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Task Analysis – Independent Bathing in Children

independent-bathing-step-by-step-analysisThe majority of individuals shower or bathe independently for personal hygiene reasons and as a stress reliever.  The calm, peaceful warm shower or tub can be very relaxing and purposeful.  When motor skill deficits are present in children, bathing can be a very complicated, arduous task.  When you stop and think about bathing and showering, you start to realize it requires extensive fine motor, gross motor, sensory processing and visual perceptual skills.  In order to for children to accomplish independence with bathing, breaking the skills down into a step by step analysis can be beneficial to determine where certain skills need to be practiced or modified.  Here are 4 different task analysis for independent bathing in children.

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STEP BY STEP ANALYSIS OF BATHING/SHOWERING – GROSS MOTOR SKILLS

  1. Get a towel – walk and carry a towel
  2. Get undressed – removing clothing requires balance and coordination skills
  3. Turn on water – reaches forward while maintaining balance
  4. Transfer into shower or tub – lifts leg high enough to clear tub, balance on one foot and step over the tub
  5. Stand in shower – maintains balance on wet surface
  6. Sit in tub – lowers body down into tub and positions legs
  7. Clean body with soap – reaches down and around to clean body while maintaining balance
  8. Rinse body clean – turns body in shower or lowers extremities in tub to rinse
  9. Wash hair – raises arms up overhead to wash hair and maintains balance while eyes are closed
  10. Rinse hair clean – extends neck to rinse out shampoo
  11. Transfer out of shower – lifts leg high enough to clear tub, balance on one foot and step over tub
  12. Dry off with towel – reaches down and around to dry off body without losing balance
  13. Get dressed – maintains balance and coordinates getting dressed (see previous post on gross motor skills and dressing)

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STEP BY STEP ANALYSIS OF BATHING/SHOWERING – FINE MOTOR SKILLS

  1.  Get undressed – manipulate any fasteners on clothing
  2. Turn on water – rotation of the hand to turn the faucet on
  3. Pick up soap – grasp the soap so it does not slip out of the hand
  4. Hold soap – grasps soap while washing body
  5. Open shampoo – isolate the muscles in the fingers to open a flip lid or rotation to unscrew a cap
  6. Hold shampoo bottle – contract the muscles in the hand to hold the weight of the bottle
  7. Squeeze shampoo out – has the strength and graded muscle control in the hands to squeeze an appropriate amount of shampoo out
  8. Rubs shampoo into hair – isolates fingertips to rub shampoo into hair and scalp
  9. Rinse shampoo out – opens hands to rinse shampoo out
  10. Wash with wash cloth – wrings out wash cloth to wipe face
  11. Hold wash cloth – grasps wash cloth while wiping face and/or body
  12. Turn off water – rotates faucet off

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STEP BY STEP ANALYSIS OF BATHING/SHOWERING – SENSORY PROCESSING SKILLS

  1. Turn on water to proper temperature – determines hot versus cold
  2. Hear water running – auditory system tolerates the sounds of running water
  3. Wash body – tolerates tactile input of soap
  4. Smells shampoo or soap – olfactory system tolerates the smells of shampoo and soap
  5. Use wash cloth – tolerates tactile input on skin of wash cloth
  6. Leans head back to wash hair – vestibular system tolerates head being tilted back
  7. Wash hair – tolerates water on head and over face
  8. Wash face – tolerates tactile input to face and closes mouth to avoid soap in mouth (sensation of taste)
  9. Towel dry – tolerates the feel of the towel over the body

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STEP BY STEP ANALYSIS OF BATHING/SHOWERING – VISUAL PERCEPTUAL SKILLS

  1. Find hand soap, shampoo, washcloth and towel – visually locates all items necessary for bathing
  2. Turn on/off water – uses eye hand coordination to reach for faucet
  3. Step into shower or tub – visual spatial skills needed to gauge how high to step over tub
  4. Reach for shampoo, soap or wash cloth – requires eye hand coordination skills
  5. Use shampoo or conditioner – requires visual discrimination skills to determine which bottle is which
  6. Get dressed – requires extensive visual perceptual skills (read more about visual perceptual skills and dressing here)

READ MORE about tips and strategies to facilitate independent showering and bathing for a child with special needs.

Check out Personal Hygiene Rubrics (includes bathing and showering rubrics) for assessment at initial evaluation and annual reviews, progress reports, establishing entrance or exit criteria for therapy and creating measurable goals.

This post is part of the Functional Skills for Kids series is on personal hygiene.  This series is a 12-month long series written by occupational and physical therapy bloggers on the development of 12 functional skills for children.  Stop by to see what the other occupational therapists and physical therapists in the Functional Skills for Kids series have written personal hygeine.

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Tips and Tricks for Teaching Hand Washing with Kids  | Growing Hands-On Kids

I can brush my teeth! Tips for Tooth Brushing and Oral Care!  | Your Kids OT

Screen Free Quiet Time When Daytime Naps are History  | Kids Play Space

Tips to Help Kids Learn How to Blow Their Nose | Sugar Aunts

Tips to Help Kids Who Hate Haircuts | Mama OT

Sensory Friendly Tips for Kids Who Have Trouble Sleeping  |  The Inspired Treehouse

Your Child With Special Needs: How to Conquer Showering Independently | Miss Jaime OT

Adolescent Hygiene Challenges  | Therapy Fun Zone