How to Bathe Your Kid with Medical Issues by Susan Agrawal

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1 How to Bathe Your Kid with Medical Issues by Susan Agrawal How hard can bathing a kid be? Well, if your kid has medical issues, motor impairments, or medical technology, it can be surprisingly hard. And if your child has all three, it can be downright impossible. This article will describe all the various ways you can bathe a child with complex medical issues, suggesting the pros and cons of each system. First we will tackle the issue of getting your child into the bath or shower, and then we will discuss the available styles of bath chairs, shower chairs, and adapted bathtubs. Getting into the Bathtub or Shower The first challenge is just getting your child into the bathtub or shower. Small children can be carried and lifted with no problem, but once children reach 30 or 40 pounds, it is time to think about a system for lifting your child. Wet children, especially those with muscle tone abnormalities or movement disorders, are unbelievably difficult to lift safely. For safety reasons, children should have a secure system for transferring into the bathtub, bath chair, or shower chair. Ceiling lift with a Comfortline height-adjustable tub Copyright 2012 by Complex Child E-Magazine. All Rights Reserved. This document may be distributed for educational use only with proper citation.

2 2 While many families use a portable lift such as a Hoyer, these lifts are rarely helpful in transferring children into a bathtub. Lifts are designed to slide underneath medical devices like wheelchairs, beds, or standers, and it is impossible to slide underneath a bathtub. These lifts may be used to transfer to a mobile shower chair or a bath transfer system, but are otherwise not particularly beneficial. Ceiling lifts are much more helpful for transfer into the bathtub. These lifts run on ceiling tracks, often from the child's bedroom to the bathroom, and will transfer a child from the bed to the bathtub with ease. There are several bathtub transfer systems available on the market, including two models made by Columbia Medical, and another incorporating the Snug Seat Manatee bath chair. These systems allow a child to transfer from bed or wheelchair onto a bath chair on top of a trolley. The bath chair then slides seamlessly into the bath tub, allowing easy bathing. Some models include a detachable trolley, meaning you can load the child into the bath chair anywhere, while others need to be loaded next to the bath tub. Columbia Medical Transfer System Some children may be able to transfer with simple assistive devices, such as grab bars, rails, and similar products. Other options include bath seats that raise up for transfer and then lower back into the bathtub, and simple plastic transfer seats. Shower Chairs Many children with motor impairments benefit from using a shower chair that can be rolled into a roll-in shower. In most cases, the roll-in shower will need to be customized, as most shower stalls have a lip or threshold that keeps the water in the stall. This lip cannot be navigated easily by a shower chair. Families typically design roll-in showers as separate stalls without a lip, or families may simply place a drain in an open portion of the bathroom and use the entire bathroom as a shower area. Children are transferred into a shower chair from their beds or wheelchairs, either directly or using a ceiling or portable lift. The shower chair is then wheeled into the shower for bathing.

3 3 Bath chair with shower trolley Shower chairs come in a wide variety of styles, including bath chairs on trolleys, combination shower chairs with commodes, or bath chair-commode-trolley combinations. The most common style is a standard bath chair that can be placed on top of a cart or trolley to raise the height of the chair and make it mobile (see picture above). The child can be transferred into the chair and simply rolled into the shower. Also common are one-piece units that combine an upright commode for toileting with a shower chair (see picture below). Finally, Columbia Medical makes a bath chair with trolley or transfer system and an integrated commode that can be used by children with more significant motor impairments. Flamingo Shower/Commode A regular stationary bath chair can also be used in the shower, though these are typically lower in height and cannot be moved to facilitate transfers. Some have stationary risers or a tub stand available to raise the height.

4 4 Bath Chairs Bath chairs are adaptive devices that allow a child to be placed directly into the bathtub, usually at a lower height than a shower chair. They range from simple back supports to full-length chairs that support the entire body. Columbia Medical High-Back Bath Support If a child actually wants to be fully submerged in the water, a simple back support is ideal, as it allows a child to play in the water. Both low and high back supports are available from a variety of manufacturers, with virtually all including a seatbelt. Some more supportive bath chairs can also be lowered so they are almost flat in the bathtub, but you still need to fill the bathtub up quite high in order to submerge the child. A few newer products, such as the Snug Seat Penguin and Otto Bock Robby, are beginning to allow children to receive full support while being fully submersed in the water. Penguin Bath Chair Most bath chairs position children higher up in the bathtub. These tend to be very adjustable, with a reclining backrest, adjustable leg rest, height adjustable legs, and various positioning aids and belts. Some families keep them low in the bathtub so the child can play in the water, while other families choose to keep them up high, showering the child with a handheld shower at a height more comfortable for the caregiver. Some have a tub stand available to raise the height of the child even further.

5 5 Manatee Bath Chair Adapted Bathtubs There are a few adapted bathtubs designed specifically for children with special needs, as well as numerous walk-in bathtubs with a side entrance door. These range from the Snug Seat Orca, a simple raised bathtub for small children, to products such as the Comfortline from TR Equipment (shown above in lift picture). The bathtubs from TR Equipment raise and lower to make bathing more comfortable for the caregiver. You can also use a standard portable lift with some of these devices, since the lift can be positioned under the raised bathtub. Orca Tub Walk-in bathtubs have become more readily available since they are marketed toward senior citizens. These bathtubs allow you to replace your normal bathtub or a shower with a side-entry bathtub model. This eliminates the need for a child to climb into the bathtub, and can help facilitate transfers for children who only need minor assistance. Some models even included an integrated chair lift within the bathtub that will lower the child to the floor. Bed Bath In some circumstances, a bed bath may be the only option. There are many products available to help make a bed bath easier and more successful. Microwaveable disposable

6 6 washcloths make bed baths very easy, but are often not covered by insurance. Dry shampoos that do not need to be rinsed out have also become more readily available. In-Bed Head Wash System There are several products on the market that can be used to wash hair in bed. These include the EZ-SHAMPOO basin, an inexpensive inflatable basin, and several hard plastic basins, such as the In-Bed Head Wash System, that run in the $ range. The Technology for Long-Term Care website includes a nice selection of available models (