use e.g. shaver, deodorant, sanitary wear etc. Early introduction, before they become necessary, may allow young people with autism to investigate and accommodate any sensory issues. Some young people with autism will have a heightened sense of smell or touch which can make some aspects of personal hygiene uncomfortable. The feel of water from a shower, the smell of particular soaps or shampoos and the texture of some towels may all have an impact.
Although all teenagers have the same basic hygiene issues there will be a need to address some specific issues for:
Girls will need help to manage their periods. For example, parents might need to talk about how often to change her pad or tampon, and parents and school will have to discuss how to dispose of it hygienically.
Boys will need advice about shaving (how to do it and when to start), looking after their genitals, and about bodily fluids. Parents might talk to their son about wet dreams and how to clean up hygienically afterwards.
Some areas of personal hygiene which often require additional more individualised support for children and young people with autism include:
Toileting can be a difficult and for some embarrassing topic to discuss. Families may be embarrassed to explain that their child who is no longer a toddler may experience difficulties with toileting and may feel pressured by societal expectations. Also, practitioners may not appreciate that this is an area of difficulty experienced by autistic learners and therefore may not have the understanding and knowledge to support their learner and their family.
The process of developing a toilet routine can take longer for autistic children and can involve its own particular challenges. For example, autistic children:
- Do not have the same social motivation to want to use the toilet in order to be like people they know
- May not know when they need to go to the toilet
- May like the sensory experience of smearing
- May not see the value in changing to use the toilet after using nappies for a number of years successfully
- May find the sensory experience of going to the toilet very stressful – this could be due to the physical environment, using different toilets, loud hand dryers, smells of cleaning products
- May find the physical experience of going to the toilet stressful
- May struggle to communicate that they need the toilet or may not recognise the signs that their bladder is full until the very last moment
- Specific bowel and bladder continence problems
- May find it very difficult to wipe themselves properly.
However, with patience and appropriate structured support many autistic learners develop independent toiling skills.
- It might help an autistic learner to know why keeping clean is important, because they might not fully understand the social rules behind personal hygiene. For example: ‘We sweat more when we reach puberty. Most people don’t like the smell of sweat, so we wash regularly. If your body and breath smell ok and your clothes are clean it can help you to fit in with other people’
- Schedules or charts which break tasks (such as showering, shaving, using deodorant and cleaning teeth) into small steps can make it easier to learn hygiene: you might use words, pictures or both
- You could cover the whole routine – for example, a morning routine might be shower, wash face, brush teeth, put on deodorant, brush hair
- Daily charts might record times of day e.g. morning, before meal, bedtime and type of activity – wash hands, shower or bath, hair washing
- Teachers should incorporate Keeping Clean/ Hygiene into daily routines where possible
- Speech and Language therapists can help to create Social Stories for personal hygiene tasks
- Having a personal toiletry bag in the bathroom or toilet, with instructions, can be useful
- Identify a specific toilet in school where items are kept, with reminders of routines
- Provide information on why we need to keep clean in terms of health
- A sensory diary may help identify smells, textures, adaptations which help individuals
- Referring to a calendar with particular washing days identified e.g. bedding.