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Bathroom aids.


Children are expected to learn to carry out the everyday personal care tasks of washing and toileting -- independently and privately in the bathroom. However, mastering these tasks can be difficult because: (1) bathrooms are usually small spaces that can be slippery and have many hard surfaces; (2) washing oneself or urinating and defacating in the appropriate place can be complicated tasks to understand and remember; and (3) the nature of a child's disability. As a result, parents can spend considerable time and energy in the bathroom assisting young children.

For children who need extra help because of poor coordination, lack of sitting balance, or other disabilities, parents spend much more time and energy in this usually cramped space. As a result, the daily tasks of washing and toileting can be especially stressful.

For an older child with increasing needs for privacy and age-appropriate concerns about his/her body and appearance, needing continued assistance with washing or toileting can become increasingly troubling -- for child and parents. For parents, the task of helping a child with personal care activities can become increasingly physically taxing as well as emotionally stressful. Unfortunately, when children or adults are under stress and/or feel embarrassed, the likelihood of making mistakes increases. All these factors make the bathroom an uncomfortable, anxiety-provoking place.


When a young child can walk around the home unassisted and can use his/her arms and hands effectively, parents still have safety concerns and may want to install: hot water thermostats to prevent scalding; single control faucets; insulation around exposed pipes under sinks; padding around hard surfaces like water faucets; slip resistant floors and bathtubs; door locks that are easily opened from the outside in case of emergency; and towel bars, mirrors or toothbrush holders at appropriate heights to discourage climbing. Emergency call buttons at strategic locations in the bathroom can also be considered.

Getting into and out of a bathtub safely requires considerable physical ability, coordination, good eyesight, and an understanding of the risks of soapy water and other hazards. Although lifting a child into and out of an ordinary bathtub may be possible for some adults without back strain, for most parents it is neither practical nor safe.


Merely entering a bathroom can be difficult for a child who uses a wheelchair or needs the help of another person to get around because: (1) the doorway is too narrow; or (2) the way the door swings open can result in an obstacle. Doors that swing in decrease the maneuvering space inside the room while doors that swing out can be troublesome if the bathroom is entered via a hallway. When possible, sliding doors on tracks can solve both problems.

Even with an adequate doorway, many bathrooms lack sufficient space for turning a wheelchair so that the child can transfer to and from the chair to the toilet or shower. In addition, a sink with pipes and/or a vanity underneath means the child in a wheelchair cannot get up close enough to the sink to reach the faucets and/or use leg or knee faucet controls. There are sinks available which are adjustable in height.

These complications may result in parents carrying youngsters to and from the bathroom and/or lifting children from wheelchairs to the toilet or shower. Here the parent is faced with moving about, lowering, and lifting in tight positions -- and a child who will get larger and heavier.


Grab bars, bath benches, and bath lifts can make bathtubs accessible for some children with disabilities. However, for children with problems of sitting balance or other physical limitations, many parents turn to showers. Of course, in many homes, taking a shower still requires getting into the bathtub.

Grab rails or safety rails, attached to a tub or sink, provide something sturdy to grab; however, sometimes, attaching bars or rails can damage the tub or sink. Grab bars can be placed in various positions along walls (bars must be screwed into studs) to help in moving about anywhere in the bathroom; various textured surfaces are available to make grabbing more effective.

To use bath benches and bath seats, some transfer bench or seat is needed so that the child can transfer from the wheelchair, over the side of the bathtub and onto the bath seat. When seats and benches are combined, these units are sometimes referred to as seating systems. Some bath seats have armrests which can convert to transfer seats. To ensure privacy with a seating system, a space for the shower curtain between the transfer seat and the bath seat is needed.

