This is one of the most difficult self-care skills to teach a special needs child; maybe the most difficult skill I teach as an OTR.
Why? Three good reasons:
- When they need to do it, they are uncomfortable or sick. Not a great state for learning.
- It isn’t a daily ADL for most kids. Many need regular practice of a complex skill to achieve mastery.
- Timing and sequencing are…everything! And both of those components can be a struggle for a special needs kid!
This skill is an essential ADL skill. It gets more important when a child isn’t in a small self-contained classroom or attends a “special” like art or gym where the teacher isn’t prepared to wipe the nose of an older child. And of course, the grossness and hygiene factors! Snot is disgusting, even to healthcare professionals. We don’t like handling it any more than anyone else. And it is an easy way to spread any respiratory virus. My stomach churns a bit simply imagining a preschooler wiping their drippy nose with the back of their hand and then wiping that hand on the top of an activity table. EWWWW!
I am being hired privately more frequently to teach many of the gnarly self-care skills that a lot of special needs kids have not learned in their educational programs or in their clinic-based OT sessions. One parent told me that her school-based OT as well as her clinic-based OT told her that toilet training isn’t their responsibility. I was dumbfounded. If OT isn’t the specialty that has ADLs as its cornerstone, exactly whose job is it? I think that this mom encountered 2 OTs that have no training or experience in addressing ADL skill deficits, and would not admit it. Or worse…they learned nothing in their training about it! I am so hoping that it is the former, and not the latter. Because once you remove ADLs from our practice arena, we look less critical to the treatment team in many situations. Once you don’t need us, our profession fades away.
OK; off the soapbox and back to teaching a child how to blow their nose!
First, a child who isn’t ready to learn how to blow their nose can be more of the solution today. Make them toss out the used tissue. Then get them to give you a tissue (or 3 for a messy job!) from the box you placed in front of both of you. If there is time, tell them where the tissues are located and have them grab the right amount for the job. This protocol should be familiar to anyone who has read either of my two books on special needs potty training: The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! and The Practical guide to Toilet Training the Autistic Child. Independent self-care skills start with recognizing that you are an active part of the event. No one goes from dropping their car off for an oil change to doing it independently. This skill is no less complex and no less essential in life.
I cannot wait until a child has a cold to teach them how to blow their nose. And I don’t want to, because of reason #1. No sick child is in great shape to learn. It is also why I don’t recommend practicing after dinner. Kids and parents are bushed. Just too tired to get a lot of learning out of a practice session. So I use saline sprays in a bottle. They are cheap, sanitary, and I can model use with my own bottle. Some skills (wiping after a bowel movement, for example) are not going to be modeled in my sessions! Kids are told that the salty water isn’t fun, but it isn’t bad for them, and getting used to it dripping on their upper lip acts as a desensitization strategy. There are kids who are so sensitive that this makes them gag. That is another post on how to manage that degree of sensitivity. So we practice with receiving the spray and sniffing the spray until they can handle it for a very short period. I always follow up nose blowing practice with something fun. A child really has to have a reason to participate in this practice. I bring my “A” game for this ADL skill.
I also use the softest and most absorbent tissues, often bringing my own supply and leaving it in the child’s home. Some kids do better with a soft washcloth. That can add up, so I only suggest it if they are particularly sensitive.
Remember reason #3? The sequence of spray-sniff-wipe is first. I go to Spray-sniff-wipe-blow out of both nostrils next. The final step is Spray-sniff-wipe-blow out of one nostril then the other only when the first 2 are seamless. The bilateral control and respiratory sequence is not easy for any child that struggles with straw drinking or respiratory support for speech.
At every level of teaching, we have to get to a point at which the child can practice at home. They almost always need parental assistance and support to do so. This means a parent has to be in my session and learn the finer points of assistance and cuing. Some take a video of me so that they have a teaching tool for use at home. This addresses the problem in reason #2. This skill needs practice.
Cold and allergy season will be with us soon enough. Now is the time to start practicing!
