Is every morning a struggle to get your preschooler dressed? This episode of Sensory Chat is for you, particularly if your little one has sensory issues around clothing or struggles with balance, body awareness or fine motor skills. Listen as four international therapists draw on their personal and professional experience to chat over what difficulties your child could be experiencing around clothing and dressing along with some practical tips to try.

TRANSCRIPT

Lelanie

Hello. Welcome to Sensory Chat. My name is Lelanie. I'm an Occupational Therapist and an Advanced Practitioner in Sensory Integration. I'm calling in from Germany.

Amy

Hi, I'm Amy, I'm a Speech and Language Therapist and also an Advanced Practitioner in Ayre's Sensory Integration and I'm calling in from Salisbury in Southwest England.

Angela

Hi everyone. My name is Angela. I am an Occupational Therapist and an Advanced Sensory Integration Practitioner, and I'm calling from Melbourne, Australia.

Emma

And good morning from me, I'm Emma Snowden. I am a Physiotherapist and I'm also an Advanced Sensory Integration Practitioner, and I'm calling in from Warwickshire.

Lelanie

Welcome to this episode of Sensory Chat. Today we're going to be looking at dressing skills in two year olds and what type of sensory challenges we might see in this group of children and what tips can we give you. This podcast is for parents, but it will also be helpful for therapists and teachers.

Amy

So I think when we're thinking about trying to get a child dressed or trying to help a child get themselves dressed, we have in mind preschoolers, we're thinking about two year olds. There is nothing that brings out that terrible twos as much as perhaps dressing. So I'm wondering if we're thinking about things from a sensory perspective, what kind of challenges the two year olds nervous system would be encountering with that whole procedure of getting dressed. Emma, would you like to kick us off?

Emma

Yeah. So there's so many things to consider again, isn't there really. If we just take it straight into getting dressed in terms of the sensory issues, I suppose the first thing most people are going to think about is the sort of texture of clothes, whether the child's going to be able to tolerate that. So there's all those elements of it, but then I think the environment bit as well about in the morning that they're waking up from hopefully a nice sleep, and where's their level of arousal? Are they going to be able to cope with that, or are we going to have to think about getting them up and getting them regulated first? Whether that's up-regulating them, getting them awake, so the sorts of issues around that.

Amy

When you say level of arousal as Sensory Integration Therapists, we know what that means, but obviously a parent might be horrified hearing that. What do you mean when you mean sensory arousal? What do you mean by that?

Emma

So just sort of how alert and how well the child is, are they still very sleepy in the morning like I am? Takes me a lot to get going in the morning, or were they the child that's been awake from 4 o'clock that morning bouncing off the ceiling? So where the child is, is going to really impact on whatever you're going to be doing, basically isn't it. So there's that to consider first, before we even think about getting dressed. I certainly know from my experience of being a parent, it was very much about "let's just get the job done". That's probably not always the best way to do it, particularly if you've got sensory demands, because for that child, probably the last thing they want to do is think about getting dressed at that point. Is that okay? Does that explain?

Amy

Yeah, absolutely. So I'm hearing that kind of almost you're saying in some cases, that kind of urge just to get on with it is a little bit counterproductive and actually it might be worth spending a little bit of time trying to get the child's nervous system regulated enough to be able to cope with dressing, and actually that's going to save time in the long run.

Emma

Absolutely. And particularly if they've got some sensory sensitivities to certain textures and things like that. And also coupled with what you're going to be doing from that point as well, because often this is a big transition for children; waking up in the morning, getting dressed and potentially going somewhere is the massive transition. So there could be other factors like I don't want to be going somewhere or what have you, that could impact that child's desire to get dressed and do what's expected of them. So we do need to look at the bigger picture, and then actually bring it right down to the textures and things of what the clothing is, that's going to be difficult. So there is preparation, I mean, I know a lot of the children I work with, parents have realized this is a really difficult time, and so they will start with some preparation. So that might be some deep pressure hugs in the morning, so big bear hugs. So we using deep pressure there to regulate our nervous system and make it more likely that the child's going to cope with sort of difficult things like funny textures or scenes on socks and things like that. So we can put that deep pressure on, we can also do things like deep pressure massage, and certain vibration can work as well quite nicely to calm the child down in preparation for the actual thing of getting dressed. But that's really only just looking at the texture of clothes that might be difficult, and there're so many other skills involved with dressing such as the actual motor skills needed for it and everything else.