By using hammock-like bath seats (also called bath chairs) made of plastic, fabric, or foam (so that the water can drain easily) that can be placed on metal frames with legs (adjustable to different heights) and include supports to secure the child, parents can put a child into a tub at a level that is safe for the child and workable for parents (both hands free) giving baths (sponge baths) or showers (usually with a hand-held flexible shower hose). The height adjustments also help parents avoid back strain. Sometimes, a fold down table built along the wall in the shower area can serve as a shower seat (bed). Inflatable bath beds (tubs) are also available and may be convenient for some children.

Various types of bath lifts are available; they operate via water hydraulic, oil hydraulic, or mechanical systems. Some can be operated by the bather with sufficient ability and strength; others require a helping person. Usually the seat (which may have different size and/or weight limits) swings over the edge of the tub and then lowers into the water. The seat and the lift mechanism can be in the tub, alongside the tub, or even mounted on a wall or ceiling; some are portable, others are not. The seat may be adjustable (armrests, seating angle) for safe, comfortable sitting. Some bath lifts can also be used to lift a child onto the toilet.

Shower areas that are separate from bathtubs usually have a threshold which makes the area inaccessible to wheelchairs or special chairs with casters that are called shower chairs or commode chairs. (The term commode chair means the chair can also be used with a bedpan attachment and/or wheeled over an ordinary toilet seat). Any chair with casters or wheels needs a way to lock the wheels.

While it is possible to create a special ramp and a raised floor inside the shower, a wheel-in shower without a threshold (usually with a slanted floor for proper drainage) is ideal. Inside the shower area, when the child can transfer, various shower seats are available (also called shower benches) which are similar to bath seats. It helps to put water controls at seated height and to use shower curtains rather than space limiting doors.

While bathing, products like soap on a rope, wash mitts or soap bags, and brushes or sponges attached to handles can help children wash themselves.


An ordinary toilet seat may be a significant challenge for some children. A variety of adaptations for toileting are commercially available to help the child be as independent as possible and maintain personal dignity. Sometimes, only urinals or bed pans are practical.

When children outgrow potty chairs (including potty chairs with supports, belts, and/or legs), various types of commodes may be appropriate, especially when a bathroom is not large enough for a child to enter it and transfer from a wheelchair. Commodes are available which include torso supports, headrests, safety straps, and other supports that a child with seating problems may require. Some commode chairs can be wheeled over a toilet seat while others use removeable pans (like bed pans).

When the child can get near enough to the toilet seat and has the skills to transfer to it, the toilet seat can be raised to the level of the wheelchair so it is easier to transfer. (Boys may need a guard to help their urine go in the proper direction.) Besides a raised seat, a child may need a seat with a smaller hole (toilet seat reducer) for additional support. For some children, a more complete seating support system complete with trunk and head supports is necessary. For the child who needs to sit a long time, a padded toilet seat can be important. If their feet do not touch the floor while sitting on the toilet (especially a raised toilet seat), children may need a footrest to provide security and balance.

For more flexible space to maneuver a wheelchair, toilet tissue holders can be recessed. Flush controls need to be within easy reach. If it were possible to use a sink while seated on the toilet, that would be helpful.

Grab bars can be attached to the side of the toilet or be mounted on the floor or walls. Grab bars on the side of or attached to the toilet seat may interfere with transferring; some grab bars have arms that swing out of the way. In addition to finishes that are easy to grip, grab bars should have no sharp or abrasive edges and should be made of material that will not break or chip.

Paperless, "no hands" toilets (and toilet seats) are available from a few companies. However, cleaning oneself after using the toilet remains an awkward, embarrassing problem for many youngsters -- one that needs to be discussed openly with therapists to consider various options.


Although dental hygience is a subject of its own, a new product has been developed for individuals who cannot use hand-held toothbrushes but can control head and mouth movements. This product is being studied for use with children with various disabilities. For information, contact Northern Electric Company, P.O. Box 70 Highway 49 North, Hattiesburg, MS 39401; (601)268-2880.

PHOTO : Rifton Shower Chairs on a mobile aluminum frame.
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Publication:The Exceptional Parent
Article Type:buyers guide
Date:Jul 1, 1989
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