Amy

That's good. Well, maybe we can pick up on that Angela, tell us about the motor skills. What does a child's body need to be able to do in order to get dressed or to take part in getting dressed?

Angela

Sure. Yeah. So it really involves a sequence of tasks, doesn't it? Some kids may struggle with their balance, and dressing can be done in sitting which removes that need for balance, or it could also be done in standing and in that situation, most two year olds would need to put their hands on their parent's shoulders for support to enable them to lift up one leg, to put that through their pants, and then to shift their weight over to the other foot and to put that foot through their pants. And so this idea of balance and having body awareness to be able to put their head through the hole of their jumper, all of these skills or steps involved with dressing, generally need adult support to be successful. And I think one of the tricky things about this age is that they're like, "I can do it", and they want to do these bits independently, all by themselves. So it's finding that balance between providing them with the support that they need, but also either helping them to think that they're contributing or enabling them to play a part, so for little things like zips, it could be that we align the bits at the bottom, we connect the zip to the base, and then the little one can actually do the pulling action and that involves the control of the small muscles in the fingers. So there are little bits and pieces throughout the dressing sequence that we can help our toddlers to practice and develop. But it takes time, it really does take time and repeated success.

Amy

That sounds like what we would perhaps describe as sort of backward training, giving the child the last bit of the process to do more and more. Lelanie, I mean, that works really beautifully when you've got a child who's, who's onboard with the project and really willing to take part but I know you've done quite a lot of research Lelanie, around families and children, where that isn't the case where. Well, dressing becomes a bit of a flashpoint for that.

Lelanie

Absolutely. So one of the things I want to go back through though is what Angela said about body awareness. So this is an experience that happened to me at work once. We had a nice sensory bin and the children were finding objects in all the beans and all the sensory materials and this little boy not two, but older, but still, this shows you what children with sensory difficulties can experience, was really excited to find a finger! He did not make the connection that this was his own finger. And this is actually, if you think about dressing and actually this is having a hand or your where's your foot. That's actually, if you think about the concept trying to get dressed, but you're not even sure where your body is in space, so this is your hand or your foot or your legs that are actually parts of your own body. So think of that and the added challenge of getting dressed. In terms of, to go back to your point about not wanting to get dressed, I think there's a lot of factors that influence that and it can really raise anxiety levels in parents and the children, and they can bounce off each other as well when people don't want to get dressed, and things that can be helpful sometimes is even just a t-shirt with a favourite TV character on can sometimes make a huge difference. Sometimes it's not about the texture or how to get dressed, but just something that the child likes. I remember the age where my own daughter, every second item in our house said Pepper Pig or Ben and Holly's little kingdom on it. And that was fine, that that's how we got dressed. And then you're also thinking about what's comfortable for the child, is it appropriate? I wouldn't worry too much about fancy clothes or over-dressing, if it's comfortable, if it's appropriate for the weather, I would say, stick with it, go with what's easy to wear. I would also add that comfort is key as well for children to be able to play. So all of the, sort of Frilly dresses for girls, for example, think of something that's easy to wear that enables your child to play. That's a different topic though, but it's also easy in terms of dressing. The other thing to add in as well, in consideration of clothes is at two you might start thinking about toilet training as well, which we're not going to talk about in this podcast, but you also want to start thinking about clothes that will be easy for toilet training, which we'll touch on in another podcast. But in terms of strategies for children who did want to get dressed as I think, try and work with them and find what they like. Another helpful tool to understand the concept of dressing is to maybe look at some of the dolls that you get, some of the life-size baby dolls and selection of clothes and lots of opportunities to practice the role play element and I think dressing the baby or dressing the doll would be helpful too.

Amy

I think that picks up on something we've talked about a lot and that one of the things that's hugely helpful and largely overlooked is predictability. So if the child understands what the sequence of getting dressed is, then it's much easier to be part of that routine. You can anticipate what's coming next. I think there's a fine line if I'm thinking about it from a speech and language point of view, there's a fine line between allowing the child to have some control and having some choices versus creating a level of demand that the child can't really cope with on top of coping with the motor demand and the sensory demand of getting dressed too.

So one of the things that I talk about a lot, is it's really easy to overestimate how much negotiation a two year old can manage. So I know those of us who've been locked in a battle of will with two year old children kind of thing, they're brilliant negotiators, but actually, they don't really have the language skills to be able to compromise so they can express what they want and hold to it or release it, but they don't really have the skills to be able to find somewhere that isn't their choice or not their choice. So almost kind of as an adult, if you find yourself getting locked in that battle of wills, you're on a hiding to nothing. And the other thing to remember is that two year old children typically don't really understand conditional language very well. So conditional language is where you say something like if you do this, then you can do that. Or if you don't do this, then this will happen. So, you know, here's the, if what will happen here as a consequence, those conditions, children don't really understand those at two very well. So if you find yourself moving into language, which is kind of promising, "if you just put your trousers on I'll buy you a bicycle" out of frustration or whatever it is, children don't really understand that framing at two, and all they'll hear is "bicycle" here we go. So whatever you're promising, that's what they're expecting. So trying to avoid those I think would be, would be helpful. Any other thoughts Angela? What do you think?

Angela

One of the things that I was thinking about is, I guess, this process of moving into dressing often involves needing to stop something that might be quite fun for the child. And you know, sometimes there's no real easy way around this because you have to go somewhere. And so I guess I'm thinking about preparing the child for this upcoming change and acknowledging that, "Oh, I know you really want to watch more Bluey, but it's now time to get dressed." And then so bringing the clothes over, showing the clothes to the child, giving them a moment to kind of allow that, that idea to sink in, and then. I guess following through with what you've said, you know, so this idea of being predictable and doing what you say you would do. And so that can be quite tricky because it can often result in a child getting upset, because something fun is needing to stop or a favourite thing is stopping. But it's about providing that visual cue, that verbal cue and then, you know, transitioning into the task.

Lelanie

The other risk that I see that really tips parents over the edge, is like taking your child to an open wardrobe and say, pick your own outfit. That is how a colleague's son ended up going to church wearing a Batman suit and his slippers because she didn't have the will to argue with him. So to eliminate that risk, my suggestion is take up the clothes out of the dresser, maybe put it on the bed, or if you really feel that your child needs a choice, limited to two things that are appropriate for the weather or where you're going and just try and stick with it. But it's like taking a child to a candy store and saying, choose one thing. I think is just not going to work really well.

Amy

Yeah, I'm sure this is something we're going to pick up on a lot in a future podcasts. It's something that we say when we're talking about sensory integration all the time, and that is there's so much, you have to pick your battles, you have to pick the thing that's going to make the biggest impact. And quite frankly, if wearing the Batman outfit is going to mean that you get what you need done in the day, there are bigger things to put your attention and put your energies into.

So wrapping up this episode, and I'm wondering if people maybe have a thought or a word of support for parents who are struggling with terrible twos and dressing? Emma, what would you say?

Emma

I think the theme that comes out in most of the things that we talk about really is that predictability and being very clear of the expectations and routine, the structure and everything like that. So I think that's something that's really important for parents to think about with everything, but particularly with dressing. And also from a sensory perspective, always think about that preparation. You know, if you can think about your child, where are they? Because if they're bouncing off the ceiling, getting dressed might not be quite, it's going to be quite difficult for them at that moment. So think about your child in terms of where they're at, what they're doing and support that transition that they need to do. And, and I completely agree, you know, I think there's worse things to be wearing than Batman outfits. So yeah chose your battles!

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